MR imaging of the posterior hypophysis in children with tuberculous meningitis

Andronikou, Savvas; Toorn, Ronald van; Boerhout, Els

doi:10.1007/s00330-009-1408-4

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…The inflammatory response and granulation tissue formation in CNS TB is commonly concentrated around the basal cisterns [16]. CNS TB associated endarteritis and vascular thrombosis could result in destruction of parts of pituitary gland and disruption of the hypothalamichypophysial pathways which lie in close anatomical proximity [12]. As a result of these, there could be a decreased storage of vasopressin in posterior pituitary thereby causing absence of PPBS.…”

Section: Plos Onementioning

confidence: 99%

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Absence of posterior pituitary bright spot in adults with CNS tuberculosis: A case-control study

Smitesh

Mannam²,

Chandiraseharan³

et al. 2022

PLoS ONE

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Introduction Current diagnostic methods used in Central Nervous System Tuberculosis (CNS TB) are limited by the paucibacillary nature of this form of tuberculosis. Posterior pituitary bright spot (PPBS) refers to an area of T1 hyperintensity in the posterior pituitary in MR imaging of the brain. It is found in 80–90% of healthy children and adults. In children with CNS TB, nearly half have absence of PPBS. This finding has not been described in adults. Our study looked for absence of PPBS in MR imaging and its association with CNS tuberculosis. Objective To study prevalence of the absence of PPBS in patients with CNS tuberculosis when compared to a control group of normal patients. Methods This was a retrospective case-control study of 100 patients with CNS tuberculosis and 200 controls (matched in 1:2 ratio) of patients with normal MRI brain. The MRI images were presented to a blinded radiologist in a randomised sequence to report for absence of PPBS. The data was subsequently analysed to look for association of absence of PPBS with CNS tuberculosis. Results Absence of PPBS (cases (47%), controls (8.5%)) was significantly associated with CNS tuberculosis in (Odds ratio-7.90, 95%CI 4.04–15.44, P-value<0.0001). The specificity, sensitivity, positive predictive value and positive likelihood ratio are 91.5%, 47%, 73.4% and 5.53 respectively. Adding of absence of PPBS as an additional radiological feature in diagnosis of CNS TB increased the sensitivity from 77% to 84%. Conclusion Absence of PPBS is significantly associated with CNS tuberculosis and could be a relatively simple diagnostic aid in the diagnosis of CNS tuberculosis.

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Section: Plos Onementioning

confidence: 99%

“…The loss of normal posterior pituitary bright spot (PPBS) was previously described in primary diabetes insipidus and in water intoxication [10,11]. Andronikou et al had found that there was absence of PPBS in 55% of children with TB meningitis [12]. However, its absence in adults with CNS tuberculosis hasn't been studied so far.…”

Section: Introductionmentioning

confidence: 99%

Absence of posterior pituitary bright spot in adults with CNS tuberculosis: A case-control study

Smitesh

Mannam²,

Chandiraseharan³

et al. 2022

PLoS ONE

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“…MRI has been demonstrated to be superior to CT in diagnosing TBM and its associated complications. [28][29][30] In particular, it is more sensitive in detecting basal enhancement, tuberculomas, and infarcts for diagnosis and prognosis in pediatric TBM. It is, however, unlikely to make an impact on the worldwide diagnosis of TBM because of the limited access to MRI in areas where TBM occurs more frequently.…”

Section: Ademmentioning

confidence: 99%

“…MRI has been demonstrated to be superior to CT in diagnosing TBM and its associated complications 28–30 . In particular, it is more sensitive in detecting basal enhancement, tuberculomas, and infarcts for diagnosis and prognosis in pediatric TBM.…”

Section: Specific Issues When Diagnosing Cns Tb and The Role Of Mrimentioning

confidence: 99%

Pediatric and adult meningeal, parenchymal, and spinal tuberculosis: A neuroimaging review

Mertiri,

Freiling,

Desai

et al. 2023

Journal of Neuroimaging

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Neurotuberculosis is defined as a tuberculous infection of the meninges, brain parenchyma, vessels, cranial and spinal nerves, spinal cord, skull, and spine that can occur either in a localized or in a diffuse form.It is a heterogeneous disease characterized by many imaging appearances and it has been defined as “the great mimicker” due to similarities with many other conditions.The diagnosis of central nervous system (CNS) tuberculosis (TB) is based on clinical presentation, neuroimaging findings, laboratory and microbiological findings, and comprehensive evaluation of the response to anti‐TB drug treatment.However, the absence of specific symptoms, the wide spectrum of neurological manifestations, the myriad of imaging findings, possible inconclusive laboratory results, and the paradoxical reaction to treatment make the diagnosis often challenging and difficult, potentially delaying adequate treatment with possible devastating short‐term and long‐term neurologic sequelae.Familiarity with the imaging characteristics helps in accurate diagnosis and may prevent or limit significantly morbidity and mortality. The goal of this review is to provide a comprehensive up‐to‐date overview of the conventional and advanced imaging features of CNS TB for radiologists, neuroradiologists, and pediatric radiologists. We discuss the most typical neurotuberculosis imaging findings and their differential diagnosis in children and adults with the goal to provide a global overview of this entity.

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“…Inflammation and granulation tissue is most prominent in the suprasellar cistern, surrounding the pituitary gland and hypothalamus. It is thought that this inflammation may be the cause of the syndrome of inappropriate anti-diuretic hormone secretion/diabetes insipidus that is seen in up to 70% of children [ 66 ]. Meningeal, parenchymal and ependymal tuberculoma formation can be seen in 15% of children with TB meningitis.…”

Section: Introductionmentioning

confidence: 99%

Tuberculosis revisted: classic imaging findings in childhood

Mahomed,

Kilborn,

Smit

et al. 2023

Pediatr Radiol

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Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system. Graphical Abstract

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MR imaging of the posterior hypophysis in children with tuberculous meningitis

Cited by 7 publications

References 17 publications

Absence of posterior pituitary bright spot in adults with CNS tuberculosis: A case-control study

Absence of posterior pituitary bright spot in adults with CNS tuberculosis: A case-control study

Pediatric and adult meningeal, parenchymal, and spinal tuberculosis: A neuroimaging review

Tuberculosis revisted: classic imaging findings in childhood

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