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Insights into Imaging
Fig. 13 | Insights into Imaging

Fig. 13

From: Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions

Fig. 13

Tuberculoma. Conventional MRI Findings: a, b Axial T2W and post-contrast T1W sequences show T2W hypointense confluent lesions in the right frontal lobe with extensive perilesional oedema and enhancement. Multiparametric MRI: c ADC map shows intermediate values (900 × 10−6 mm2 s−1), (d) PWI shows perfusion higher than the contralateral white matter, (e, f) MRS shows very high levels of lipid at 1.3 ppm (thin arrows), without any lactate. There is slightly elevated Cho/Cr ratio (1.5) on short TE MRS (thick arrow), moderately low NAA/Cr ratio and absence of mI. In this case of tuberculoma, the combination of a T2W hypointense lesion, raised rCBV, raised lipids and moderately increased Cho/Cr ratio helped to make the diagnosis. The patient commenced anti-tuberculosis treatment, and surgical intervention was avoided.

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