Central Nervous System involvement in tuberculosis: An MRI study considering differences between patients with and without Human Immunodeficiency Virus 1 infection

Alberto Di Napoli, Massimo Cristofaro, Andrea Romano, Elisa Pianura, Gioia Papale, Federica Di Stefano, Edoardo Ronconi, Ada Petrone, Maria Camilla Rossi Espagnet, Vincenzo Schininà, Alessandro Bozzao

Research output: Contribution to journalArticle

Abstract

Background: Magnetic resonance imaging (MRI) is largely used in the diagnosis of central nervous system involvement of tuberculosis (CNSTB), yet there is no MRI comparison study between HIV+ and HIV− patients with CNSTB. The aim of the present study was to identify MRI differences in CNSTB between HIV+ and HIV− patients and possibly find early characteristics that could raise the suspect of this disease. Methods: We included all patients admitted in our institution between 2011 and 2018 with confirmed diagnosis of CNSTB, and MRI performed in the first week. Patients with preexisting brain pathology or immunodeficiency not HIV related were excluded. We compared CNSTB MRI features between the two groups. Results: Sixty-nine patients were included (19 HIV+; 50 HIV−). Findings in HIV+ group: 6 lung TB, 5 hydrocephalus, 4 meningeal enhancement, 6 stroke, 2 hemorrhages, and 10 tuberculomas. HIV− group: 22 lung tuberculosis, 15 hydrocephalus, 21 meningeal enhancement, 5 stroke, 4 hemorrhages, 20 tuberculomas. The only statistically significant difference between the two groups was in the stroke occurrence, more frequent in the HIV+ group (P =.028), all involving the basal ganglia. Conclusions: Stroke involving the basal ganglia best differentiates CNSTB patients who are HIV+ from those HIV−. This finding was not correlated with meningeal enhancement suggesting that small arteries involvement might precede it. Therefore, we think that HIV+ patients with a new onset of stroke should be evaluated for CNSTB. Follow-up MRI should also be planned since meningeal enhancement might appear in later stages of the disease.

Original languageEnglish
Pages (from-to)1-18
Number of pages18
JournalJournal of Neuroradiology
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Virus Diseases
Central Nervous System Tuberculosis
HIV-1
Tuberculosis
Central Nervous System
Magnetic Resonance Imaging
HIV
Stroke
Tuberculoma
Hydrocephalus
Basal Ganglia
Hemorrhage
Lung
Arteries
Pathology

Keywords

  • HIV
  • MRI
  • Stroke
  • Tuberculosis

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

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title = "Central Nervous System involvement in tuberculosis: An MRI study considering differences between patients with and without Human Immunodeficiency Virus 1 infection",
abstract = "Background: Magnetic resonance imaging (MRI) is largely used in the diagnosis of central nervous system involvement of tuberculosis (CNSTB), yet there is no MRI comparison study between HIV+ and HIV− patients with CNSTB. The aim of the present study was to identify MRI differences in CNSTB between HIV+ and HIV− patients and possibly find early characteristics that could raise the suspect of this disease. Methods: We included all patients admitted in our institution between 2011 and 2018 with confirmed diagnosis of CNSTB, and MRI performed in the first week. Patients with preexisting brain pathology or immunodeficiency not HIV related were excluded. We compared CNSTB MRI features between the two groups. Results: Sixty-nine patients were included (19 HIV+; 50 HIV−). Findings in HIV+ group: 6 lung TB, 5 hydrocephalus, 4 meningeal enhancement, 6 stroke, 2 hemorrhages, and 10 tuberculomas. HIV− group: 22 lung tuberculosis, 15 hydrocephalus, 21 meningeal enhancement, 5 stroke, 4 hemorrhages, 20 tuberculomas. The only statistically significant difference between the two groups was in the stroke occurrence, more frequent in the HIV+ group (P =.028), all involving the basal ganglia. Conclusions: Stroke involving the basal ganglia best differentiates CNSTB patients who are HIV+ from those HIV−. This finding was not correlated with meningeal enhancement suggesting that small arteries involvement might precede it. Therefore, we think that HIV+ patients with a new onset of stroke should be evaluated for CNSTB. Follow-up MRI should also be planned since meningeal enhancement might appear in later stages of the disease.",
keywords = "HIV, MRI, Stroke, Tuberculosis",
author = "{Di Napoli}, Alberto and Massimo Cristofaro and Andrea Romano and Elisa Pianura and Gioia Papale and {Di Stefano}, Federica and Edoardo Ronconi and Ada Petrone and {Rossi Espagnet}, {Maria Camilla} and Vincenzo Schinin{\`a} and Alessandro Bozzao",
year = "2019",
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TY - JOUR

T1 - Central Nervous System involvement in tuberculosis

T2 - An MRI study considering differences between patients with and without Human Immunodeficiency Virus 1 infection

AU - Di Napoli, Alberto

AU - Cristofaro, Massimo

AU - Romano, Andrea

AU - Pianura, Elisa

AU - Papale, Gioia

AU - Di Stefano, Federica

AU - Ronconi, Edoardo

AU - Petrone, Ada

AU - Rossi Espagnet, Maria Camilla

AU - Schininà, Vincenzo

AU - Bozzao, Alessandro

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Magnetic resonance imaging (MRI) is largely used in the diagnosis of central nervous system involvement of tuberculosis (CNSTB), yet there is no MRI comparison study between HIV+ and HIV− patients with CNSTB. The aim of the present study was to identify MRI differences in CNSTB between HIV+ and HIV− patients and possibly find early characteristics that could raise the suspect of this disease. Methods: We included all patients admitted in our institution between 2011 and 2018 with confirmed diagnosis of CNSTB, and MRI performed in the first week. Patients with preexisting brain pathology or immunodeficiency not HIV related were excluded. We compared CNSTB MRI features between the two groups. Results: Sixty-nine patients were included (19 HIV+; 50 HIV−). Findings in HIV+ group: 6 lung TB, 5 hydrocephalus, 4 meningeal enhancement, 6 stroke, 2 hemorrhages, and 10 tuberculomas. HIV− group: 22 lung tuberculosis, 15 hydrocephalus, 21 meningeal enhancement, 5 stroke, 4 hemorrhages, 20 tuberculomas. The only statistically significant difference between the two groups was in the stroke occurrence, more frequent in the HIV+ group (P =.028), all involving the basal ganglia. Conclusions: Stroke involving the basal ganglia best differentiates CNSTB patients who are HIV+ from those HIV−. This finding was not correlated with meningeal enhancement suggesting that small arteries involvement might precede it. Therefore, we think that HIV+ patients with a new onset of stroke should be evaluated for CNSTB. Follow-up MRI should also be planned since meningeal enhancement might appear in later stages of the disease.

AB - Background: Magnetic resonance imaging (MRI) is largely used in the diagnosis of central nervous system involvement of tuberculosis (CNSTB), yet there is no MRI comparison study between HIV+ and HIV− patients with CNSTB. The aim of the present study was to identify MRI differences in CNSTB between HIV+ and HIV− patients and possibly find early characteristics that could raise the suspect of this disease. Methods: We included all patients admitted in our institution between 2011 and 2018 with confirmed diagnosis of CNSTB, and MRI performed in the first week. Patients with preexisting brain pathology or immunodeficiency not HIV related were excluded. We compared CNSTB MRI features between the two groups. Results: Sixty-nine patients were included (19 HIV+; 50 HIV−). Findings in HIV+ group: 6 lung TB, 5 hydrocephalus, 4 meningeal enhancement, 6 stroke, 2 hemorrhages, and 10 tuberculomas. HIV− group: 22 lung tuberculosis, 15 hydrocephalus, 21 meningeal enhancement, 5 stroke, 4 hemorrhages, 20 tuberculomas. The only statistically significant difference between the two groups was in the stroke occurrence, more frequent in the HIV+ group (P =.028), all involving the basal ganglia. Conclusions: Stroke involving the basal ganglia best differentiates CNSTB patients who are HIV+ from those HIV−. This finding was not correlated with meningeal enhancement suggesting that small arteries involvement might precede it. Therefore, we think that HIV+ patients with a new onset of stroke should be evaluated for CNSTB. Follow-up MRI should also be planned since meningeal enhancement might appear in later stages of the disease.

KW - HIV

KW - MRI

KW - Stroke

KW - Tuberculosis

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