We have compared and analyzed the value of in vivo
proton MR spectroscopy (PMRS) and T1 weighted magnetization transfer (MT) MR imaging in tissue characterization of brain
tuberculomas. We studied 33 cases of proven intracranial
tuberculomas with in vivo PMRS and T1 weighted MT MR imaging. MT ratios from the rim and core of the
tuberculomas were calculated and compared with metabolites seen on PMRS. Final diagnosis of
tuberculoma was based on histopathology (n = 26) and/or associated
tuberculous meningitis (n = 7) in all the cases. Out of the 33 patients who underwent both PMRS and T1 weighted MT MR imaging, spectroscopy showed only
lipids at 0.9 ppm, 1.3 ppm, 2.0 ppm, and 2.80 ppm in 26 cases while
lipids at 0.9 ppm, 1.3 ppm, 2.0 ppm and 2.80 ppm along with
choline at 3.22 ppm was seen in remaining 7 patients. MT ratios from the core or solid
necrosis varied from 21-29% while from the rim or cellular region varied from 16-24%. MT ratios from all the 33 lesions were consistent with
tuberculomas while PMRS showed
choline along with
lipids in 7 predominantly cellular lesions simulating a
neoplasm. We conclude that T1 weighted MT MR imaging appears to be more consistent in the tissue characterization of brain
tuberculomas.