High-Resolution Vessel Wall MRI as a Complementary Investigation for CNS Tuberculosis

Cerebrospinal fluid (CSF) acid-fast smears and culture have low sensitivity, and CSF nucleic acid amplification tests are highly specific but also lack sensitivity.5 Some studies have demonstrated poor specificity of adenosine deaminase (ADA) for TBM diagnosis in certain populations, particularly in HIV-infected adults with concurrent infections or cerebral lymphomas.5 Treatment is recommended upon a clinical, preliminary CSF test and imaging suspicion. The angiographic pattern already described consists of narrowing of arteries at the base of the brain and narrowed small or medium-sized arteries.1 HR-VWI complements luminal imaging and can differentiate many potential causes of luminal narrowing.2–4 Vessel wall enhancement usually corresponds to expected patterns of vessel wall inflammation and/or increased vasa vasorum density in distinct vascular pathologies2 and can also detect cranial nerve enhancement,4 as illustrated in this report. Fabiano Reis, PhD, MD, Neuroradiology Chief, Associate Professor, Department of Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Tessália Vieira de Camargo Street, 126, Cidade Universitária Zeferino Vaz, Campinas, 13083-888, SP, Brazil.