Using MRI for pulmonary tuberculomas evaluation

SummaryPulmonary tuberculomas have a high probability of the infectious process reactivation during the first four years since their formation, it is also specifically difficult to define the inflammation activity in case of a stable clinical and radiological picture, hence difficult to select the treatment tactics. Aim of study. To develop and test the MRI technique in case of pathological pulmonary formations in order to check the MRI capabilities as an additional tool for the diagnostics of pulmonary tuberculomas’ activity. Маterials and methods. The MRI technique for checking the lungs of patients with verified pulmonary tuberculomas of various degree of activity was proposed and tested. Results. Radial patterns of pulmonary tuberculomas were identified and demonstrated in standard pulse sequences, radial features of tuberculomas of various degree of activity were established. Non-active tuberculoma is characterized by higher signal on diffusion weighted MRI images and hypointense signal on ADC maps. In dynamic contrast enhanced MRI, low active tuberculomas were slowly accumulating the contrast, while the active ones did this fast and intensely in the capsule with further reaching the plateau, at the same time the central part accumulated the contrast at a slower pace. Conclusion. Using MRI may be promising for the pulmonary tuberculomas’ activity evaluation. The MRI technique for pulmonary tuberculoma evaluation has to include a protocol with standard pulse sequences: Т2, Т1 WI, STIR WI in coronal and axial planes; DWI with maximum b-factor 800 s/mm2and ADC maps; dynamic contrast enhancement.