Imaging of Cerebral Tuberculomas

Intracranial tuberculomas represent one of the most serious localisations of tuberculosis. The most intra-parenchymal sites are the grey matter (GM)/white matter (WM) junction, the periventricular regions and the posterior cerebral fossa (a frequent site of lesions, especially for children). They may also be deeper, involving the basal ganglia, protuberance and cerebellum. In the early phase, the tuberculoma presents a discrete high signal in T1 sequence and low intense signal in T2 sequence with nodular enhancement. Non-caseating tuberculomas appear in low signal in T1 sequence and high signal in T2 sequence compare to the brain parenchyma and are intensely and homogeneously enhanced after injection of contrast in T1 sequence. Caseating tuberculomas with a solid centre appear low- or iso signal in both T1 and T2 sequences and are often associated with perilesional oedema. Caseating tuberculomas with a necrotic centre appear in low signal in T1 sequence and high signal in T2 sequence and are enhanced in the periphery after injection of contrast medium.