Risk stratification in intracranial tuberculosis patients based on contrast-enhanced MRI

To investigate clinical and contrast-enhanced brain MRI factors associated with unfavorable long-term outcomes in patients with intracranial tuberculosis, aiming to provide a basis for clinical management and early intervention. We retrospectively analyzed clinical data and contrast-enhanced cranial MRI images of 119 patients with intracranial tuberculosis admitted to our hospital from January 2018 to March 2026. Recorded variables included age, sex, initial Glasgow Coma Scale (GCS) score, imaging classification, meningeal thickening, acute cerebral infarction, hydrocephalus, Evans index, cerebral arteritis, tuberculoma, and tuberculous abscess. All patients were followed for more than 12 months and classified into a favorable prognosis group (modified Rankin Scale [mRS] 0–2, n=67) and a poor prognosis group (mRS 3–6, n=52). Differences in clinical and imaging characteristics were compared, and multivariate logistic regression analysis was performed to identify independent risk factors for poor prognosis. The discriminatory performance of the model was evaluated using receiver operating characteristic (ROC) curves. Compared with the favorable prognosis group, patients in the poor prognosis group were older, had a higher proportion of males, and more frequently exhibited meningeal-type or mixed-type intracranial tuberculosis. They also had higher incidences of meningeal thickening, involvement of basal and pericallosal cisterns, multi-site meningeal involvement, acute cerebral infarction, hydrocephalus, and cerebral arteritis, while the proportions of parenchymal-type intracranial tuberculosis and tuberculoma were lower (all P < 0.05). Multivariate logistic regression identified age, acute cerebral infarction, and hydrocephalus as independent risk factors for poor long-term prognosis. The logistic regression model based on these factors achieved an area under the ROC curve (AUC) of 0.861, with a sensitivity of 70.1%, specificity of 89.6%, and overall accuracy of 80.7%. Age, acute cerebral infarction, and hydrocephalus are independent predictors of poor long-term prognosis in patients with intracranial tuberculosis. Contrast-enhanced cranial MRI plays a critical role in detecting key imaging complications such as cerebral infarction and hydrocephalus, providing valuable guidance for prognostic assessment.