Retrospectively Analysis In Imaging Manifestations Of Tubereulous Meningitis And Cryptococcal Meningitis

Objective:To compare the imaging features of tuberculous meningitis (TBM) and cryptococcal meningitis (CM), in order to provide evidences for rational diagnosis and differential diagnosis.Methods:Imaging data of167cases of TBM and65cases of CM admitted to Xiangya Hospital of Central South University from January2007to December2012were investigated retrospectively.Results:1.54(50%) cases had abnormal chest X-ray in108TBM patients who had the examination, while12(36.4%) cases had abnormal chest X-ray in33CM patients who had the examination. The incidence rates of chest X-ray abnormalities had no difference (P=0.169).66(77.6%) cases had abnormal chest CT in85TBM patients who had the examination, while11(68.8%) cases had abnormal chest CT in16CM patients who had the examination. The incidence rates of chest CT abnormalities had no difference (P=0.523).2.28(50.9%) cases had abnormal brain CT in55TBM patients who had the examination, while9(30.0%) cases had abnormal brain CT in30CM patients who had the examination. The incidence rates of brain CT abnormalities had no difference (P=0.063). And hydrocephalus was the most common manifestation in both TBM (17cases) and CM (4cases). Basal ganglia lesions were the most frequent in TBM (9cases).3.126(88.1%) cases had abnormal brain MR in143patients with TBM who,had the examination, while43(78.2%) cases had abnormal brain MR in55patients with CM who had the examination. The incidence rates of brain MR abnormalities had no difference (P=0.077). The incidence rate of cerebral infarction in TBM (21.0%) was higher than that of CM (7.3%)(P=0.022), while the incidence rate of gelatinous pseudocysts in CM (21.8%) was higher than that of TBM (0.0%)(P=0.000). Meanwhile, there were no difference in the incidence rates of hydrocephalus (TBM24.5%, CM21.8%), granuloma (TBM8.4%, CM9.1%), leukoaraiosis (TBM7.7%, CM9.1%), brain atrophy (TBM5.6%, CM3.6%), arachnoid cyst (TBM1.4%, CM5.5%), sinusitis (TBM23.1%, CM3.6%) and otitis media and mastoiditis (TBM5.6%, CM3.6%). There were44(32.6%) cases who had meningeal enhancement in135TBM patients with MR enhancement, which was higher than that of CM (14.3%)(P=0.014). There were no difference in the incidence rate of lesions of basal ganglia (TBM25.9%, CM27.3%), frontal lobe (TBM25.9%, CM21.8%), temporal lobe (TBM18.2%, CM12.7%) and parietal lobe (TBM22.4%, CM16.4%).Conclusions:1. Specific changes of pulmonary tuberculosis, basal meningeal enhancement, granuloma in brain parenchyma and cerebral infarction in basal ganglia suggest TBM; while clustered fine gelatinous pseudocysts in basal ganglia suggest CM.2. Hydrocephalus is a common manifestation in both TBM and CM, and could not provide a clue for differential diagnosis of TBM and CM.