The First Experience of Using T1 Fs Mri in Patients with Tuberculosis for the Assessment of Brain Pathology

Abstract

Purpose: To evaluate the diagnostic value of the fat-suppressed T1-weighted (T1 FS) MRI sequence in the assessment of brain pathology in patients with tuberculosis, including those with HIV co-infection. Material and methods: The study included 29 patients aged 21–65 years treated at the Moscow Regional TB Clinical Dispensary. Twenty-two patients (75.7 %) had concurrent HIV/TB infection. All subjects underwent contrast-enhanced brain MRI on a 1.5 T Siemens Magnetom Sempra scanner using a 10-channel Head/Neck coil. The protocol incorporated a 3D fat-suppressed T1-weighted gradient sequence (FL3D, isotropic voxel 1 mm³) in addition to conventional T1 3D TSE post-contrast and delayed acquisitions. Comparative analysis was performed between these sequences to assess lesion conspicuity and contrast enhancement using a three-grade visual scale rated independently by two radiologists. Results: Focal contrast-enhancing lesions were detected in 24 (82.8 %) patients, corresponding to infectious CNS involvement such as tuberculoma, meningoencephalitis, abscess, PML, toxoplasmosis, and others. The T1 FS 3D sequence demonstrated the highest lesion detectability, revealing 56.9 % of grade 2 and 48.4 % of grade 3 lesions, markedly exceeding conventional T1 3D TSE post-injection (19.0 % and 39.1 %) and delayed (24.1 % and 12.4 %) scans (χ² = 28.98; p < 0.001). T1 FS 3D provided superior delineation of lesion borders and improved visualization of subtle foci, especially in patients with severe immunodeficiency. Conclusion: Incorporating the fat-suppressed T1 FS 3D sequence into post-contrast brain MRI protocols significantly enhances sensitivity and image quality in the diagnosis of CNS tuberculosis. This technique improves the detection of contrast-enhancing foci and is particularly valuable for evaluating patients with HIV-associated neurotuberculosis and low immune status.