Journal Article

Absence of posterior pituitary bright spot in adults with CNS tuberculosis: A case-control study

Prakash, Turaka Vijay, George, Tina, G., Smitesh G., Mannam, Pavithra, Yadav, Bijesh, K., Murugabharathy, Kumar, Vignesh, Sudarsanam, Thambu David

2022

Overview

Current diagnostic methods used in Central Nervous System Tuberculosis (CNS TB) are limited by the paucibacillary nature of this form of tuberculosis. Posterior pituitary bright spot (PPBS) refers to an area of T1 hyperintensity in the posterior pituitary in MR imaging of the brain. It is found in 80-90% of healthy children and adults. In children with CNS TB, nearly half have absence of PPBS. This finding has not been described in adults. Our study looked for absence of PPBS in MR imaging and its association with CNS tuberculosis. To study prevalence of the absence of PPBS in patients with CNS tuberculosis when compared to a control group of normal patients. This was a retrospective case-control study of 100 patients with CNS tuberculosis and 200 controls (matched in 1:2 ratio) of patients with normal MRI brain. The MRI images were presented to a blinded radiologist in a randomised sequence to report for absence of PPBS. The data was subsequently analysed to look for association of absence of PPBS with CNS tuberculosis. Absence of PPBS (cases (47%), controls (8.5%)) was significantly associated with CNS tuberculosis in (Odds ratio-7.90, 95%CI 4.04-15.44, P-value<0.0001). The specificity, sensitivity, positive predictive value and positive likelihood ratio are 91.5%, 47%, 73.4% and 5.53 respectively. Adding of absence of PPBS as an additional radiological feature in diagnosis of CNS TB increased the sensitivity from 77% to 84%. Absence of PPBS is significantly associated with CNS tuberculosis and could be a relatively simple diagnostic aid in the diagnosis of CNS tuberculosis.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Adults / Biology and Life Sciences / Brain / Case studies / Case-Control Studies / Central nervous system / Child / Children / Diagnosis / Diagnostic systems / Health aspects / Humans / Hydrocephalus / Likelihood ratio / Magnetic resonance imaging / Medical diagnosis / Medical examination / Medical imaging / Medical records / Medical schools / Medicine / Medicine and Health Sciences / Neuroimaging / People and Places / Physiological aspects / Pituitary (posterior) / Pituitary gland / Pituitary Gland, Posterior / Research and Analysis Methods / Retrospective Studies / Sensitivity / Sensitivity and Specificity / Tuberculosis / Tuberculosis - diagnosis / Tuberculosis, Central Nervous System - diagnostic imaging / Tuberculous meningitis