Table 4 MRI and MRS features differentiating NCC from tuberculoma [22, 23]
| Â | Neurocysticercosis | Tuberculoma |
|---|---|---|
Margin | Regular | Irregular with conglomeration |
Size | Smaller (< 20 mm) | Larger (> 20 mm) |
Signal intensity | T1W hypointense, T2W hyperintense | T1W and T2W hypo- to iso-intense, often with hyperintense rim, rarely onion-peal appearance (alternating rings of hypo- and hyper-intense signals) |
DWI | Variable | Variable, those with T2W hyperintense centers usually show restricted diffusion |
Midline shift | No | Yes |
MR spectroscopy | • Elevated succinate (related to aerobic metabolism of scolices), lactate, and alanine levels | • Elevated lipid (mycobacteria which mainly composed of lipid), lactate, and Cho levels (associated benign inflammatory reaction) |
• Low NAA and Cr levels | • Even lower NAA and Cr levels | |
• Cho/Cr ratio < 1 | • Cho/Cr ratio > 1 | |
• Prominent decrease in NAA/Cr, slight decrease in NAA/Cho |