Peripheral blood CD4+ T-lymphocyte count as a predictor of MRI findings in intracranial parenchymal tuberculomas.

OBJECTIVE: This study aims to evaluate the association between peripheral blood CD4+ T-lymphocyte count and magnetic resonance imaging (MRI) features of intracranial parenchymal tuberculomas in patients diagnosed with hematogenous disseminated pulmonary tuberculosis. METHODS: A retrospective analysis was conducted on patients diagnosed with hematogenous disseminated pulmonary tuberculosis accompanied by intracranial parenchymal tuberculomas. Patients were categorized into two groups based on MRI findings: those demonstrating perilesional edema (edematous type) and those without (non-edematous type). Demographic data, clinical symptoms, peripheral blood T-lymphocyte subsets, and additional MRI features were compared between the two groups. RESULTS: Among 144 patients included in the analysis, 56 were classified into the edematous group and 88 into the non-edematous group. The frequency of headache was higher in the edematous group (60.7%) compared to the non-edematous group (40.9%). The median age was lower in the edematous group [27.0 years (IQR: 20.8, 42.0)] relative to the non-edematous group [33.5 years (IQR: 24.0, 51.0)]. A higher proportion of female patients was also observed in the edematous group (55.4%), compared to the non-edematous group (35.2%). Univariate analysis indicated that female sex, elevated peripheral blood CD3+ T-lymphocyte count, and elevated CD4+ T-lymphocyte count were significantly associated with the presence of perilesional edema [Odds ratio (OR) = 2.28 (95% Confidence Interval (CI): 1.15-4.522); OR = 1.001 (95% CI: 1.000-1.002); OR = 1.002 (95% CI: 1.000-1.003)], respectively. In multivariate analysis, elevated CD4+ T-lymphocyte count remained an independent predictor of perilesional edema [OR = 1.001 (95% CI: 1.000-1.002)]. On contrast-enhanced MRI, ring-enhancing lesions were more frequently observed in the edematous group (76.8%), compared to the non-edematous group (25%). CONCLUSION: In patients with hematogenous disseminated pulmonary tuberculosis and concurrent intracranial tuberculomas, higher peripheral CD4 + T-lymphocyte counts are independently associated with the presence of perilesional edema and a greater likelihood of ring-like enhancement on MRI.