Neuroradiological Findings in Central Nervous System Tuberculosis: A Systematic Review and Meta-analysis Comparing Adult and Pediatric Populations.

Authors

Pedro Henrique Abreu Tiradentes, Fabiano Reis, Hortência De Jesus Ferreira, Juliana Avila Duarte, Mariana Dalaqua, Matheus de Lima Ruffini, Thierry A G M Huisman

Published in

AJNR. American journal of neuroradiology. Sep 04, 2026. Epub Sep 04, 2026.

Abstract

Neurotuberculosis is a severe form of extrapulmonary tuberculosis causing significant morbidity and mortality.
To compare the imaging phenotypes of adult and pediatric populations with CNS tuberculosis through a quantitative meta-analysis, and to characterize the broader spectrum of neurotuberculosis radiological findings through a systematic review emphasizing standard and advanced imaging techniques.
A systematic search was conducted across Embase, LILACS, PubMed, and Scopus databases.
Following PRISMA guidelines, observational studies detailing CT and MRI findings in CNS tuberculosis were included.
Screening and data extraction were conducted using Rayyan and R software. Random-effects meta-analyses calculated pooled prevalence estimates (95% CI) stratified by age (adult vs. pediatric).
From 91 studies (5,955 patients) in the systematic review, 32 low-risk-of-bias studies (1,675 patients: 24 adult, 1,415 patients; 8 pediatric, 260 patients) were meta-analyzed. Weighted mean age (by study sample size) was approximately 32.0 years in adults (23/24 studies reporting age; N=1,301) and 6.0 years in children (8/8 studies; N=260). Pooled prevalence estimates were numerically higher in pediatric than adult cohorts for meningovascular complications, including leptomeningeal enhancement (89% vs. 61%), hydrocephalus (81% vs. 36%), and brain infarctions (65% vs. 33%, with greater proportional cortical involvement). Tuberculomas showed similar prevalence (∼60%, predominantly multiple). Advanced MRI modalities (DWI, 1H-MRS, vessel wall imaging) provided detailed lesion characterization. Spinal involvement was evaluated almost exclusively in adults, precluding a quantitative comparative meta-analysis due to sparse pediatric spinal data.
High heterogeneity across primary studies, geographic concentration in endemic regions, and insufficient pediatric spinal data.
Neurotuberculosis imaging phenotypes differed numerically by age group, with pediatric cases showing a higher pooled burden of meningovascular complications. While intracranial age-stratified differences were established, comparative spinal analysis was limited by sparse pediatric data.

PMID:
42697724
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.

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