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Early diagnosis and institution of therapy is important in the management of tuberculous brain abscess (TBA). We prospectively evaluated the usefulness of contrast-enhanced computed tomography (CT) in the early diagnosis of TBAs in children. We studied 35 children under 14 years old with intracranial lesions who were clinically suspected of having TBA. All patients underwent contrast-enhanced CT of the brain. A diagnosis of TBA was based on findings in the T2-weighted images of the cranial CT and either the contrast-enhanced CT or T1-weighted images of the cranial MRI. Among the 35 patients, the definitive diagnosis was TB in 17 (group 1), and non-TB in 18 (group 2). In all cases, contrast-enhanced CT showed an accumulation of contrast medium, in which contrast-enhanced MRI showed ring-shaped high signal intensity in the T2-weighted image and the contrast-enhanced MRI showed a ring-shaped, low-signal intensity mass on T1-weighted images. In groups 1 and 2, nine (52.9%) and seven (38.9%) cases, respectively, were correctly diagnosed with only the contrast-enhanced CT. The sensitivity and specificity were 55.9% and 97.6%, respectively. However, contrast-enhanced MRI correctly diagnosed eight (44.4%) and 13 (72.2%) cases in groups 1 and 2, respectively. The sensitivity and specificity were 66.7% and 100%, respectively. Contrast-enhanced CT was useful in diagnosing TBA in children because it showed a definitive accumulation of contrast medium and also in depicting the inflammatory response associated with the abscess in both group 1 and 2. Contrast-enhanced MRI was better than contrast-enhanced CT at diagnosing
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