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Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT
1Department of Diagnostic Radiology, College of Medicine, Seoul National University, Korea.
Abstract:
Plain and Gd-DTPA-enhanced MR images of the brain were obtained in 18 consecutive patients with meningitis (eight with tuberculous, five with bacterial, three with viral, and two with fungal infections); the MR images were compared with CT scans. MR images were obtained on a 2.0-T superconducting unit with both T1- and T2-weighted pulse sequences before injection and with a T1-weighted sequence after injection of Gd-DTPA (0.1 mmol/kg) in all patients. In tuberculous meningitis, MR imaging depicted ischemia/infarct, hemorrhagic infarct of basal ganglia, meningeal enhancement at either basal cistern or convexity surface of brain, and associated small granulomas in a few more patients than CT did. In bacterial meningitis, primary foci of extracranial inflammation (i.e., mastoid, paranasal sinuses) and adjacent intracranial lesions including localized dural inflammation, subdural fluid collection, and/or brain parenchymal lesions were demonstrated much better on MR than on CT. Otherwise, MR images generally matched the CT scan. Although the plain MR images, both T1- and T2-weighted, were the most sensitive in delineating ischemia/infarct, hemorrhage, and edema, they were not as specific as Gd-DTPA-enhanced T1-weighted images and postcontrast CT scans in defining the active inflammatory process of the meninges and focal lesions precisely. We conclude that if Gd-DTPA is used, MR imaging appears to be superior to CT in the evaluation of patients with suspected meningitis. Precontrast MR is needed to delineate ischemia/infarct, edema, and subacute hemorrhage.
Insights
Magnetic resonance imaging (MRI) with gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) is superior to CT scans for evaluating meningitis. MRI better detects inflammation, ischemia, and lesions associated with various meningitis types.
Area of Science:
- Neuroradiology
- Infectious Disease Imaging
- Neuroimaging
Background:
- Meningitis diagnosis often relies on imaging to assess inflammation and complications.
- Comparing the efficacy of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) in meningitis evaluation is crucial.
Purpose of the Study:
- To compare the diagnostic performance of Gd-DTPA-enhanced MRI with CT scans in patients with various types of meningitis.
- To determine the specific advantages of MRI in visualizing inflammatory and ischemic changes associated with meningitis.
Main Methods:
- 18 patients with confirmed meningitis (tuberculous, bacterial, viral, fungal) underwent both plain and Gd-DTPA-enhanced MRI (2.0-T, T1/T2-weighted sequences) and CT scans.
- Image analysis focused on detecting ischemia, infarcts, hemorrhage, edema, meningeal enhancement, and associated lesions.
Main Results:
- MRI, particularly with Gd-DTPA, demonstrated superior visualization of meningeal enhancement, ischemia/infarcts, and associated lesions compared to CT in tuberculous and bacterial meningitis.
- Plain MRI (T1/T2-weighted) excelled at delineating ischemia, infarct, hemorrhage, and edema.
- Gd-DTPA-enhanced MRI and postcontrast CT were more specific for active meningeal inflammation and focal lesions.
Conclusions:
- Gd-DTPA-enhanced MRI is a superior imaging modality to CT for the comprehensive evaluation of suspected meningitis.
- Precontrast MRI is essential for identifying ischemia, infarct, edema, and subacute hemorrhage, complementing contrast-enhanced sequences.