Magnetic Resonance Imaging Cerebrospinal Fluid Hydrodynamics in Patients with Meningitis

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, can cause significant cerebrospinal fluid (CSF) flow alterations.
• Accurate differentiation of meningitis etiologies is crucial for appropriate clinical management.

Purpose of the Study:

• To evaluate cerebrospinal fluid (CSF) flow dynamics in patients with meningitis using phase-contrast magnetic resonance imaging (PCMRI).
• To assess the potential of PCMRI in differentiating between viral and non-viral meningitis.

Main Methods:

• Cardiac-gated PCMRI was used to quantitatively analyze CSF flow at the cerebral aqueduct in 50 meningitis patients and 20 controls.
• Patients were categorized into groups with and without hydrocephalus.
• Velocity encoding (Venc) was standardized at 20 cm/s.

Main Results:

• Meningitis patients exhibited altered mean peak CSF velocity and stroke volume compared to controls, with significant differences noted in patients without hydrocephalus.
• CSF flow dynamics varied widely in meningitis, irrespective of ventricular dilatation.
• PCMRI demonstrated 100% specificity and 22.7% sensitivity in differentiating viral from non-viral meningitis at a peak CSF velocity cutoff of 3.57 cm/s.

Conclusions:

• PCMRI-derived CSF flow alterations can aid in segregating patients into viral and non-viral meningitis categories.
• This imaging technique is particularly valuable when contrast agents are contraindicated.
• Improved etiological differentiation can facilitate timely and appropriate clinical treatment initiation.