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MR vessel wall imaging in cerebral bacterial and fungal infections
Neha Choudhary1, Sameer Vyas2, Chirag Kamal Ahuja1
1Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Purpose:
Central nervous system (CNS) bacterial and fungal infections can cause secondary vasculitis which worsens the prognosis due to development of complications like infarctions or hemorrhages. In this prospective study, we aim to study intracranial vessel wall imaging findings in bacterial and fungal infections.
Methods:
We included 12 cases of nontubercular bacterial and fungal CNS infections each, in whom definitive microbiological diagnosis could be made. High-resolution vessel wall imaging (VWI) and time of flight MR angiography (TOF MRA) were incorporated in the routine imaging protocol. All cases were evaluated for the presence of vascular enhancement, pattern of enhancement, and stenosis on VWI. Statistical analysis was done to evaluate association between findings of vessel wall imaging and infarctions.
Results:
We found infarctions in 5 out of 12 cases (41.7%) of the bacterial group and 7 out of 12 cases (58.3%) of the fungal group. Vessel wall enhancement was seen in 5 cases (41.7%) of the bacterial group and 9 cases (75%) of the fungal group. There was a significant association between infarctions and vessel wall enhancement in the fungal group. However, pattern of enhancement or stenosis on VWI was not significantly associated with presence of infarction. VWI detected more cases of vascular involvement than TOF MRA.
Conclusion:
Secondary infectious vasculitis in bacterial and fungal infections can be detected by VWI, which can play an important role in better patient management as detection of vascular involvement can prompt early treatment to prevent complications like infarctions or hemorrhages.
Insights
Vessel wall imaging (VWI) detects secondary vasculitis in central nervous system (CNS) bacterial and fungal infections, aiding early treatment to prevent complications like infarctions.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Central nervous system (CNS) infections by bacteria and fungi can lead to secondary vasculitis.
- This vasculitis complicates prognosis, increasing risks of infarctions and hemorrhages.
Purpose of the Study:
- To investigate intracranial vessel wall imaging (VWI) findings in bacterial and fungal CNS infections.
- To assess the role of VWI in detecting secondary vasculitis and associated complications.
Main Methods:
- Prospective study of 12 bacterial and 12 fungal CNS infection cases with confirmed diagnosis.
- Utilized high-resolution VWI and time of flight MR angiography (TOF MRA).
- Evaluated VWI for vascular enhancement, enhancement patterns, and stenosis, correlating with infarctions.
Main Results:
- Infarctions occurred in 41.7% of bacterial and 58.3% of fungal infections.
- Vessel wall enhancement was observed in 41.7% of bacterial and 75% of fungal cases.
- VWI identified more vascular involvement than TOF MRA, with significant infarction-enhancement association in fungal infections.
Conclusions:
- VWI effectively detects secondary infectious vasculitis in CNS bacterial and fungal infections.
- Early detection of vascular involvement via VWI can guide timely treatment, preventing infarctions and hemorrhages.
- VWI is a valuable tool for managing CNS infectious vasculitis.
