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Positive Predictive Value of Contrast-Enhanced Fluid-Attenuated Inversion Recovery (FLAIR) Magnetic Resonance Imaging

Sadia Shabbir1, Maryam Sheikh2

  • 1Department of Radiology, The Children's Hospital Lahore, The University of Child Health Sciences, Lahore, PAK.

Cureus
|December 11, 2024
PubMed
Abstract

Insights

Contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (CE-FLAIR MRI) shows a high positive predictive value (PPV) of 94.4% for diagnosing meningitis. This non-invasive imaging technique offers a promising alternative to traditional cerebrospinal fluid analysis.

Area of Science:

  • Radiology
  • Pediatric Neurology
  • Infectious Diseases

Background:

  • Cerebrospinal fluid (CSF) analysis is the standard for meningitis diagnosis but is invasive and time-consuming.
  • Alternative diagnostic methods are needed, especially for pediatric patients where CSF analysis may be delayed or inappropriate.
  • Contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (CE-FLAIR MRI) has emerged as a potential non-invasive diagnostic tool.

Purpose of the Study:

  • To evaluate the positive predictive value (PPV) of CE-FLAIR MRI in diagnosing meningitis.
  • To compare the diagnostic accuracy of CE-FLAIR MRI with the gold standard CSF analysis.
  • To assess the consistency of CE-FLAIR MRI's diagnostic performance across different pediatric age and gender subgroups.

Main Methods:

  • A cross-sectional study involving 198 pediatric patients (age 1-15 years) with suspected meningitis.
  • Patients underwent CE-FLAIR MRI, with results compared against CSF analysis as the gold standard.
  • Statistical analysis, including the chi-square test, was used to determine significance (p < 0.05).

Main Results:

  • CE-FLAIR MRI diagnosed meningitis in 187 (94.4%) patients, yielding a PPV of 94.4%.
  • The PPV remained consistent across various age and gender subgroups, with no statistically significant differences (p > 0.05).
  • The majority of patients were male (63.1%) and under 5 years old (58.6%).

Conclusions:

  • CE-FLAIR MRI demonstrates a high positive predictive value for meningitis diagnosis, comparable to CSF analysis.
  • The non-invasive and radiation-free nature of CE-FLAIR MRI makes it a suitable alternative for pediatric meningitis diagnosis.
  • CE-FLAIR MRI is recommended for future clinical practice due to its efficacy and safety profile.
Keywords:
cerebral spinal fluid analysiscontrast enhanced fluid-attenuated inversion recoverymagnetic resonance imagingmeningitispositive predictive value

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