Abstract
Purpose To evaluate the performance of amide proton transfer-weighted (APTw) imaging against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1w) in children with intracranial infection. Materials and Methods Twenty-eight pediatric patients (15 males and 13 females; age range 1-163 months) with intracranial infection were recruited in this study. 2D APTw imaging and conventional MR sequences were conducted using a 3 T MRI scanner. Kappa (κ) statistics and the McNemar test were performed to determine whether the hyperintensity on APTw was related to the enhancement on Gd-T1w. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of APTw imaging to predict lesion enhancement were calculated. Result In twelve patients with brain abscesses, the enhancing rim of the abscesses on the Gd-T1w images was consistently hyperintense on the APTw images. In eight patients with viral encephalitis, three showed slight spotted gadolinium enhancement, while the APTw image also showed a slight spotted high signal. Five of these patients showed no enhancement on Gd-T1w and isointensity on the APTw image. In eleven patients with meningitis, increased APTw signal intensities were clearly visible in gadolinium-enhancing meninges. Sixty infectious lesions (71%) showed enhancement on Gd-T1w images. The sensitivity and specificity of APTw were 93.3% (56/60) and 91.7% (22/24). APTw demonstrated excellent agreement (κ = 0.83) with Gd-T1w, with no significant difference (P = 0.69) in detection of infectious lesions. Conclusions These initial data show that APTw MRI is a noninvasive technique for the detection and characterization of intracranial infectious lesions. APTw MRI enabled similar detection of infectious lesions to Gd-T1w and may provide an injection-free means of evaluation of intracranial infection.
Highlights
Intracranial infection in children continues to be a worldwide health problem, in poor and developing countries
Our study demonstrates the feasibility of amide proton transfer-weighted (APTw) Magnetic resonance imaging (MRI) to reveal signals from intracranial infection that are unique compared to conventional MRI sequences
Our study has shown that the lesion hyperintensity on APTw is significantly related to lesion enhancement on gadolinium-enhanced T1-weighted imaging (Gd-T1w) in children with intracranial infection
Summary
Intracranial infection in children continues to be a worldwide health problem, in poor and developing countries. The incidence of acute encephalitis syndrome in children is estimated to be 10.5-13.8/100,000 [1]. The case fatality rate is 30%, and one-third of survivors develop neurological disabilities [2]. The Global Burden of Disease network (WHO) estimated that meningitis caused approximately 422,900 deaths and encephalitis caused 143,500 deaths in 2010 [3]. Because of the potential for rapid deterioration and causing devastating short- and long-term neurologic sequels, timely diagnosis is of the utmost importance. Magnetic resonance imaging (MRI) is the imaging modality of choice for the diagnosis and therapeutic surveillance of pediatric intracranial infection [4,5,6]. The clinical diagnosis of intracranial infection in children mainly relies on either morphological changes or contrast-enhancement
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