The value of contrast-enhanced FLAIR magnetic resonance imaging in detecting meningeal abnormalities in suspected cases of meningitis compared to conventional contrast-enhanced T1WI sequences

Wael Hamza Kamr,Amr Saadawy,Mohamed Gaber Eissawy

doi:10.1186/s43055-020-00348-2

Abstract

BackgroundEarly diagnosis of meningitis with magnetic resonance imaging (MRI) would be useful for appropriate and effective management, decrease morbidity and mortality, and provide better diagnosis and treatment. The objective of the current study is to compare the accuracy of contrast-enhanced FLAIR (CE-FLAIR) and contrast-enhanced T1WI (CE-T1WI) in the detection of meningeal abnormalities in suspected cases of meningitis.ResultsOut of 45 patients, 37 patients were confirmed to have meningitis on CSF analysis. Out of the 37 patients, 34 patients were positive on CE-FLAIR sequence and 27 were positive on CE-T1WI. The sensitivity of CE-FLAIR sequence was 91.9% and specificity 100%, while the sensitivity of CE-T1WI sequence was 73% and specificity 100%.ConclusionCE-FLAIR is more sensitive than CE-T1WI in diagnosis of meningitis. It is recommended to be used in any cases with clinically suspected meningitis.

Highlights

Diagnosis of meningitis with magnetic resonance imaging (MRI) would be useful for appropriate and effective management, decrease morbidity and mortality, and provide better diagnosis and treatment
Fifty patients with symptoms suspicious of meningitis during the recruitment period were sent for MRI examination
The total number of patients included in this study was 45, who were exposed to MRI for clinically suspected meningitis

Summary

Introduction

Diagnosis of meningitis with magnetic resonance imaging (MRI) would be useful for appropriate and effective management, decrease morbidity and mortality, and provide better diagnosis and treatment. It can be a fatal disease if not properly managed [1]. Clinical and laboratory evaluation can establish the diagnosis of meningitis. Evaluation of cerebrospinal fluid (CSF) is the most critical component of meningitis diagnosis [2]. In the diagnosis of meningitis, computed tomography (CT) and MRI may have major roles, but MRI is much more reliable and should be considered as the first-line imaging modality in brain infections [1, 3]. Contrast-enhanced MRI (CE-MRI) is superior to contrast-enhanced CT to locate the meningeal affection and its complications. MRI is superior in detecting extra-axial fluid collections due to the lack of the skull bony artifacts. Contrast administration aids in recognizing the blood-brain barrier breakdown and helps in recognizing the disease process that may not be visible on CT [4]

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