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Table of Content Volume 9 Issue 2 - February 2019


 

A study of diagnostic accuracy of MRI in the contrast-enhanced magnetic resonance imaging in diagnosis of meningitis correlated with CSF analysis at tertiary health care centre

 

Vinayak Gautam1, Shambhavi2*, Nishit3

 

1Associate Professor, Government Medical College, Betiyah, Bihar, INDIA.

2Post Graduate, Katihar Medical College, Katihar, Bihar, INDIA.

Senior resident, Department of Pathology, AIIMS, Patna, Bihar, INDIA.

Email: drshambhaviarunkr1118@gmail.com

 

Abstract               Background: Meningitis is a significant health problem worldwide and can be a life-threatening emergency if not suspected, appropriately diagnosed, and managed expeditiously Aims and Objective: To Study diagnostic accuracy of MRI in the Contrast-Enhanced Magnetic Resonance Imaging in Diagnosis of Meningitis Correlated with CSF Analysis at tertiary health care centre. Methodology: This was cross-sectional study carried out in the department of radiology at tertiary health care centre during the one year period i.e. March 2017 to March 2018. In the one year period with written and explained consent; 60 patients suspected with meningitis were undergone Contrast-Enhanced Magnetic Resonance Imaging and CSF examination with all standard protocols. The sensitivity and specificity Positive Predictive Value and Negative Predictive Value was calculated by MEDCAL Software. Result: In our study we have seen that The majority of the patients were in the age group of 40-50 were 40.00% followed by 50-60 Were 21.67%, 30-40 were 20.00%, >60 were 10.00%, 20-30 were 8.33%. The majority of the patients were Male i.e. 58.33% and Female were 41.67% Sensitivity was 93.33% (77.93% to 99.18%) and Specificity was 90.00 % (73.47% to 97.89%) . Positive Predictive Value 90.32% (76.06% to 96.48%), Negative Predictive Value was 93.10 % (77.88% to 98.11%) Conclusion: It can be concluded from our study that Contrast-Enhanced Magnetic Resonance Imaging was very efficacious in the diagnosis of meningitis so must be accompanied with CSF for the correct diagnosis of meningitis.

Key Word: Contrast-Enhanced Magnetic Resonance Imaging (CE-MRI), CSF (Cerebro Spinal Fluid), Meningitis.

 

 

INTRODUCTION

Meningitis is a significant health problem worldwide and can be a life-threatening emergency if not suspected, appropriately diagnosed, and managed expeditiously12. Estimated prevalence of meningitis in our region is 1.57%3. Delay in administration of antibiotics is associated with death in adults suffering from acute bacterial meningitis. A delay of 4–6 hours in the administration of antibiotics after presentation independently conferred an 8.4-fold greater risk of death from meningitis4. Infective meningitis including tuberculous and bacterial meningitis is the leading cause of stroke in young patients in our country5. Bacterial meningitis is the major cause of morbidity in children below the age of 5 years6. There are typical features of each type of meningitis on MRI and detected by Contrast-Enhanced Magnetic Resonance Imaging So we have compared the Sensitivity and specificity of Contrast-Enhanced MRI with respect to Gold standard CSF examination.

 

METHODOLOGY

This was cross-sectional study carried out in the department of radiology at tertiary health care centre during the one year period i.e. March 2017 to March 2018. In the one year period with written and explained consent; 60 patients suspected with meningitis were undergone Contrast-Enhanced Magnetic Resonance Imaging and CSF examination with all standard protocols. The sensitivity and specificity Positive Predictive Value and Negative Predictive Value was calculated by MEDCAL* Software.

 

RESULT

Table 1: Age wise distribution of the patients

Age

No.

Percentage (%)

20-30

5

8.33

30-40

12

20.00

40-50

24

40.00

50-60

13

21.67

>60

6

10.00

Total

60

100.00

The majority of the patients were in the age group of 40-50 were 40.00% followed by 50-60 Were 21.67%, 30-40 were 20.00%, >60 were 10.00%, 20-30 were 8.33%.

 

Table 2: Distribution of the patients as per the sex

Sex

No.

Percentage (%)

Male

35

58.33

Female

25

41.67

Total

 60

100.00

The majority of the patients were Male i.e. 58.33% and Female were 41.67%

 

Table 3: Distribution of the patients as per the MRI and CSF examination

MRI Features of

meningitis

CSF Examination

Features of Meningitis

Total

Present

Absent

Present

28

3

31

Absent

2

27

29

Total

30

30

60

 

Table 4: Distribution of the patients as per the Sensitivity and Specificity

Statistic

Formula

Value

Range (95% CI)

Sensitivity

93.33%

77.93% to 99.18%

Specificity

90.00 %

73.47% to 97.89%

Positive Predictive Value

90.32% (*)

76.06% to 96.48%

Negative Predictive Value

93.10 % (*)

77.88% to 98.11%

From Table 3 and 4 the Sensitivity was 93.33% (77.93% to 99.18%) and Specificity was 90.00 % (73.47% to 97.89%) Positive Predictive Value 90.32% (76.06% to 96.48%), Negative Predictive Value was 93.10 % (77.88% to 98.11%)

 

DISCUSSION

 Magnetic resonance imaging (MRI) plays a crucial role in the detection of infectious meningitis, especially in situations where a lumbar puncture is contraindicated. Abnormal meningeal enhancement is an important imaging feature that can reliably indicate meningitis. Modifications of T1-based sequences, incorporating fat suppression (FS), and magnetization transfer (MT) led to an improved detection of enhancing meninges compared to the conventional T1-weighted spin-echo (SE) sequence but presented limitations related to the suboptimal differentiation of vascular from meningeal enhancement7,8. The nullification of the cerebrospinal fluid (CSF) signal, inconspicuous vascular enhancement as compared to T1-weighted imaging, and some degree of the T1 relaxivity effect, makes meningeal enhancement easily discernible on contrast-enhanced fluid-attenuated inversion recovery (CE-FLAIR) images, but the sequence has still to find a place in routine MRI protocol. The existing literature has compared the CE-FLAIR sequence with either of the two T1-based sequences and has yielded variable results9,16. In our study we have seen that The majority of the patients were in the age group of 40-50 were 40.00% followed by 50-60 Were 21.67%, 30-40 were 20.00%, >60 were 10.00%, 20-30 were 8.33%. The majority of the patients were Male i.e. 58.33% and Female were 41.67% Sensitivity was 93.33% (77.93% to 99.18%) and Specificity was 90.00 % (73.47% to 97.89%). Positive Predictive Value 90.32% (76.06% to 96.48%), Negative Predictive Value was 93.10 % (77.88% to 98.11%) These findings are similar to Aneel Kumar Vaswani 17 et al they found In the diagnosis of meningitis, the sensitivity of postcontrast FLAIR sequence was 96% and specificity 85.71%

 

CONCLUSION

It can be concluded from our study that Contrast-Enhanced Magnetic Resonance Imaging was very efficacious in the diagnosis of meningitis so must be accompanied with CSF for the correct diagnosis of meningitis.

 

REFERENCES

  1. Y. Nudelman and A. R. Tunkel, “Bacterial meningitis: epidemiology, pathogenesis and management update,” Drugs, vol. 69, no. 18, pp. 2577–2596, 2009.
  2.  I. A. Qureshi, M. Akhtar, N. Saud, and M. Ahmed, “Role of CT in meningitis,” Pakistan Armed Forces Medical Journal, vol. 54, no. 2, pp. 137–141, 2004.
  3. B. A. Kakar, E. K. Tareen, A. Bari, and R. M. Kakar, “Acute pyogenic meningitis, incidence in paediatrics (in infants and children),” Professional Medical Journal, vol. 14, no. 2, pp. 272– 275, 2007.
  4. N. Proulx, D. Frechette, B. Toye, J. Chan, and S. Kravcik, “Delays ´ in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis,” Quarterly Journal of Medicine, vol. 98, no. 4, pp. 291–298, 2005.
  5. S. Samiullah, M. Humaira, G. Hanif, A. A. Ghouri, and K. Shaikh, “Etiological patterns of stroke in young patients at a tertiary care hospital,” Journal of the Pakistan Medical Association, vol. 60, no. 3, pp. 201–204, 2010.
  6.  I. Ahmad, I. Haq, H. Rehman, A. A. Khattak, and F. M. Khan, “Bacterial meningitis in children,” Journal of Postgraduate Medical Institute, vol. 18, no. 3, pp. 523–528, 2004.
  7. Ahmad A, Azad S, Azad R. Differentiation of leptomeningeal and vascular enhancement on post-contrast FLAIR MRI sequence: role in early detection of infectious meningitis. J Clin Diagn Res 2015;9:TC08-12
  8. Finelli DA, Hurst GC, Gullapali RP, Bellon EM. Improved contrast of enhancing brain lesions on postgadolinium, T1-weighted spin-echo images with use of magnetization transfer. Radiology 1994; 190: 553-559
  9. Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx 2005; 2: 324-332
  10. Kamra P, Azad R, Prasad KN, Jha S, Pradhan S, Gupta RK. Infectious meningitis: prospective evaluation with magnetization transfer MRI. Br J Radiol 2004; 77: 387-394
  11. Galassi W, Phuttharak W, Hesselink JR, Healy JF, Dietrich RB, Imbesi SG. Intracranial meningeal disease: comparison of contrast-enhanced MR imaging with fluid-attenuated inversion recovery and fat-suppressed T1-weighted sequences. AJNR Am J Neuroradiol 2005; 26:553-559
  12. Singh SK, Leeds NE, Ginsberg LE. MR imaging of leptomeningeal metastases: comparison of three sequences. AJNR Am J Neuroradiol 2002; 23: 817-821
  13. Mehta RC, Pike GB, Haros SP, Enzmann DR. Central nervous system tumor, infection, and infarction: detection with gadolinium-enhanced magnetization transfer MR imaging. Radiology 1995; 195: 41-46
  14. Dousset V, Armand JP, Lacoste D, Mièze S, Letenneur L, Dartigues JF, et al. Magnetization transfer study of HIV encephalitis and progressive multifocal leukoencephalopathy. Groupe d’Epidémiologie Clinique du SIDA en Aquitaine. AJNR Am J Neuroradiol 1997; 18: 895-901
  15. Burke JW, Mathews VP, Elster AD, Ulmer JL, McLean FM, Davis SB. Contrast-enhanced magnetization transfer saturation imaging improves MR detection of herpes simplex encephalitis. AJNR Am J Neuroradiol 1996; 17: 773-776
  16.  Kamran S, Bener AB, Alper D, Bakshi R. Role of fluidattenuated inversion recovery in the diagnosis of meningitis: comparison with contrast-enhanced magnetic resonance imaging. J Comput Assist Tomogr 2004; 28: 68-72
  17. Aneel Kumar Vaswani, Waseem Mehmood Nizamani, Muhammad Ali. Diagnostic Accuracy of Contrast-Enhanced FLAIR Magnetic Resonance Imaging in Diagnosis of Meningitis Correlated with CSF Analysis. Hindawi Publishing Corporation ISRN Radiology Volume 2014, Article ID 578986, 7 page
  18. MEDCAL easy to use software. Available at: https://www.medcalc.org/calc/diagnostic_test.php . Acessed online on Jan 2019.

 
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