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Meningitis

Andrew E. Auber¹, Clifford Belden¹

¹Brooke Army Medical Center, San Antonio, Texas

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A4.2

DOI:

10.1002/0471142719.mia0402s01

Online Posting Date:

August, 2001

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Abstract

Magnetic Resonance Imaging (MRI) in meningitis, as with most other forms of intracranial inflammatory or infectious diseases, is a powerful though largely non-specific diagnostic tool. The technique is used to detect the presence of disease, and also complications related to the primary process, as well as assess for alternative diagnoses. For imaging these patients, a standard imaging protocol is utilized which includes gadolinium-enhanced sequences. This unit presents a protocol based on diffusion MRI (dMRI), which can be employed if specific clinical situations require further clarification. The parameters given in this unit are derived from experience at 1.5T and may need to be altered slightly depending on the field strength available and the specific equipment manufacturer.

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Unit Introduction
Basic Protocol: Imaging of Meningitis
Alternate Protocol: Special Situations
Commentary
Bibliography
Figures
Tables

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Materials

Basic Protocol: Imaging of Meningitis

Materials

Extravascular contrast agent (e.g., 0.1 mmol/kg patient body weight of gadolinium chelate from Mangevist, Omniscan, or Prohance)
Normal saline (0.9% NaCl) sterile

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Figures

Figure A4.2.1

This 20-year-old female with known pulmonary tuberculosis presented with new-onset seizures. MRI shows parenchymal hemorrhage of a venous infarction pattern on this T₂-weighted (T_R = 2500 msec, T_E = 80 msec, N_acq = 0.75) transverse (A) vertex image (arrows). Also noted is abnormal increased T₂ signal intensity suggesting dural thickening in bifrontal distribution (arrowheads). Enhancement of the dura confirming pachymeningitis is seen on the T₁-weighted (T_R = 600 msec, T_E = 23 msec, N_acq = 2) post-contrast coronal (B) image (arrowheads). The MRV (C) discloses abnormal attenuation of the superior sagittal sinus (arrow) in parietal location, confirming a stenosis likely causing the venous hypertension and infarction in this patient.

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Figure A4.2.2

This 16-year-old boy presented to the emergency room with subtle mental status changes and a fever of one week duration. A proton-density weighted (T_R = 2500 msec, T_E = 30 msec, N_acq = 0.75) transverse image (A) through the lateral ventricles shows increased ventricular volume relative to the extra-transverse CSF spaces. There is also subtle abnormal increased signal seen rimming the ventricles (arrowheads) compatible with acute hydrocephalus and transependymal flow of CSF. The transverse pre- and post-contrast (T_R = 500 msec, T_E = 11 msec, N_acq = 2) images (B) at the level of the basilar cisterns demonstrates diffuse “sugar-coating” enhancement of the basilar meninges (arrows on the post-contrast image) diagnostic of basilar meningitis. A positive tuberculin skin test was obtained and CSF analysis was confirmatory for tuberculosis.

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Literature Cited

Literature Cited
	Hansman-Whiteman, M., Bowen, B.C., Donovan-Post, M.J., and Bell, M.D. 1996. Intracranial infection. In Magnetic Resonance Imaging of the Brain and Spine, 2nd edition (Atlas, S.W. ed.) pp. 707-772. Lippincott-Raven, Philadelphia.
	Harris, D.E. and Enterline, D.S. 1997. Neuroimaging of AIDS. I. Fungal infections of the central nervous system. Neuroimaging Clin. N. Am. 7:187-198.
	Pomper, M.G., Miller, T.J., Stone, J.H., Tidmore, W.C., and Hellmann, D.B. 1999. CNS vasculitis in autoimmune disease: MR imaging findings and correlation with angiography. A.J.N.R. 20:75-85.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Taveras, J.M. and Pile-Spellman, J. 1996. Inflammatory diseases. In Neuroradiology, 3rd ed. pp. 259-326. Williams and Wilkins, Baltimore.
	Wong, J. and Quint, D.J. 1999. Imaging of central nervous system infections. Semin. Roentgenol. 34:123-143.
Key Reference
	Harris, D.E. and Enterline, D.S. 1997. See above.
Contains lucid explanations for the physics and basic scan parameters of standard and advanced magnetic resonance imaging studies.