Original Research Diagnostic performance of contrast-enhanced T2-FLAIR MRI in the detection of meningitis

Sanjay P., Vittal Manohar, Sushmita Balol, Yashwanth Naik M.B.

About the author(s) Sanjay P., Department of Radiodiagnosis, Mysore Medical College and Research Institute, Mysore, India
Vittal Manohar, Department of Radiodiagnosis, Mysore Medical College and Research Institute, Mysore, India
Sushmita Balol, Department of Radiodiagnosis, Mysore Medical College and Research Institute, Mysore, India
Yashwanth Naik M.B., Department of Radiodiagnosis, Mysore Medical College and Research Institute, Mysore, India

Abstract

Background: The contrast-enhanced T2-FLAIR (CE-T2-FLAIR) sequence on MRI, through the suppression of CSF and vascular signals, can detect subtle meningeal enhancement in meningitis that may not be appreciable on the routinely used contrast-enhanced T1W (CE-T1W) sequence.

Objectives: To assess CE-T2-FLAIR compared to CE-T1W in the diagnosis of meningitis, using CSF analysis as the gold standard, using both qualitative and quantitative approaches for assessment.

Method: A retrospective study was conducted on 53 patients with clinically suspected meningitis referred for brain MRI. Twenty-seven patients, positive for meningitis on CSF analysis, were classified as the case group; the remaining patients were designated as controls. The pre-contrast, CE-T1W and CE-T2-FLAIR images were assessed and analysed, qualitatively for the detection of abnormal meningeal enhancement, and quantitatively by measuring single pixel signal intensities (SPSI) over the meninges and vessels.

Results: Contrast-enhanced T2-FLAIR demonstrated significantly higher sensitivity (92.59% vs. 57.69%), negative predictive value (92.59% vs. 70.27%) and diagnostic accuracy (94.34% vs. 78.85%) compared to CE-T1W. Additionally, CE-T2-FLAIR showed significantly greater meningeal SPSI and enhancement than CE-T1W.

Conclusion: Contrast-enhanced T2-FLAIR is better at detecting abnormal meningeal enhancement in meningitis than CE-T1W, because of significantly greater signal intensity and enhancement of the meninges compared to vessels.

Contribution: This study reiterates the usefulness of CE-T2-FLAIR as an additional sequence for the detection of abnormal meningeal enhancement in cases of meningitis as confirmed both qualitatively and quantitatively.

Keywords

meningitis; meninges; abnormal meningeal enhancement; contrast-enhanced T2-FLAIR; contrast-enhanced T1W; magnetic resonance imaging; single pixel signal intensity; central nervous system; retrospective study.

Sustainable Development Goal

Goal 3: Good health and well-being

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