International Journal of Scientific Research in Dental and Medical Sciences

International Journal of Scientific Research in Dental and Medical Sciences

Diagnostic Accuracy of Contrast-enhanced Flair Magnetic Resonance Imaging in Detecting Meningeal Abnormalities in Suspected Cases of Infectious Meningitis

Document Type : Original Article

Authors
Ashapurna Bhagawati 1
Lipee Nath Dhanowar 1
Rajesh Kr Dhanowar 1
Gargi Choudhury 2
Pronami Borah 1
Venkatesh Dharavath 1
1 Department of Radio-diagnosis, Assam Medical College, Dibrugarh, India
2 Department of Microbiology, Assam Medical College, Dibrugarh, India
10.30485/ijsrdms.2025.493096.1625
Abstract
Background and aim: To determine the diagnostic accuracy of contrast-enhanced fluid-attenuated inversion recovery in the diagnosis of meningitis and compare it with contrast-enhanced T1 sequence, taking cerebrospinal fluid (CSF) analysis as the gold standard.
Material and methods: Forty patients referred to the Department of Radiodiagnosis of Assam Medical College and Hospital (AMCH) with clinical symptoms of meningitis were subjected to Magnetic Resonance Imaging (MRI) examination of the brain with pre- and post-contrast sequences, including T1 and fluid-attenuated inversion recovery sequences. Cerebrospinal fluid (CSF) analysis reports were the gold standard and correlated with the MRI findings. Also, an attempt was made to identify patterns of leptomeningeal enhancement in various aetiologies of meningitis.
Results: The post-contrast fluid-attenuated inversion recovery (PC FLAIR) showed a significantly higher sensitivity of 97.06% (95% CI: 84.67% to 99.93%) than the PC T1FS, which had a sensitivity of 76.47% (95% CI: 58.83% to 89.25%). The specificity for PC FLAIR was found to be 83.33% (95% CI: 35.88% to 99.58%), while for PC T1FS, it is 66.67% (95% CI: 22.28% to 95.67%) without significant difference in specificity between the two sequences. The diagnostic accuracy of the PC FLAIR sequence was 95.00%, compared to 75.00% for the post-contrast T1 fat suppression (PC T1FS) sequence in diagnosing meningitis.
Conclusions: The PC FLAIR sequence outperforms the PC T1FS sequence regarding sensitivity, area under the curve, and diagnostic accuracy. Adding this sequence to the conventional sequence can optimize the early detection of abnormal meningeal enhancement.
Keywords
Cerebrospinal Fluid
Magnetic Resonance Imaging
Meningitis

Subjects

[1] Bystritsky RJ, Chow FC. Infectious meningitis and encephalitis. Neurologic Clinics. 2022;40(1):77-91. https://doi.org/10.1016/j.ncl.2021.08.006.
[2] Zunt JR, Kassebaum NJ, Blake N, Glennie L, Wright C, Nichols E, et al. Global, regional, and national burden of meningitis, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology. 2018;17(12):1061-82. https://doi.org/10.1016/S1474-4422(18)30387-9.
[3] 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. Journal of clinical and diagnostic research: JCDR. 2015;9(1):TC08-TC12. https://doi.org/10.7860/JCDR/2015/11519.5387.
[4] Adam A, Dixon AK, Gillard JH, Schaefer-Prokop C. Grainger & Allison's diagnostic radiology. Elsevier Health Sciences; 2020.
[5] Kamr WH, Eissawy MG, Saadawy A. 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. Egyptian Journal of Radiology and Nuclear Medicine. 2020 ;51:231. https://doi.org/10.1186/s43055-020-00348-2.
[6] Jawwad S, Gul N, Mehmood K, Iqbal B, Afzal K. Diagnostic Accuracy of Contrast Enhanced Flair Magnetic Resonance Imaging in Diagnosis of Meningitis Taking Lumbar Puncture as Gold Standard. Life and Science. 2022;3(3):120-126. http://doi.org/10.37185/LnS.1.1.259.
[7] Azad R, Tayal M, Azad S, Sharma G, Srivastava RK. Qualitative and quantitative comparison of contrast-enhanced fluid-attenuated inversion recovery, magnetization transfer spin echo, and fat-saturation T1-weighted sequences in infectious meningitis. Korean Journal of Radiology. 2017;18(6):973-82. https://doi.org/10.3348/kjr.2017.18.6.973.
[8] Kohil A, Jemmieh S, Smatti MK, Yassine HM. Viral meningitis: an overview. Archives of virology. 2021 Feb;166:335-45.  https://doi.org/10.1007/s00705-             020-04891-1.
[9] Akaishi T, Tarasawa K, Fushimi K, Yaegashi N, Aoki M, Fujimori K. Demographic profiles and risk factors for mortality in acute meningitis: A nationwide population‐based observational study. Acute Medicine & Surgery. 2024;11(1):e920. https://doi.org/10.1002/ams2.920.
[10] Reddy GK, Padmavathi AR, Nancharaiah YV. Fungal infections: Pathogenesis, antifungals and alternate treatment approaches. Current Research in Microbial Sciences. 2022;3:100137. https://doi.org/10.1016/j.crmicr.2022.100137.
[11] Mustafa W, Ali S, Elgendy N, Salama S, El Sorogy L, Mohsen M. Role of contrast-enhanced FLAIR MRI in diagnosis of intracranial lesions. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57(1):108. https://doi.org/10.1186/s41983-021-00360-x.
[12] Gad M, Elsorogy LG, Moustafa SA. Diagnostic utility of contrast-enhanced FLAIR MRI in imaging of demyelinating and infectious brain lesions. Egyptian Journal of Radiology and Nuclear Medicine. 2023;54(1):104. https://doi.org/10.1186/s43055-023-01049-2.
[13] Marwan M, Fatouh MM, Mohammed FA, Nermeen M. Diagnostic Utility of Contrast-Enhanced Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Intracranial Pathologies: Qualitative and Quantitative Analyses. The Medical Journal of Cairo University. 2024;92(03):1-3. https://doi.org/10.21608/mjcu.2024.353074.
[14] Ma Q, Yi Y, Liu T, Wen X, Shan F, Feng F, et al. MRI-based radiomics signature for identification of invisible basal cisterns changes in tuberculous meningitis: a preliminary multicenter study. European Radiology. 2022;32(12):8659-69. https://doi.org/10.1007/s00330-022-08911-3.
[15] Wu D, Chen Q, Chen X, Han F, Chen Z, Wang Y. The blood–brain barrier: structure, regulation, and drug delivery. Signal Transduction and Targeted Therapy. 2023;8(1):217. https://doi.org/10.1038/s41392-023-01481-w.
International Journal of Scientific Research in Dental and Medical Sciences
Volume 6, Issue 4
Autumn 2024
Pages 157-162

  • Receive Date 06 October 2024
  • Revise Date 13 November 2024
  • Accept Date 25 November 2024
  • Publish Date 01 December 2024