Contrast Enhanced Fluid-Attenuated Inversion Recovery Versus Contrast Enhanced T1-Spin Echo Magnetic Resonance Imaging in the Evaluation of Infectious Meningitis

Abstract

Background                                                                                                                                         Infectious meningitis is an infection of the subarachnoid space causing inflammation of the leptomeninges. Early diagnosis is crucial to initiate appropriate therapy, avoid complications, and improve prognosis. Cerebrospinal fluid analysis is important in the diagnosis and is done by performing lumbar puncture with some limitations and complications. MRI plays a role in the diagnosis by depicting abnormal leptomeningeal enhancement. Aim of the study To evaluate the efficiency of contrast-enhanced fluid-attenuated inversion recovery compared with contrast-enhanced T1 spin echo in the diagnosis of infectious meningitis. Patients and Methods A prospective analytical study of diagnostic tests was conducted. Brain MRI was done using a 3-Tesla system. Gadolinium was used as contrast material. The final diagnosis of meningitis was made based on cerebrospinal fluid analysis. Validity parameters, predictive values, and diagnostic accuracy for both sequences were calculated and compared to each other. Quantitative and qualitative analysis was performed. Results Fifty-six patients were involved (31 males and 25 females) in this study, and they ranged from 15 to 68 years in age. Cerebrospinal fluid analysis was positive in 41 patients and negative in 15. Contrast enhanced–fluid attenuated inversion recovery has higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy compared with contrast enhanced–T1 spin echo. The mean net meningeal enhancement is significantly higher in contrast enhanced–fluid attenuated inversion recovery. Substantial interobserver agreement between the two sequences was observed. Conclusion Contrast enhanced–fluid attenuated inversion recovery is superior to contrast enhanced–T1 spin echo in the diagnosis of infectious meningitis. .