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British Journal of Radiology (2004) 77, 387-394
© 2004 British Institute of Radiology
doi: 10.1259/bjr/23641059
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Full Paper

Infectious meningitis: prospective evaluation with magnetization transfer MRI

P Kamra, MD1, R Azad, MD1, K N Prasad, MD2, S Jha, MD3, S Pradhan, MD3 and R K Gupta, MD1

Departments of 1 Radiology, 2 Microbiology and 3 Neurology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India–226014

The study was performed with the aim of prospectively characterizing infectious meningitis of different aetiology using magnetization transfer (MT) MRI. Spin-echo (SE) T1, T2 and pre- and post-contrast T1 weighted MT images in 100 patients with aetiologically proven meningitis were evaluated for the visibility and enhancement of the meninges on pre- and post-contrast T1 weighted MT images, respectively. The MT ratio (MTR) was calculated from the thickened meninges in tuberculous meningitis. In addition, the percentage difference in the mean signal intensity (SI) of the meninges and adjacent brain parenchyma was calculated and compared between different groups using 2-tailed student's t-test. T1 weighted MT images were highly sensitive (96%) in the detection of abnormal meningeal enhancement. Meninges were visible on pre-contrast T1 weighted MT images only in patients with tuberculous meningitis. The MTR from meninges in tuberculous infection was 19.10±1.02, and the percentage difference in the mean SI of the meninges and the adjacent T2 normal brain parenchyma was significantly higher (p<0.05) in the tuberculous group compared with that in the non-tuberculous group. MT MRI is an important technique for the detection and characterization of infectious meningitis of different aetiology. Visibility of the meninges on pre-contrast T1 weighted MT images may be considered highly suggestive of tuberculous meningitis.






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