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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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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



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  		Figure 1. Tuberculous meningitis. (a) T2 and (b) pre-contrast T1 weighted axial images show presence of hydrocephalus. (c) Pre-contrast T1 weighted magnetization transfer (MT) image shows thick basal meninges as hyperintense signal around the brain stem (small arrows), not seen on T1 weighted image (b). (d) Post-contrast T1 weighted MT axial demonstrate thick enhancement of the basal meninges and exudates.

 


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  		Figure 2. Herpes simplex encephalitis. (a) T2 weighted axial image shows abnormal increased signal intensities in both temporal lobes involving gray and white matter. These are hypointense on (b) T1 weighted image and mildly hyperintense on (c) T1 weighted magnetization transfer (MT) image. No abnormal meninges are seen on pre-contrast images. (d) Post-contrast T1 weighted MT image shows abnormal meningeal enhancement in both hemispheres along with left ependymal enhancement.

 


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  		Figure 3. Pyogenic meningitis. (a) T2, (b) pre-contrast T1, and (c) T1 weighted magnetization transfer (MT) axial images do not reveal any abnormality except for the compressed ventricular system. Abnormal meningeal enhancement is seen on (d) post-contrast T1 weighted MT image.

 


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  		Figure 4. Cryptococcal meningitis (a) T2 weighted axial image shows presence of dilated Virchow Robin spaces (VRS) in bilateral basal ganglia region along with presence of few larger lesions (gelatinous pseudocysts) in bilateral cerebral parenchyma, one of which in the right frontal region shows enhancement on (d) post-contrast T1 weighted magnetization transfer (MT) image suggestive of cryptococcoma. Pre-contrast T1 (b) and T1 weighted MT (c) images do not reveal any meningeal abnormality. Abnormal meningeal enhancement is however noted on post-contrast T1 weighted MT image (d).

 




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