Bacterial meningitis imaging in children

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Abstract

In this review, we provide the data on the modern use of different MRI modalities and computer tomography (CT) as diagnostic and prognostic tools for meningitis of various etiology, first of all, bacterial purulent meningitis. Each of these techniques has its own field of application depending on the stage of the disease and the patient’s condition (necessity of intensive care procedures, ventilation support). The opinions on the diagnostic value of CT and structural MRI data differ and depend on the etiology and phase of the inflammatory process. In the recent years, the techniques of multiparametric MRI are widely implemented in the practice. Beside structural MRI, they include diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI) and MR spectroscopy (MRS), as well as studies with artificial contrast; there are some reports that these modalities are more effective as a diagnostic tool in meningitis. Thus, the use of multiparametric MRI techniques and CT with contrast is promising and justified for the diagnostics of patients with bacterial purulent meningitis from the viewpoint of enhanced sensitivity.

About the authors

Natalia V. Marchenko

Pediatric Research and Clinical Center for Infectious Diseases

Email: gmv2006@mail.ru
ORCID iD: 0000-0002-2684-9980
SPIN-code: 9813-1529

Cand. Sci. (Med.)

Russian Federation, 9 Prof. Popov street, 197022 Saint-Petersburg

Vladislav B. Voitenkov

Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg; Academy of Postgraduate Education under the FSBU “Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency”

Email: vlad203@inbox.ru
ORCID iD: 0000-0003-0448-7402
SPIN-code: 6190-6930

Cand. Sci. (Med.)

Russian Federation, 9 Prof. Popov street, 197022 Saint-Petersburg; Moscow

Natalia V. Skripchenko

Pediatric Research and Clinical Center for Infectious Diseases; Saint Petersburg State Pediatric Medical University; Saint Petersburg State Pediatric Medical University

Email: snv@niidi.ru
ORCID iD: 0000-0001-8927-3176
SPIN-code: 7980-4060

Dr. Sci. (Med.), Professor

Russian Federation, 9 Prof. Popov street, 197022 Saint-Petersburg; Saint Petersburg

Dmitry L. Dubitsky

Pediatric Research and Clinical Center for Infectious Diseases

Email: ddl_spb@mail.ru
ORCID iD: 0000-0002-8277-6050
SPIN-code: 6120-3730

Cand. Sci. (Med.)

Russian Federation, 9 Prof. Popov street, 197022 Saint-Petersburg

Mariia A. Bedova

Pediatric Research and Clinical Center for Infectious Diseases

Author for correspondence.
Email: dr.bedova@yandex.ru
ORCID iD: 0000-0001-8924-5300
SPIN-code: 9667-3210

MD

Russian Federation, 9 Prof. Popov street, 197022 Saint-Petersburg

Artem S. Ovchinnikov

Pediatric Research and Clinical Center for Infectious Diseases

Email: md-ovchinnikov@mail.ru
ORCID iD: 0000-0001-9785-5512

MD

Russian Federation, 9 Prof. Popov street, 197022 Saint-Petersburg

Darya N. Churkina

Pediatric Research and Clinical Center for Infectious Diseases

Email: churkina_darya@mail.ru
ORCID iD: 0000-0002-6940-5431

MD

Russian Federation, 9 Prof. Popov street, 197022 Saint-Petersburg

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2. Fig. 1. Brain MRI of a 3 year-old patient with bacterial meningitis. Diffuse increase in the MR signal in the FLAIR mode in the furrows of the brain, isointense in the DWI mode (1000 s/mm2), no signs of the contrast accumulation. Focal changes in the subcortical parts of the brain without signs of blood-brain barrier disturbance.

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3. Fig. 2. Contrast-free CT of the brain of a patient M, 3 months, diagnosis-bacterial meningitis of meningococcal etiology. Dynamic observation in the acute period with a difference of 6 days (the first observation on the first day of admission, red arrows). Increase of changes in the form of expansion of the subarachnoid space (green arrows), decrease in the density indicators of gray matter in the area of the anterior and posterior horns of the lateral ventricles (own data).

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4. Fig. 3. Brain MRI of a child with clinically confirmed bacterial endocarditis: a — FLAIR (abscess in the left occipital lobe); b — ADC mape (restriction of diffusion from the contents of the abscess); с — T1-weighted brain MRI with contrast (contrast enhancement in the abscess wall).

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5. Fig. 4. Native CT and MRI in the T2 and T1 modes with contrast enhancement in a child with clinically confirmed bacterial meningitis. Own data. a — native brain CT scan (extra-axial collection medial to the left frontal lobe, frontal sinuses are opacified); b — T2-weighted MRI scan of brain (subdural empyema); с — T1-weighted brain MRI with contrast (subdural empyema, leptomeningeal contrast enhancement) (own data).

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6. Fig. 5. CT scan of the brain of a patient M., 4 months. Diagnosis at admission – meningitis of unknown etiology. The study was performed in the first hours after admission. The expansion of the external cerebrospinal fluid spaces of the frontal areas with a partially delimited accumulation of protein fluid and formation of sedimentation levels (empyema is marked by an arrow) is determined. Fragmented uneven accumulation of the contrast medium in the arachnoid membrane: a — CT scan of the brain, axial plane, native scan; b — CT scan of the brain, venous phase of contrast, axial plane (own data).

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7. Fig. 6. A 2-year old patient. Meningitis, etiology — Haemophilis influenzae (b). With native CT in the right frontal lobe, a fuzzy hypodensity (+ 25HUvs+ 35HU) area is determined without signs of contrast agent accumulation. Increased accumulation of the contrast medium in the adjacent shells of the brain. (own data). a — native CT scan of brain; b — CT scan of the brain with contrast; с — CT scan of brain with contrast, (own data).

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Copyright (c) 2021 Marchenko N.V., Voitenkov V.B., Skripchenko N.V., Dubitsky D.L., Bedova M.A., Ovchinnikov A.S., Churkina D.N.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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