Differentiation of Leptomeningeal and Vascular Enhancement on Post-contrast FLAIR MRI Sequence: Role in Early Detection of Infectious Meningitis

Ahmad, Armeen; Azad, Sheenam; Azad, Rajiv

doi:10.7860/jcdr/2015/11519.5387

Cited by 17 publications

(32 citation statements)

References 17 publications

(48 reference statements)

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“…Although no evidence of infection was found in the present case after a thorough test of cerebrospinal fluid, concurrent viral meningitis cannot be completely ruled out. However, the meningeal enhancement in the present case was not consistent with viral etiology because the grade of enhancement should be low and subtle in viral meningitis, particularly on contrast-enhanced images based on T1-weighted [6,7].…”

Section: Case Presentationcontrasting

confidence: 68%

Isolated Leptomeningeal Enhancement in Anti-N-methyl-D-aspartate Receptor Encephalitis: A case report

Niu¹,

Song²,

Xu³

2019

Preprint

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Background Magnetic resonance imaging findings of anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis have been reported to lack specificity. The hippocampus, frontal lobe, white matter, basal ganglia, and even spinal cord can be involved. However, isolated leptomeningeal enhancement is rare in anti-NMDA receptor encephalitis. Case presentation We report a 17-year-old boy who presented with a 2-week history of mild fever and progressive encephalopathy with behavioral and psychological abnormalities. Finally, a diagnosis of anti-NMDA receptor encephalitis was made. Initial magnetic resonance imaging results revealed diffuse contrast enhancement of the leptomeninges without parenchymal lesions. After treatment with high-dose intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulin, the enhancement showed substantially decrease at the 3-week follow-up. Conclusions This case is unusual because isolated leptomeningeal enhancement is rare in anti-NMDA receptor encephalitis. The present case suggests that isolated diffuse leptomeningeal enhancement could be one of the imaging findings in patients with anti-NMDA receptor encephalitis.

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Section: Case Presentationcontrasting

confidence: 68%

Isolated Leptomeningeal Enhancement in Anti-N-methyl-D-aspartate Receptor Encephalitis: A case report

Niu¹,

Song²,

Xu³

2019

Preprint

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“…Additionally, CE-FLAIR is more sensitive to lower Gd concentrations due to its extreme sensitivity to minimal modification of the CSF composition ( Fig. 4 ) ( 5 10 18 26 27 28 29 30 31 ).…”

Section: Leptomeningeal Lesionsmentioning

confidence: 99%

Importance of Contrast-Enhanced Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Various Intracranial Pathologic Conditions

2016

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Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.

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“…For its diagnosis, CSF examination remains as a gold standard or an invasive procedure is compulsory. In clinical imaging like MRI has been established to be useful in detection of leptomeningitis [28] . Routinely T1W conventional sequences been used for diagnosis of meningitis.…”

Section: Discussionmentioning

confidence: 99%

“…In 2015 Armeen Ahmad and his colleagues [8] conducted a study to determine the discrimination of leptomeningeal and vascular enhancement on post contrast FLAIR for early detection of infectious leptomeningitis. This study suggests that post contrast FLAIR sequence has significant meningeal enhancement and insignificant component of vascular enhancement.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Gadolinium Based T1 Weighted and Flair Mr Sequences for the Assessment of Leptomeningeal Enhancement in Meningoencephalitis

Ahmed¹

2018

International Journal of Radiology

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diagnosed positive as having meningitis and 12 patients were negative. Out of these 43 patients, post contrast FLAIR sequence was positive in 41 patients and 33 patients were positive on post contrast T1W sequence. In the finding of meningitis, post contrast FLAIR sequence sensitivity was 95.3% and specificity was 83.3%. While, post contrast T1W sequence sensitivity was 76.7% and 75% was specificity. CONCLUSION: The sensitivity and specificity of post contrast FLAIR sequence is more as compared to post contrast T1W sequence in the diagnosis of meningitis. In suspected cases of meningitis post contrast FLAIR sequence should be used as a routine sequence for the diagnosis of meningitis.

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Differentiation of Leptomeningeal and Vascular Enhancement on Post-contrast FLAIR MRI Sequence: Role in Early Detection of Infectious Meningitis

Cited by 17 publications

References 17 publications

Isolated Leptomeningeal Enhancement in Anti-N-methyl-D-aspartate Receptor Encephalitis: A case report

Isolated Leptomeningeal Enhancement in Anti-N-methyl-D-aspartate Receptor Encephalitis: A case report

Importance of Contrast-Enhanced Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Various Intracranial Pathologic Conditions

Comparison of Gadolinium Based T1 Weighted and Flair Mr Sequences for the Assessment of Leptomeningeal Enhancement in Meningoencephalitis

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