MR vessel wall imaging in cerebral bacterial and fungal infections

Abstract

Purpose Central nervous system (CNS) bacterial and fungal infections can cause secondary vasculitis which worsens the prognosis due to development of complications like infarctions or hemorrhages. In this prospective study, we aim to study intracranial vessel wall imaging findings in bacterial and fungal infections. Methods We included 12 cases of nontubercular bacterial and fungal CNS infections each, in whom definitive microbiological diagnosis could be made. High-resolution vessel wall imaging (VWI) and time of flight MR angiography (TOF MRA) were incorporated in the routine imaging protocol. All cases were evaluated for the presence of vascular enhancement, pattern of enhancement, and stenosis on VWI. Statistical analysis was done to evaluate association between findings of vessel wall imaging and infarctions. Results We found infarctions in 5 out of 12 cases (41.7%) of the bacterial group and 7 out of 12 cases (58.3%) of the fungal group. Vessel wall enhancement was seen in 5 cases (41.7%) of the bacterial group and 9 cases (75%) of the fungal group. There was a significant association between infarctions and vessel wall enhancement in the fungal group. However, pattern of enhancement or stenosis on VWI was not significantly associated with presence of infarction. VWI detected more cases of vascular involvement than TOF MRA. Conclusion Secondary infectious vasculitis in bacterial and fungal infections can be detected by VWI, which can play an important role in better patient management as detection of vascular involvement can prompt early treatment to prevent complications like infarctions or hemorrhages.

Cerebrovascular Complications Associated With Iatrogenic Fungal Meningitis Following Surgical Procedures in Mexico

“…In contrast, larger fungi tend to cause variable-size infarcts and characterize by their angioinvasive nature and elastase production, which ultimately increases the risk for arterial dissection, aneurysms, and stroke. 5…”

“…In contrast, larger fungi tend to cause variable-size infarcts and characterize by their angioinvasive nature and elastase production, which ultimately increases the risk for arterial dissection, aneurysms, and stroke. 5 The US and Mexican laboratories have documented the presence of F. solani in cerebrospinal fluid samples of patients affected by this outbreak. 6 Thus, despite this fungus was isolated only in 1 patient, it was presumed to be the culprit in the other 2 patients.…”

High-resolution intracranial vessel wall imaging in cerebral viral infections evaluations

“…Smooth enhancement implies diffuse involvement of the vessel wall secondary to leukocytic infiltration and contiguous extension from inflamed meninges [ 30 ]. On the other hand, nodular enhancement implies that there is focal pathology in the arterial wall, like development of granuloma or chronic proliferative angiitis [ 10 , 31 ]. Previous studies have shown nodular or eccentric enhancement predominates in tubercular infections, which incites chronic granulomatous inflammation [ 10 ].…”

“…On the other hand, nodular enhancement implies that there is focal pathology in the arterial wall, like development of granuloma or chronic proliferative angiitis [ 10 , 31 ]. Previous studies have shown nodular or eccentric enhancement predominates in tubercular infections, which incites chronic granulomatous inflammation [ 10 ]. However, further studies with histopathological correlation are needed in this regard.…”

“…Various studies have shown detection of vasculitic changes by VWI in various infections of CNS, including viral [ 10 – 12 ]. Cheng-Ching et al have shown that VWI not only helps in diagnosis of varicella vasculopathy, but also has an immense role in guiding treatment duration and assessing treatment response [ 11 ].…”