Neuroimaging of pediatric brain infections

Triulzi, Fabio; Doneda, Chiara; Parazzini, Cecilia

doi:10.1586/eri.11.38

Cited by 9 publications

(3 citation statements)

References 56 publications

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“…Because of the potential for rapid deterioration and causing devastating short-and long-term neurologic sequels, timely diagnosis is of the utmost importance. Magnetic resonance imaging (MRI) is the imaging modality of choice for the diagnosis and therapeutic surveillance of pediatric intracranial infection [4][5][6]. Currently, widely used pulse sequences are T2-weighted, T1-weighted, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI), and gadolinium-enhanced T1-weighted imaging (Gd-T1w) in clinical MR imaging studies.…”

Section: Introductionmentioning

confidence: 99%

Amide Proton Transfer-Weighted (APTw) Imaging of Intracranial Infection in Children: Initial Experience and Comparison with Gadolinium-Enhanced T1-Weighted Imaging

Zhang

Tang

et al. 2020

BioMed Research International

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Purpose. To evaluate the performance of amide proton transfer-weighted (APTw) imaging against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1w) in children with intracranial infection. Materials and Methods. Twenty-eight pediatric patients (15 males and 13 females; age range 1-163 months) with intracranial infection were recruited in this study. 2D APTw imaging and conventional MR sequences were conducted using a 3 T MRI scanner. Kappa (κ) statistics and the McNemar test were performed to determine whether the hyperintensity on APTw was related to the enhancement on Gd-T1w. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of APTw imaging to predict lesion enhancement were calculated. Result. In twelve patients with brain abscesses, the enhancing rim of the abscesses on the Gd-T1w images was consistently hyperintense on the APTw images. In eight patients with viral encephalitis, three showed slight spotted gadolinium enhancement, while the APTw image also showed a slight spotted high signal. Five of these patients showed no enhancement on Gd-T1w and isointensity on the APTw image. In eleven patients with meningitis, increased APTw signal intensities were clearly visible in gadolinium-enhancing meninges. Sixty infectious lesions (71%) showed enhancement on Gd-T1w images. The sensitivity and specificity of APTw were 93.3% (56/60) and 91.7% (22/24). APTw demonstrated excellent agreement (κ=0.83) with Gd-T1w, with no significant difference (P=0.69) in detection of infectious lesions. Conclusions. These initial data show that APTw MRI is a noninvasive technique for the detection and characterization of intracranial infectious lesions. APTw MRI enabled similar detection of infectious lesions to Gd-T1w and may provide an injection-free means of evaluation of intracranial infection.

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Section: Introductionmentioning

confidence: 99%

Amide Proton Transfer-Weighted (APTw) Imaging of Intracranial Infection in Children: Initial Experience and Comparison with Gadolinium-Enhanced T1-Weighted Imaging

Zhang

Tang

et al. 2020

BioMed Research International

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“…This is in accordance with other reports that brain MRI findings in pediatric cerebral infections could be normal. 36,37 The abnormal MRI findings that were seen included: T2-weighted signal parenchymal hyperintensities in various cerebral and cerebellar regions (some which were gadolinium-enhancing lesions), leptomeningeal enhancement, subdural empyemas and abscesses, apex-petrositis and base of skull osteomyelitis. As seen in Table 7 (supplemental material), some of these infection-related cases ended up as sinus vein thrombosis and acute demyelinating conditions, which could explain the discrepancy between the initially suspected infection and the eventual final diagnosis.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children

et al. 2020

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The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.

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“…appearances of these infections depend upon various factors, including stage of brain development, host response, and infectious agent. 1,2 The imaging appearances of various infections are different, but calcification and necrosis remain common finding. 2…”

Section: Atypical Intracranial Infections and Mimicsmentioning

confidence: 99%

Imaging of Atypical Brain Infections and Infection Mimics in Children

2017

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Atypical brain infections in the pediatric age group are uncommon and different from the adult population; however, when present, they pose a diagnostic challenge and can result in serious and potentially fatal complications if not recognized and treated early in the course of the disease. Imaging plays a vital role because of relative inaccessibility to tissue sampling. This review article regroups the atypical pediatric brain infections (parasitic, fungal, viral, and bacterial) by age group (prenatal, perinatal, and post-neonatal period) and elucidates their characteristic imaging appearance, as well as focuses on their complications, in an aim to help clinicians (pediatricians/pediatric neuroradiologists/radiologists) better characterize, diagnose, and guide patient treatment. In addition, this review article also emphasizes on infection mimics of the central nervous system in order to empower our differential diagnosis, improve our diagnostic accuracy, and avoid unindicated patient management and treatment.

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Neuroimaging of pediatric brain infections

Cited by 9 publications

References 56 publications

Amide Proton Transfer-Weighted (APTw) Imaging of Intracranial Infection in Children: Initial Experience and Comparison with Gadolinium-Enhanced T1-Weighted Imaging

Amide Proton Transfer-Weighted (APTw) Imaging of Intracranial Infection in Children: Initial Experience and Comparison with Gadolinium-Enhanced T1-Weighted Imaging

The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children

Imaging of Atypical Brain Infections and Infection Mimics in Children

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