American Journal of Roentgenology, Vol 154, 809-816, Copyright © 1990 by American Roentgen Ray Society
Gd-DTPA-enhanced MR imaging of the brain in patients with meningitis: comparison with CT
KH Chang, MH Han, JK Roh, IO Kim, MC Han and CW Kim
Department of Diagnostic Radiology, College of Medicine, Seoul National University, Korea.
Plain and Gd-DTPA-enhanced MR images of the brain were obtained in 18
consecutive patients with meningitis (eight with tuberculous, five with
bacterial, three with viral, and two with fungal infections); the MR images
were compared with CT scans. MR images were obtained on a 2.0-T
superconducting unit with both T1- and T2-weighted pulse sequences before
injection and with a T1-weighted sequence after injection of Gd- DTPA (0.1
mmol/kg) in all patients. In tuberculous meningitis, MR imaging depicted
ischemia/infarct, hemorrhagic infarct of basal ganglia, meningeal
enhancement at either basal cistern or convexity surface of brain, and
associated small granulomas in a few more patients than CT did. In
bacterial meningitis, primary foci of extracranial inflammation (i.e.,
mastoid, paranasal sinuses) and adjacent intracranial lesions including
localized dural inflammation, subdural fluid collection, and/or brain
parenchymal lesions were demonstrated much better on MR than on CT.
Otherwise, MR images generally matched the CT scan. Although the plain MR
images, both T1- and T2-weighted, were the most sensitive in delineating
ischemia/infarct, hemorrhage, and edema, they were not as specific as
Gd-DTPA-enhanced T1-weighted images and postcontrast CT scans in defining
the active inflammatory process of the meninges and focal lesions
precisely. We conclude that if Gd-DTPA is used, MR imaging appears to be
superior to CT in the evaluation of patients with suspected meningitis.
Precontrast MR is needed to delineate ischemia/infarct, edema, and subacute
hemorrhage.
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