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Diffusion-Weighted MR Imaging of Pyogenic Ventriculitis

¹ All authors: Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903.

View larger version (139K): [in a new window]   Fig. 1A. —50-year-old man with purulent ventriculitis after resection of cerebellar hemangioblastoma and ventricular shunt placement. Fluid-attenuated inversion recovery image (TR/TE, 9000/105; inversion time, 2500 msec) shows ventricular debris in dependent part of occipital horns (straight arrows) has higher signal intensity than cerebrospinal fluid in nondependent parts of lateral ventricles. Hyperintense signal around ventricles (curved arrow) is consistent with ependymitis and periventricular inflammation.

View larger version (135K): [in a new window]   Fig. 1B. —50-year-old man with purulent ventriculitis after resection of cerebellar hemangioblastoma and ventricular shunt placement. Contrast-enhanced T1-weighted MR image (650/17) shows irregular ventricular debris with curved and oblique layering (arrows) in occipital horns. This nonlinear fluid—fluid interface is consistent with pus. Faint linear ependymal contrast enhancement is also present.

View larger version (149K): [in a new window]   Fig. 1C. —50-year-old man with purulent ventriculitis after resection of cerebellar hemangioblastoma and ventricular shunt placement. Tensor diffusion-weighted MR image (4000/110; b value, 1000 m2/sec) shows pus in dependent position of occipital horns and marked hyperintense signal (arrows) compared with cerebrospinal fluid and brain.

View larger version (143K): [in a new window]   Fig. 2A. —32-year-old man with purulent ventriculitis after resection of cerebellar hemangioblastoma. Fluid-attenuated inversion recovery (FLAIR) image (TR/TE, 9000/105; inversion time, 2500 msec) shows hyperintense debris (arrow) in occipital horns of both lateral ventricles and hyperintense signal around ventricles.

View larger version (150K): [in a new window]   Fig. 2B. —32-year-old man with purulent ventriculitis after resection of cerebellar hemangioblastoma. Tensor diffusion-weighted MR image (4000/110; b value, 1000 m2/sec) shows greater relative hyperintensity in intraventricular pus (arrow) than on FLAIR image (A).

View larger version (128K): [in a new window]   Fig. 2C. —32-year-old man with purulent ventriculitis after resection of cerebellar hemangioblastoma. Magnified apparent diffusion coefficient map of left lateral ventricle shows that pus in more dependent position has lower apparent diffusion coefficient (33.1 x 10-3 mm2/sec) than pus in more anterior, less dependent position (97.6 x 10-3 mm2/sec). Circular regions of interest are outlined and numbered (1-4).

View larger version (127K): [in a new window]   Fig. 2D. —32-year-old man with purulent ventriculitis after resection of cerebellar hemangioblastoma. In contrast to C, this image, which is same apparent diffusion coefficient map image as that shown in C, shows normal-appearing cerebrospinal fluid and much higher apparent diffusion coefficient values; in addition, no position-dependent gradation is visible. Circular regions of interest are outlined and numbered (1-4).

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