Comparison of MRI Sequences to Detect Ventriculitis
Akira Fujikawa1,
Kazuhiro Tsuchiya2,
Keita Honya2 and
Toshiaki Nitatori2
1 Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24,
Ikejiri, Setagaya, Tokyo 154-8532, Japan.
2 Department of Radiology, Kyorin University Hospital School of Medicine, Tokyo,
Japan.
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Fig. 1A —68-year-old man with severe mastoiditis and acute petrositis.
T2-weighted image shows areas of slight hypointensity relative to CSF in
bilateral trigone of lateral ventricle. This finding is suggestive of
intraventricular debris and pus. Slight ventricular wall abnormality is
noted.
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Fig. 1B —68-year-old man with severe mastoiditis and acute petrositis.
FLAIR image shows hyperintense intraventricular lesions relative to CSF and
hyperintensity along ventricular lining, suggesting ependymitis.
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Fig. 1C —68-year-old man with severe mastoiditis and acute petrositis.
Contrast-enhanced T1-weighted image shows abnormal curvilinear enhancement
along the ventricular wall. Intraventricular debris and pus are slightly
hyperintense relative to CSF.
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Fig. 1D —68-year-old man with severe mastoiditis and acute petrositis.
Diffusion-weighted image shows areas of conspicuous intraventricular and
periventricular hyperintensity, indicating restricted water diffusion in those
areas.
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Fig. 1E —68-year-old man with severe mastoiditis and acute petrositis.
Apparent diffusion coefficient (ADC) map shows areas of decreased ADC values
in corresponding lesions on diffusion-weighted image (D).
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Fig. 2A —2-month-old boy with acute pyogenic meningitis. T2-weighted
image shows slight dilatation of left occipital horn of lateral ventricle
without findings of intraventricular and periventricular lesion.
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Fig. 2B —2-month-old boy with acute pyogenic meningitis. FLAIR image
shows small area of slight hyperintensity in left occipital horn and slight
hyperintensity along ventricular wall of left occipital horn. Leptomeningeal
hyperintensity is also noted in left frontal region, suggesting
meningitis.
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Fig. 2C —2-month-old boy with acute pyogenic meningitis.
Contrast-enhanced T1-weighted image shows no significant enhancement of
ventricular lining compared with meningeal enhancement in left frontal region,
which is consistent with meningitis.
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Fig. 2D —2-month-old boy with acute pyogenic meningitis.
Diffusion-weighted image reveals areas of intraventricular hyperintensity in
bilateral occipital horn. Right intraventricular lesion is not detected on
other sequence images. Periventricular abnormal signal intensity is
indeterminate.
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Fig. 2E —2-month-old boy with acute pyogenic meningitis. Apparent
diffusion coefficient (ADC) map shows decreased ADC values in areas
corresponding to lesions on diffusion-weighted image (D).
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Fig. 3A 39-year-old man with AIDS and intracranial tuberculous infection. FLAIR
image shows intraventricular lesions in left occipital horn of lateral
ventricles with areas of hyperintensity along ventricular lining. Alteration
of signal intensity in right occipital horn is minimal. Areas of
hyperintensity suggesting infarction of bilateral basal ganglia and right
frontal region are also seen.
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Fig. 3B 39-year-old man with AIDS and intracranial tuberculous infection.
Contrast-enhanced T1-weighted image shows areas of slight hyperintensity
relative to CSF in bilateral occipital horn. No periventricular enhancement is
seen.
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Fig. 3C 39-year-old man with AIDS and intracranial tuberculous infection.
Diffusion-weighted image reveals bilateral hyperintense intraventricular
lesions with left predominance.
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Fig. 3D 39-year-old man with AIDS and intracranial tuberculous infection. FLAIR
image 10 days after initial study shows newly developed cerebral lesion in
left occipital region adjacent to left occipital horn in which
intraventricular lesions have persisted. Areas of hyperintensity along
ventricular wall are prominent. Dilated lateral ventricles and third ventricle
are also newly seen.
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Fig. 3E 39-year-old man with AIDS and intracranial tuberculous infection.
Contrast-enhanced T1-weighted image 10 days after initial study shows focal
enhancement in left occipital region, suggesting cerebritis. No enhancement of
ventricular wall is noted.
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Fig. 3F 39-year-old man with AIDS and intracranial tuberculous infection.
Diffusion-weighted image 10 days after initial study shows areas of
conspicuous focal hyperintensity in left occipital horn and along ventricular
wall of bilateral occipital horn, which are different from other sequences in
distribution. Hyperintensity in left occipital region suggests newly developed
cerebritis.
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Fig. 3G 39-year-old man with AIDS and intracranial tuberculous infection.
Diffusion-weighted image obtained at pons level 10 days after initial study
shows hyperintensity in dependent portion of dilated fourth ventricle and in
right cerebellopontine cistern, suggesting intraventricular debris and pus and
meningitis, respectively.
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Copyright © 2006 by the American Roentgen Ray Society.
