IMAGING OF INTRACRANIAL INFECTIONS
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1 IMAGING OF INTRACRANIAL INFECTIONS Dr Carolina Kachramanoglou LYSHOLM DEPARTMENT OF NEURORADIOLOGY NATIONAL HOSPITAL FOR NEUROLOGY AND NEUROSURGERY
2 Plan Introduce MR sequences that are useful in the diagnosis of intracranial infections Learn a systematic approach for the interpretation of imaging findings Review a series of cases
3 NEUROINFECTIONS Several outbreaks of encephalitis in this century ebola, zika In endemic areas, common cause of neurological morbidity tuberculosis, cysticercosis Urbanization and encroachment on natural environments, ease of world travel and climate change mosquito-borne diseases - malaria, dengue, and viral encephalitides Immunosuppressed and immunodeficient states post-transplant, chemotherapy, disease modifying therapy, recreational drug use, HIV Transmissible virus and protein particles prion
4 CNS INFECTIONS: APPROACH Supporting Clinical features, background info and laboratory findings rash, travel or therapy, CSF, CD4 counts Pathogens location of infection within the CNS, geographic exposures, vaccination status, age, surgery and immune suppression Imaging of neuraxis to include spinal cord and caudal equina extent of involvement ; multifocal, diffuse, atypical clinical or CSF findings Choice of Tools and Tricks diagnosis and monitoring
5 ROLE OF IMAGING LOCATION AND EXTENT OF INVOLVEMENT TYPE OF INFECTION DETECTION OF COMPLICATIONS GUIDANCE TO BIOPSY OR THERAPY RESPONSE TO THERAPY
6 INTRACRANIAL INFECTIONS CALVARIAL Osteomyelitis MENINGEAL Leptomeningeal Pachymeningeal Arachnoiditis Effusions Empyema VENTRICULAR Choroid Plexitis Hydrocephalus Pneumocephalus Ventriculitis PARENCHYMAL LESIONS Encephalitis / Myelitis Cerebritis Abscess Cysts Granuloma Gliotic scar Calcification Infarcts -arterial or venous Haemorrhages
7 septic embolism acute invasive aspergillosis cysticercosis acute blood products mineralisation calcification CT
8 MR CONTRAST MECHANISMS Endogenous Exogenous relaxation (T1 ; T2; T2*) diffusion (DWI, DTI) susceptibility ( T2*,SWI) flow (MRA, ASL, CSF flow) perfusion (DCE, DSC, ASL) BOLD (fmri) Gd -chelating agents (BBB, perfusion) J. Magn. Reson. Imaging 2007;26:
9 T1-weighted hyperintense signal Fat proteinaceous fluid Melanin Methaemoglobin Mineralisation (manganese, copper) gadolinium T2-weighted hypointense signal Fat Melanin early methaemoglobin Colloid calcium
10 PARENCHYMAL DISEASE WJR 2014; 28; 6(9):
11 ABSCESS
12 BRAIN ABSCESSES Bacterial Tuberculoma Toxoplasmosis TB
13 RING ENHANCING LESIONS Metastases GBM Infarction
14 ABSCESS - DWI
15 ABSCESS : sinogenic FRONTAL SINUSITIS EMPYEMA CEREBRAL ABSCESS Restricted diffusion due to highly viscous material within the abscess
16 DWI - FUNGAL ABSCESS INTRACAVITARY PROJECTIONS
17 ABSCESS VS GBM
18 SWI- ABSCESS Toh C et al. AJNR Am J Neuroradiol 2012;33: by American Society of Neuroradiology
19 A 57-year-old man with a right temporal necrotic glioblastoma. Toh C et al. AJNR Am J Neuroradiol 2012;33: by American Society of Neuroradiology
20 BASAL GANGLIA SOL
21 BASAL GANGLIA INVOLVEMENT - CRYPTOCOCCUS
22 BASAL GANGLIA INVOLVEMENT - TOXOPLASMOSIS
23 BASAL GANGLIA INVOLVEMENT - TOXOPLASMOSIS
24 SPECTROSCOPY
25 MR Spectroscopy in Brain Infections Neuroimaging Clinics of North America, 23, 3, 2013,
26 GRAY MATTER - ENCEPHALITIS
27
28
29 CREUTZFELDT -JAKOB DISEASE
30 WHITE MATTER - ENCEPHALITIS
31
32 PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY
33 IMAGING IN MENINGITIS 85% of acute bacterial meningitis: Pneumococcus or Streptococcus lumbar puncture and urgent initiation of antibiotic therapy, without prior imaging
34 MENINGEAL ENHANCEMENT LEPTOMENINGEAL PACHYMENINGEAL
35 TB MENINGITIS Post-contrast T1-weighted
36 CRYPTOCOCCAL MENINGITIS Post-contrast T1-weighted
37 VENTRICULITIS CRYPTOCOCCUS : EPENDYMAL ENHANCEMENT
38 SUBDURAL EMPYEMA
39 OSTEOMYELITIS
40 CNS INFECTIONS: APPROACH CT MR T1W, T2W FLAIR ; STIR neuroparenchymal features meningeal processes extra-axial collections Gd-enhanced DWI cerebritis, abscess, empyema, ventriculitis ischaemic complications MR Spectroscopy metabolic signatures
41 THANK YOU ANY QUESTIONS?
42 REFERENCES WJR 2014; 28; 6(9): N Engl J Med 2006;354:44-53 Curr Infect Dis Rep (2014) 16:449 Curr Infect Dis Rep (2014) 16:443 N Engl J Med 2014;371: Lancet Neurol 2012; 11: Neuroimag Clin N Am 23 (2013) Neuroimag Clin N Am 21 (2011) 42
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A ADC. See Apparent diffusion coefficient (ADC) Aneurysm cerebral artery aneurysm, 93 CT scan, 93 gadolinium, 93 Angiography, 13 Anoxic brain injury, 25 Apparent diffusion coefficient (ADC), 7 Arachnoid
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