IMAGING OF INTRACRANIAL INFECTIONS

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Transcription:

IMAGING OF INTRACRANIAL INFECTIONS Dr Carolina Kachramanoglou LYSHOLM DEPARTMENT OF NEURORADIOLOGY NATIONAL HOSPITAL FOR NEUROLOGY AND NEUROSURGERY

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

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

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

ROLE OF IMAGING LOCATION AND EXTENT OF INVOLVEMENT TYPE OF INFECTION DETECTION OF COMPLICATIONS GUIDANCE TO BIOPSY OR THERAPY RESPONSE TO THERAPY

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

septic embolism acute invasive aspergillosis cysticercosis acute blood products mineralisation calcification CT

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;26:823 837.

T1-weighted hyperintense signal Fat proteinaceous fluid Melanin Methaemoglobin Mineralisation (manganese, copper) gadolinium T2-weighted hypointense signal Fat Melanin early methaemoglobin Colloid calcium

PARENCHYMAL DISEASE WJR 2014; 28; 6(9):716-725

ABSCESS

BRAIN ABSCESSES Bacterial Tuberculoma Toxoplasmosis TB

RING ENHANCING LESIONS Metastases GBM Infarction

ABSCESS - DWI

ABSCESS : sinogenic FRONTAL SINUSITIS EMPYEMA CEREBRAL ABSCESS Restricted diffusion due to highly viscous material within the abscess

DWI - FUNGAL ABSCESS INTRACAVITARY PROJECTIONS

ABSCESS VS GBM

SWI- ABSCESS Toh C et al. AJNR Am J Neuroradiol 2012;33:1534-1538 2012 by American Society of Neuroradiology

A 57-year-old man with a right temporal necrotic glioblastoma. Toh C et al. AJNR Am J Neuroradiol 2012;33:1534-1538 2012 by American Society of Neuroradiology

BASAL GANGLIA SOL

BASAL GANGLIA INVOLVEMENT - CRYPTOCOCCUS

BASAL GANGLIA INVOLVEMENT - TOXOPLASMOSIS

BASAL GANGLIA INVOLVEMENT - TOXOPLASMOSIS

SPECTROSCOPY

MR Spectroscopy in Brain Infections Neuroimaging Clinics of North America, 23, 3, 2013, 475-498

GRAY MATTER - ENCEPHALITIS

CREUTZFELDT -JAKOB DISEASE

WHITE MATTER - ENCEPHALITIS

PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

IMAGING IN MENINGITIS 85% of acute bacterial meningitis: Pneumococcus or Streptococcus lumbar puncture and urgent initiation of antibiotic therapy, without prior imaging

MENINGEAL ENHANCEMENT LEPTOMENINGEAL PACHYMENINGEAL

TB MENINGITIS Post-contrast T1-weighted

CRYPTOCOCCAL MENINGITIS Post-contrast T1-weighted

VENTRICULITIS CRYPTOCOCCUS : EPENDYMAL ENHANCEMENT

SUBDURAL EMPYEMA

OSTEOMYELITIS

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

THANK YOU ANY QUESTIONS?

REFERENCES WJR 2014; 28; 6(9):716-725 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;371:447-56 Lancet Neurol 2012; 11: 605 17 Neuroimag Clin N Am 23 (2013) 475 498 Neuroimag Clin N Am 21 (2011) 42

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