Diagnostic Accuracy of Contrast Enhanced Flair Magnetic Resonance Imaging in Diagnosis of Meningitis Taking Lumbar Puncture as Gold Standard

Sobia Jawwad, Nadia Gul, Khalid Mehmood, Bushra Iqbal, Kanza Afzal

ABSTARCT

Objective: The objective of this article is to determine and compare the diagnostic accuracies of contrast enhanced FLAIR and T1W sequences of MRI brain in the detection of meningitis keeping lumbar puncture as gold standard.
Study Design: Cross-sectional validation study.
Place and Duration of Study: The study was carried out at Department of Diagnostic Radiology of POF Hospital, Wah Cantt from 23rd June 2019 to 22nd March 2020.
Materials and Methods: A total of 173 patients were included in the study by non-probability purposive sampling. Patients of age between 2-70 years, of either gender with suspected meningitis based on clinical presentation are included in our study. Patients in whom contrast enhanced MRI and lumbar puncture was contraindicated, diagnosed patient of meningitis and non-consenting patients were excluded from this study. All patients received intravenous contrast medium gadolinium at rate of 0.2 ml/second. Post gadolinium T1W and post gadolinium FLAIR images were acquired and evaluated by a consultant radiologist. Findings were recorded on a prescribed performa. Patients were followed and results of lumbar puncture were collected from laboratory.
Result: The mean age was 26.4±23.5 year ranging from 2 to 70 years. Out of 173 patients, 98 patients (56.6%) were male and 75 patients (43.4%) were female. Clinical presentations were as follows: poor feeding, irritability and lethargy 86 (49.7%), headache 137 (79.2%), nausea/vomiting 125 (72.3%), neck stiffness 89 (51.4%), altered level of consciousness 132 (76.3%), seizures 78 (45.1%) and local neurological deficit 45 (26%). Diagnostic accuracy of contrast enhanced MRI FLAIR in diagnosing meningitis taking lumbar puncture gold standard showed sensitivity 91%, specificity 85%, PPV 87.6%, NPV 89.4% and diagnostic accuracy 88.4%. Diagnostic accuracy of contrast enhanced MRI T1W in the diagnosis of meningitis taking lumbar puncture gold standard revealed sensitivity 60.2%, specificity 77.5%, PPV 75.6%, NPV 62.6% and diagnostic accuracy 68.2%.
Conclusion: The sensitivity and specificity of post contrast FLAIR sequence is greater as compared to post contrast T1W sequence to detect meningeal enhancement. Therefore, for all patients with suspicion of meningitis, post contrast FLAIR sequence should be added to MRI brain protocol as a routine sequence.

Key Words: Contrast Enhanced Flair Magnetic Resonance Imaging, Diagnostic Accuracy, Lumbar Puncture, Meningitis.

How to cite this: Jawwad S, Gul N, Mehmood K, Iqbal B, Afzal K.  Diagnostic Accuracy of Contrast Enhanced Flair Magnetic Resonance Imaging in Diagnosis of Meningitis Taking Lumbar Puncture as Gold Standard. Life and Science. 2022; 3(3): 120-126.  doi: http://doi.org/10.37185/LnS.1.1.259

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