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Values of Magnetic Resonance Imaging and Cerebrospinal fluid analysis in the diagnosis of Central Nervous System associated infectious diseases.

Byline: Dongfeng Zhang

ABSTRACT

Objective: To discuss the roles of magnetic resonance imaging (MRI) and cerebrospinal fluid analysis in the identification of central nervous system associated infection and provide a reference for the diagnosis and treatment of central nervous system associated infectious diseases.

Methods: Seventy-six patients who developed central nervous system infection and were admitted into the Henan People's Hospital between June 2014 and October 2015 were randomly selected as an observation group. Patients in the observation group were subdivided according to purulent meningitis, cryptococcal meningitis, viral meningitis and tubercular meningitis. Moreover, 35 headache patients who were admitted in the same period were selected as a control group. The MRI results and cerebrospinal fluid examination indicators were compared between the two groups.

Results: MRI results suggested that the positive rate of the observation group was 96.05% (73/76), much higher than 8.57% in the control group (3/35), and the difference had statistical significance (P<0.05). The analysis results of cerebrospinal fluid demonstrated that the concentration of lactate dehydrogenase (LDH) in the cerebrospinal fluid of the patients with tubercular meningitis was the highest, the concentration of creatine kinase (CK) in the cerebrospinal fluid of the patients with purulent meningitis was the highest, and the concentration of lactic acid (LA) in the cerebrospinal fluid of the patients with tubercular meningitis and purulent meningitis was higher than that of the other patients; the differences were statistically significant (P0.05); therefore, the results of the two groups were comparable.

A HD1.5T MR scanner produced by GE, America was used in MRI. Some patients were examined by enhancement scanning. Patients in the observation group underwent MRI twice or thrice, seven days after admission and seven days before discharge; some patients were re-examined once during hospitalization. Patients in the control group underwent MRI for more than one time. The examination results of the two groups were compared. It was determined as positive if there were areas with limited T1 and high-signal T2 weighted imaging (T2WI), central liquidation, multilocular isolation and focal abscess.

Lactate dehydrogenase (LDH), creatine kinase (CK) and lactic acid (LA) detection kits were used in the biochemical examination of cerebrospinal fluid associated indicators. AU 640 fully automatic biochemical analyser was also used. The use of all the instruments and reagents followed corresponding instructions. Cerebrospinal fluid was extracted after lumbar puncture. Purulent meningitis is induced by purulent bacterial infection, manifesting as turbid cerebrospinal fluid with a large amount of cells especially white blood cells, increased protein level and low sugar and chloride content. Tubercular meningitis is a non-suppurative inflammation induced by tubercle bacillus, manifesting as colorless and transparent or light yellow cerebrospinal fluid with significantly increased lymphocyte, increased proteins and decreased sugar and chloride.

Viral meningitis is a leptomeningeal inflammatory response induced by viral infection, manifesting as colorless and transparent cerebrospinal fluid with normal or increased pressure, normal sugar and chloride content and slightly increased proteins.

Statistical analysis: Data were processed using SPSS ver. 21.0. Categorical data were processed using Chi-square test. Measurement data were expressed as mean +- standard deviation (SD) and processed by t test. Difference was considered as statistically significant if P<0.05.

RESULTS

The MRI results of the two groups: The MRI results demonstrated that, the positive rate of the observation group was 96.05%; the positive rate of the tubercular meningitis group and the cryptococcal meningitis group was both 100%; the positive rate of the viral meningitis group (Fig.1) and the purulent meningitis group was 90.48% and 92.86% respectively. The positive rate of the control group was 8.57%. The difference of the positive rate between the two groups had statistical significance (X2=10.317, P<0.05; Table-I).

Table-I: The comparison of the positive rate of MRI between the two groups.

Group###N###No. of###Positive

###positive###rate (%)

###cases

Observation group###76###73###96.05

Tubercular meningitis group###24###24###100

Purulent meningitis group###14###13###92.86

Viral meningitis group###21###19###90.48

Cryptococcal meningitis group###17###17###100

Control group###35###3###8.57

The examination results of LDH, CK and LA between the two groups: The examination results of the cerebrospinal fluid demonstrated that, the LDH concentration of the tubercular meningitis group was the highest, the CK concentration of the purulent meningitis group was the highest, and the LA concentration of the tubercular meningitis group and purulent meningitis group was higher than the other two groups. The comparison of the LDH, CK and LA concentration in the cerebrospinal fluid between the groups suggested statistically significant differences (P<0.05; Table-II).

Table-II: The comparison of the cerebrospinal fluid examination results between the two groups.

Group###N###LDH (U/L)###CK (U/L)###LA (U/L)

Observation###Tubercular meningitis group###24###86.35+-10.18###10.47+-4.85###55.91+-7.84

group###Purulent meningitis group###14###72.47+-15.29###1.72+-1.66###12.61+-2.93

(N=76)###Viral meningitis group###21###16.88+-8.71###0.98+-0.72###10.06+-8.24

###Cryptococcal meningitis group###17###15.89+-7.63###16.93+-3.91###53.34+-8.41

Control group###35###16.25+-8.01###0.88+-0.67###11.77+-2.23

F value###7.849###10.652###9.248

P value###<0.05###<0.05###<0.05

Table-III: The diagnostic efficacy of MRI in combination with cerebrospinal fluid analysis in diagnosing CNSI (%).

Indicator###Tubercular###Viral###Cryptococcal###Purulent

###meningitis###meningitis###meningitis###meningitis

Sensitivity###62.46###68.71###64.56###24.75

Specificity###80.35###76.96###57.48###75.36

Accuracy###78.22###71.47###56.07###65.11

The diagnostic efficacy of MRI in combination with cerebrospinal fluid analysis in diagnosing CNSI: The sensitivity of MRI in combination with cerebrospinal fluid analysis in diagnosing tubercular meningitis, viral meningitis and cryptococcal meningitis was higher than that in diagnosing purulent meningitis. The specificity and accuracy of MRI in combination with cerebrospinal fluid analysis in diagnosing viral meningitis, purulent meningitis and tubercular meningitis was much higher than that in diagnosing cryptococcal meningitis (Table-III).

DISCUSSION

MRI, a new medical technology of CT, has been extensively applied in the diagnosis in various clinical departments because of many advantages.7

Firstly, multidimensional image data can be obtained through MRI, which can provide more intuitive and comprehensive information about human body. Secondly, it will not produce radiation damages on human body, suggesting high safety. Finally, it can clearly display soft tissue structure. Therefore, MRI can effectively identify the central nervous system and accurately detect lesions.8 Cheng S. et al. found that MRI and computed tomography (CT) could be used to accurately and intuitively observe lesions in the brain,6 featured by simple operation and high efficiency.9 Spudich S. et al. found that MRI has considerable advantages in diagnosing the correlation between tissues around lesions and the internal structure as well as the size,8 number and distribution scope of lesions, but the specificity was low.10 In this study, the positive rate of MRI was 96.05% in the observation group.

But someone put forward that MRI consumed much time in identifying CNSI and was not applicable to critically ill patient.11 Basal cistern or even lateral fissure enhancement, hydrocephalus and basal ganglia lacunar lesions displayed by MRI are considered as three characteristics of tubercular meningitis. As to purulent meningitis, mater enhancement is not common in enhancement scanning, and only few cases were observed with inorganic adhesion and communicating hydrocephalus because of effusion. Cryptococcal meningitis also manifests meningitis symptoms in clinics; however, cerebral base and mater enhancement and hydrocephalus are usually not obvious or only non-enhanced colloid pseudocyst or slightly enhanced cryptococcal tumors are displayed, and sometimes expanded peripheral space of special Virchow vessels in cerebral base can be seen.12

Cerebrospinal fluid examination has been one of the methods which have been extensively applied for diagnosing CNSI and also the golden standard for the acquisition of etiological basis.13 The application of etiological examination in the early diagnosis is easily affected by the external factors and moreover low-efficient.14 Cerebrospinal fluid analysis aims at objectively evaluating the content of enzymes in cerebrospinal fluid. Generally, the cerebrospinal fluid of normal people contains more than 20 kinds of enzymes. When some diseases occur to the nervous system, the content of enzymes in cerebrospinal fluid of patients with CNSI will increase immediately due to the failure of blood brain barrier function. Therefore, the changes of the content of enzymes in crebrospinal fluid reflect the severity of cerebral injury to some extent.15,16

This study further evaluated the injury of blood brain barrier and brain tissues through detecting the concentration of LDH, CK and LA in cerebrospinal fluid. LDH is distributed extensively in various tissues across human body. The increased LDH content in cerebrospinal fluid indicates a high probability of injuries in the central nervous system. CK is cytosolic enzyme which is extensively distributed in cytoplasm and mitochondria. The content of CK can reflect the damage extent of cerebral tissues and the changes of blood brain barrier. LA is the final product of anaerobic glycolysis of body metabolism, and its content can reflect the demand-supply equilibrium of oxygen in brain tissue.

The research results demonstrated that, the sensitivity of MRI in combination with cerebrospinal fluid analysis cerebrospinal fluid analysis was sensitive in identifying tubercular meningitis, viral meningitis and cryptococcal meningitis, but the accuracy and specificity of the diagnostic method were low in identifying cryptococcal meningitis, indicating the method had high application values in diagnosing CNSI.

Limitations of the study: The samples included in this study were selected from the same hospital. Therefore regional difference could not be avoided in the results obtained. Precise verification involving multiple regions and large sample size is needed in the future.

CONCLUSION

In conclusion, MRI in combination with cerebrospinal fluid analysis plays a crucial role in the identification of CNSI, but it suggests no specific performance in the comparison of imaging examination results, history of diseases and other manifestations. MRI in combination with cerebrospinal fluid analysis can improve the diagnosis rate.

Declaration of interest: None

Grant Support and Financial Disclosures: None.

REFERENCES

1. Zaffiri L, Verma R, Struzzieri K, Monterroso J, Batts DH, Loehrke ME. Immune reconstitution inflammatory syndrome involving the central nervous system in a patient with HIV infection: a case report and review of literature. New Microbiol. 2013;36(1): 89-92.

2. Vassallo M, Dunais B, Durant J, Carsenti-Dellamonica H, Harvey-Langton A, Cottalorda J, et al. Relevance of lipopolysaccharide levels in HIV-associated neurocognitive impairment: the Neuradapt study. J Neurovirol. 2013;19(4): 376-382. doi: 10.1007/s13365-013-0181-y.

3. Aras S, Tek I, Varli M, Yalcin A, Cengiz OK, Atmis V, et al. Plasma viscosity: is a biomarker for the differential diagnosis of Alzheimer's disease and vascular dementia? Am J Alzheimers Dis Other Demen. 2013;28(1): 62-68. doi: 10.1177/1533317512467682.

4. Fu HL, Guo S, Tian JF. The value of serum procalcitonin in differential diagnosis of early central nervous system infection in children. Chin J Microecol. 2014;26(7): 826-828. doi: 10.13381/j.cnki.cjm.201407021.

5. Liguori C, Sancesario G, Albanese M, Stefani A, Marciani MG, Pierantozzi M. Epstein-Barr virus neuraxis infection as a trigger for central nervous system demyelinating processes: A case report. Mult Scler. 2013;19(3): 380-381. doi: 10.1177/1352458512457850.

6. Qin YC. Exploration of clinical value of CT and MRI in the diagnosis of infection of central nervous system. Clin J Chin Med. 2015;7(9): 88-89. doi: 10.3969/j.issn.1674-7860.2015.09.046.

7. Xiao HQ, Wang XY, Xie FF, Xing W. The differential diagnosis of MRI features on tuberculous meningitis and cryptococcal neoformans meningitis. J TCM Univ Hunan. 2015;35(5): 53-55. doi: 10.3969/j.issn.1674-070X.2015.05.018.

8. Choi CS, Choi YJ, Choi UY, Han JW, Jeong DC, Kim HH, et al. Clinical manifestations of CNS infections caused by enterovirus type 71. Korean J Pediatr. 2011;54(1): 11-16. doi: 10.3345/kjp.2011.54.1.11.

9. Cheng S, Huang YG, Li CZ, Hu S, Ai HW. Analysis of immunology detection, electroencephalogram and imaging examination in children with central nervous system infection. J Appl Clin Pediatr. 2012;27(21): 1677-1678. doi: 10.3969/j.issn.1003-515X.2012.21.021.

10. Spudich S, Gisslen M, Hagberg L, Lee E, Liegler T, Brew B, et al. Central nervous system immune activation characterizes primary human immunodeficiency virus 1 infection even in participants with minimal cerebrospinal fluid viral burden. J Infect Dis. 2011;204(5): 753-760. doi: 10.1093/infdis/jir387.

11. Jiang T, Zhang AW, Fang YN, Xu RX, Di W, Xiao ZJ, et al. Role of MRI and cerebrospinal fluid analysis in early differential diagnosis of central nervous system infection. Chin J Neuromed. 2014;13(1): 76-79. doi: 10.3760/cma.j.is sn.1671-8925.2014.01.017.

12. Zhu JG, Yang YF, Li HG, Liu F, Tian J. MRI study of pediatric medulloblastoma. J Med Postgrad. 2011;24(6): 590-592. doi: 10.3969/j.issn.1008-8199.2011.06.008.

13. Steinbrink F, Evers S, Buerke B, Young P, Arendt G, Koutsilieri E et al. Cognitive impairment in HIV infection is associated with MRI and CSF pattern of neurodegeneration. Eur J Neurol. 2013;20(3): 420-428. doi: 10.1111/ene.12006.

14. Castro Caldas A, Geraldes R, Neto L, Canhao P, Melo TP. Central nervous system vasculitis associated with hepatitis C virus infection: a brain MRI-supported diagnosis. J Neurol Sci. 2014; 336(1-2): 152-154. doi: 10.1016/j.jns.2013.10.028.

15. Lee KY, Lee YJ, Kim TH, Cheon DS, Nam SO. Clinico-radiological spectrum in enterovirus 71 infection involving the central nervous system in children. J Clin Neurosci. 2014;21(3): 416-420. doi: 10.1016/j.jocn.2013.04.032.

16. Yue XS, Zhang YF, Li SD. Analysis of the results of cerebrospinal fluid examination in patients with central nervous system infections. Chin J Nosocomiol. 2015;22(16): 3729-3730, 3813. doi: 10.11816/cn.ni.2015-142024.
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Publication:Pakistan Journal of Medical Sciences
Date:Oct 31, 2017
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