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CT and MR imaging features of pyogenic ventriculitis.

Abstract

BACKGROUND AND PURPOSE

Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We hypothesized that determining characteristic imaging features of pyogenic ventriculitis in patients with appropriate risk factors might improve recognition of this severe infection.

METHODS

Review of the medical records from 1990 to 2000 revealed 17 cases (12 men, five women) that satisfied inclusion criteria of abscess (n = 3) and/or positive cultures or increased white cells and protein in ventricular (n = 12) or cisternal (n = 1) cerebrospinal fluid. In one case, the diagnosis of ventriculitis was based on the combination of bacterial growth in lumbar cerebrospinal fluid and follow-up imaging. Staphylococcus species and Enterobacter species were the most common organisms. Two neuroradiologists independently evaluated imaging studies for hydrocephalus, ventricular debris, periventricular attenuation or signal abnormality, ependymal enhancement, and signs of meningitis or abscess. Sixteen studies in 11 patients were performed after the intravenous administration of contrast material.

RESULTS

Ventricular debris was detected in 16 (94%) of 17 cases and was irregular in 13 (81%) of 16 cases. Hydrocephalus was present in 13 (76%) of 17 cases. Periventricular hyperintense signal was present in most (seven [78%] of nine) cases with MR imaging and was most conspicuous on fluid-attenuated inversion recovery sequences. Ependymal enhancement was detected in seven (64%) of 11 cases in which contrast material was administered. Signs of meningitis (eg, pial or duraarachnoid signal abnormality or enhancement) were present in 13 (76%) of 17 cases. Three cases had imaging signs of abscess.

CONCLUSION

Ventricular debris was the most frequent sign of ventriculitis in this series. An irregular level was characteristic of debris in ventriculitis. Hydrocephalus and ependymal enhancement were less frequent signs. Detection of ventricular debris might facilitate diagnosis of pyogenic ventriculitis, a potentially fatal infection, and thus permit appropriate therapy.

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  • Authors+Show Affiliations

    ,

    Division of Neuroradiology, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

    ,

    Source

    MeSH

    Adult
    Aged
    Brain Abscess
    Cerebral Ventricles
    Cerebral Ventriculography
    Encephalitis
    Female
    Humans
    Magnetic Resonance Imaging
    Male
    Middle Aged
    Risk Factors
    Tomography, X-Ray Computed

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11559498

    Citation

    Fukui, M B., et al. "CT and MR Imaging Features of Pyogenic Ventriculitis." AJNR. American Journal of Neuroradiology, vol. 22, no. 8, 2001, pp. 1510-6.
    Fukui MB, Williams RL, Mudigonda S. CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol. 2001;22(8):1510-6.
    Fukui, M. B., Williams, R. L., & Mudigonda, S. (2001). CT and MR imaging features of pyogenic ventriculitis. AJNR. American Journal of Neuroradiology, 22(8), pp. 1510-6.
    Fukui MB, Williams RL, Mudigonda S. CT and MR Imaging Features of Pyogenic Ventriculitis. AJNR Am J Neuroradiol. 2001;22(8):1510-6. PubMed PMID: 11559498.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - CT and MR imaging features of pyogenic ventriculitis. AU - Fukui,M B, AU - Williams,R L, AU - Mudigonda,S, PY - 2001/9/18/pubmed PY - 2001/10/26/medline PY - 2001/9/18/entrez SP - 1510 EP - 6 JF - AJNR. American journal of neuroradiology JO - AJNR Am J Neuroradiol VL - 22 IS - 8 N2 - BACKGROUND AND PURPOSE: Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We hypothesized that determining characteristic imaging features of pyogenic ventriculitis in patients with appropriate risk factors might improve recognition of this severe infection. METHODS: Review of the medical records from 1990 to 2000 revealed 17 cases (12 men, five women) that satisfied inclusion criteria of abscess (n = 3) and/or positive cultures or increased white cells and protein in ventricular (n = 12) or cisternal (n = 1) cerebrospinal fluid. In one case, the diagnosis of ventriculitis was based on the combination of bacterial growth in lumbar cerebrospinal fluid and follow-up imaging. Staphylococcus species and Enterobacter species were the most common organisms. Two neuroradiologists independently evaluated imaging studies for hydrocephalus, ventricular debris, periventricular attenuation or signal abnormality, ependymal enhancement, and signs of meningitis or abscess. Sixteen studies in 11 patients were performed after the intravenous administration of contrast material. RESULTS: Ventricular debris was detected in 16 (94%) of 17 cases and was irregular in 13 (81%) of 16 cases. Hydrocephalus was present in 13 (76%) of 17 cases. Periventricular hyperintense signal was present in most (seven [78%] of nine) cases with MR imaging and was most conspicuous on fluid-attenuated inversion recovery sequences. Ependymal enhancement was detected in seven (64%) of 11 cases in which contrast material was administered. Signs of meningitis (eg, pial or duraarachnoid signal abnormality or enhancement) were present in 13 (76%) of 17 cases. Three cases had imaging signs of abscess. CONCLUSION: Ventricular debris was the most frequent sign of ventriculitis in this series. An irregular level was characteristic of debris in ventriculitis. Hydrocephalus and ependymal enhancement were less frequent signs. Detection of ventricular debris might facilitate diagnosis of pyogenic ventriculitis, a potentially fatal infection, and thus permit appropriate therapy. SN - 0195-6108 UR - https://www.unboundmedicine.com/medline/citation/11559498/CT_and_MR_imaging_features_of_pyogenic_ventriculitis_ L2 - http://www.ajnr.org/cgi/pmidlookup?view=long&pmid=11559498 DB - PRIME DP - Unbound Medicine ER -