Imaging of Intracranial Infections

Abstract

Central nervous system (CNS) infections are a major source of morbidity and mortality despite the remarkable progress in prevention and treatment of infectious disease. Because of the difficulty of direct tissue sampling, imaging plays a crucial role in detecting, diagnosing, and monitoring the therapeutic response of CNS infections. An accurate diagnosis in CNS infections is especially rewarding, given the availability of potential effective antimicrobials.

Bacterial, viral, fungal, and parasitic infections may affect the brain and/or its meningeal coverings, and can be characterized by a variety of radiological patterns that help narrow the differential diagnoses and eventually tailor the optimal management.

This review addresses the typical imaging findings of intracranial infectious diseases in both immunocompetent and immunocompromised patients.

Keywords

neuroimaging - CNS infections - immunocompetent patients - immunocompromised patients

• References

• 1 Shih RY, Koeller KK. Bacterial, fungal, and parasitic infections of the central nervous system: radiologic-pathologic correlation and historical perspectives. Radiographics 2015; 35 (04) 1141-1169
• 2 Hurst RW, Judkins A, Bolger W, Chu A, Loevner LA. Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: imaging and pathologic correlation. AJNR Am J Neuroradiol 2001; 22 (05) 858-863
• 3 Camacho DLA, Smith JK, Castillo M. Differentiation of toxoplasmosis and lymphoma in AIDS patients by using apparent diffusion coefficients. AJNR Am J Neuroradiol 2003; 24 (04) 633-637
• 4 Gupta RK, Jobanputra KJ, Yadav A. MR spectroscopy in brain infections. Neuroimaging Clin N Am 2013; 23 (03) 475-498
• 5 Boisson C, Arnaud s, Vialet R, Martin C. Severe community-acquired meningitis. Crit Care 1999; 3 (04) R55-R65
• 6 Kastrup O, Wanke I, Maschke M. Neuroimaging of infections. NeuroRx 2005; 2 (02) 324-332
• 7 Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics 2007; 27 (02) 525-551
• 8 Lee EK, Lee EJ, Kim S, Lee YS. Importance of contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging in various intracranial pathologic conditions. Korean J Radiol 2016; 17 (01) 127-141
• 9 Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DJA. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgrad Med J 2010; 86 (1018): 478-485
• 10 Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis 2010; 10 (05) 317-328
• 11 Klein M, Koedel U, Pfefferkorn T, Zeller G, Woehrl B, Pfister H-W. Arterial cerebrovascular complications in 94 adults with acute bacterial meningitis. Crit Care 2011; 15 (06) R281
• 12 Pfister HW, Feiden W, Einhäupl KM. Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study. Arch Neurol 1993; 50 (06) 575-581
• 13 Bousser M-G, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6 (02) 162-170
• 14 Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg 2011; 9 (02) 136-144
• 15 Villanueva-Meyer JE, Cha S. From shades of gray to microbiologic imaging: a historical review of brain abscess imaging: RSNA Centennial Article. Radiographics 2015; 35 (05) 1555-1562
• 16 Toh CH, Wei K-C, Chang C-N. , et al. Differentiation of pyogenic brain abscesses from necrotic glioblastomas with use of susceptibility-weighted imaging. AJNR Am J Neuroradiol 2012; 33 (08) 1534-1538
• 17 Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR. Brain abscess: current management. J Neurosci Rural Pract 2013; 4 (Suppl. 01) S67-S81
• 18 Lai PH, Ho JT, Chen WL. , et al. Brain abscess and necrotic brain tumor: discrimination with proton MR spectroscopy and diffusion-weighted imaging. AJNR Am J Neuroradiol 2002; 23 (08) 1369-1377
• 19 Weingarten K, Zimmerman RD, Becker RD, Heier LA, Haimes AB, Deck MD. Subdural and epidural empyemas: MR imaging. AJR Am J Roentgenol 1989; 152 (03) 615-621
• 20 Sinclair AG, Scoffings DJ. Imaging of the post-operative cranium. Radiographics 2010; 30 (02) 461-482
• 21 Pittella JE. Neurocysticercosis. Brain Pathol 1997; 7 (01) 681-693
• 22 Carabin H, Ndimubanzi PC, Budke CM. , et al. Clinical manifestations associated with neurocysticercosis: a systematic review. PLoS Negl Trop Dis 2011; 5 (05) e1152
• 23 Kimura-Hayama ET, Higuera JA, Corona-Cedillo R. , et al. Neurocysticercosis: radiologic-pathologic correlation. Radiographics 2010; 30 (06) 1705-1719
• 24 Sarria Estrada S, Frascheri Verzelli L, Siurana Montilva S, Auger Acosta C, Rovira Cañellas A. Imaging findings in neurocysticercosis [in Spanish]. Radiologia (Madr) 2013; 55 (02) 130-141
• 25 Zhao J-L, Lerner A, Shu Z, Gao X-J, Zee C-S. Imaging spectrum of neurocysticercosis. Radiol Infect Dis 2015; 1 (02) 94-102
• 26 Carpio A, Fleury A, Romo ML. , et al. New diagnostic criteria for neurocysticercosis: reliability and validity. Ann Neurol 2016; 80 (03) 434-442
• 27 Lerner A, Shiroishi MS, Zee C-S, Law M, Go JL. Imaging of neurocysticercosis. Neuroimaging Clin N Am 2012; 22 (04) 659-676
• 28 Govindappa SS, Narayanan JP, Krishnamoorthy VM, Shastry CH, Balasubramaniam A, Krishna SS. Improved detection of intraventricular cysticercal cysts with the use of three-dimensional constructive interference in steady state MR sequences. AJNR Am J Neuroradiol 2000; 21 (04) 679-684
• 29 Tyler KL. Herpes simplex virus infections of the central nervous system: encephalitis and meningitis, including Mollaret's. Herpes 2004; 11 (Suppl. 02) 57A-64A
• 30 Sabah M, Mulcahy J, Zeman A. Herpes simplex encephalitis. BMJ 2012; 344 (02) e3166-e3166
• 31 Soares BP, Provenzale JM. Imaging of herpesvirus infections of the CNS. AJR Am J Roentgenol 2016; 206 (01) 39-48
• 32 Bulakbasi N, Kocaoglu M. Central nervous system infections of herpes virus family. Neuroimaging Clin N Am 2008; 18 (01) 53-84 , viii
• 33 Letourneau-Guillon L, Wada R, Kucharczyk W. Imaging of prion diseases. J Magn Reson Imaging 2012; 35 (05) 998-1012
• 34 Galanaud D, Haik S, Linguraru MG. , et al. Combined diffusion imaging and MR spectroscopy in the diagnosis of human prion diseases. AJNR Am J Neuroradiol 2010; 31 (07) 1311-1318
• 35 Carswell C, Thompson A, Lukic A. , et al. MRI findings are often missed in the diagnosis of Creutzfeldt-Jakob disease. BMC Neurol 2012; 12: 153
• 36 Collie DA, Summers DM, Sellar RJ. , et al. Diagnosing variant Creutzfeldt-Jakob disease with the pulvinar sign: MR imaging findings in 86 neuropathologically confirmed cases. AJNR Am J Neuroradiol 2003; 24 (08) 1560-1569
• 37 Kovalevich J, Langford D. Neuronal toxicity in HIV CNS disease. Future Virol 2012; 7 (07) 687-698
• 38 Bowen LN, Smith B, Reich D, Quezado M, Nath A. HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment. Nat Rev Neurol 2016; 12 (11) 662-674
• 39 Senocak E, Oğuz KK, Ozgen B. , et al. Imaging features of CNS involvement in AIDS. Diagn Interv Radiol 2010; 16 (03) 193-200
• 40 Kolson D. Neurologic complications in persons with HIV infection in the era of antiretroviral therapy. Top Antivir Med 2017; 25 (03) 97-101
• 41 Clifford DB, Ances BM. HIV-associated neurocognitive disorder. Lancet Infect Dis 2013; 13 (11) 976-986
• 42 Haziot MEJ, Barbosa Junior SP, Vidal JE, de Oliveira FTM, de Oliveira ACP. Neuroimaging of HIV-associated neurocognitive disorders. Dement Neuropsychol 2015; 9 (04) 380-384
• 43 Smith AB, Smirniotopoulos JG, Rushing EJ. From the archives of the AFIP: central nervous system infections associated with human immunodeficiency virus infection: radiologic-pathologic correlation. Radiographics 2008; 28 (07) 2033-2058
• 44 Mahadevan A, Ramalingaiah AH, Parthasarathy S, Nath A, Ranga U, Krishna SS. Neuropathological correlate of the “concentric target sign” in MRI of HIV-associated cerebral toxoplasmosis. J Magn Reson Imaging 2013; 38 (02) 488-495
• 45 Kumar GGS, Mahadevan A, Guruprasad AS. , et al. Eccentric target sign in cerebral toxoplasmosis: neuropathological correlate to the imaging feature. J Magn Reson Imaging 2010; 31 (06) 1469-1472
• 46 Ernst TM, Chang L, Witt MD. , et al. Cerebral toxoplasmosis and lymphoma in AIDS: perfusion MR imaging experience in 13 patients. Radiology 1998; 208 (03) 663-669
• 47 Chang L, Ernst T. MR spectroscopy and diffusion-weighted MR imaging in focal brain lesions in AIDS. Neuroimaging Clin N Am 1997; 7 (03) 409-426
• 48 Chinn RJ, Wilkinson ID, Hall-Craggs MA. , et al. Toxoplasmosis and primary central nervous system lymphoma in HIV infection: diagnosis with MR spectroscopy. Radiology 1995; 197 (03) 649-654
• 49 Arribas JR, Storch GA, Clifford DB, Tselis AC. Cytomegalovirus encephalitis. Ann Intern Med 1996; 125 (07) 577-587
• 50 Holland NR, Power C, Mathews VP, Glass JD, Forman M, McArthur JC. Cytomegalovirus encephalitis in acquired immunodeficiency syndrome (AIDS). Neurology 1994; 44 (3 Pt 1): 507-514
• 51 Maschke M, Kastrup O, Diener H-C. CNS manifestations of cytomegalovirus infections: diagnosis and treatment. CNS Drugs 2002; 16 (05) 303-315
• 52 Sarbu N, Shih RY, Jones RV, Horkayne-Szakaly I, Oleaga L, Smirniotopoulos JG. White matter diseases with radiologic-pathologic correlation. Radiographics 2016; 36 (05) 1426-1447
• 53 Berger JR. Progressive multifocal leukoencephalopathy. Handb Clin Neurol 2014; 123: 357-376
• 54 Buckle C, Castillo M. Use of diffusion-weighted imaging to evaluate the initial response of progressive multifocal leukoencephalopathy to highly active antiretroviral therapy: early experience. AJNR Am J Neuroradiol 2010; 31 (06) 1031-1035
• 55 Duarte SBL, Oshima MM, Mesquita JVDA, do Nascimento FBP, de Azevedo PC, Reis F. Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients. Radiol Bras 2017; 50 (06) 359-365
• 56 Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics 2007; 27 (05) 1255-1273
• 57 Be NA, Kim KS, Bishai WR, Jain SK. Pathogenesis of central nervous system tuberculosis. Curr Mol Med 2009; 9 (02) 94-99
• 58 El Sahly HM, Teeter LD, Pan X, Musser JM, Graviss EA. Mortality associated with central nervous system tuberculosis. J Infect 2007; 55 (06) 502-509
• 59 Chin JH. Tuberculous meningitis: diagnostic and therapeutic challenges. Neurol Clin Pract 2014; 4 (03) 199-205
• 60 Garg RK, Malhotra HS, Jain A. Neuroimaging in tuberculous meningitis. Neurol India 2016; 64 (02) 219-227
• 61 Tai MS, Viswanathan S, Rahmat K. , et al. Cerebral infarction pattern in tuberculous meningitis. Sci Rep 2016; 6: 38802
• 62 Pehlivanoglu F, Yasar KK, Sengoz G. Tuberculous meningitis in adults: a review of 160 cases. ScientificWorldJournal 2012; 2012: 169028
• 63 Rock RB, Olin M, Baker CA, Molitor TW, Peterson PK. Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 2008; 21 (02) 243-261
• 64 Trivedi R, Saksena S, Gupta RK. Magnetic resonance imaging in central nervous system tuberculosis. Indian J Radiol Imaging 2009; 19 (04) 256-265