Clinical Neuroradiology

, Volume 26, Issue 2, pp 159–167 | Cite as

Spectrum and Prevalence of Pathological Intracranial Magnetic Resonance Imaging Findings in Acute Bacterial Meningitis

  • N. Lummel
  • M. Koch
  • M. Klein
  • H. W. Pfister
  • H. Brückmann
  • J. Linn
Original Article



Aim of this study was to determine the spectrum and prevalence of pathological intracranial magnetic resonance imaging (MRI) findings in patients with acute bacterial meningitis.


We retrospectively identified all consecutive patients with cerebral spinal fluid proven bacterial meningitis who presented at our neurology department between 2007 and 2012. Pathogenic agents and clinical symptoms were noted. MR-examinations were evaluated regarding presence and localization of pathological signal alterations in the different sequences by two neuroradiologists in consensus.


A total of 136 patients with purulent bacterial meningitis were identified. In 114 cases the bacterial pathogen agent was proven and in 75 patients an MRI was available. In 62 of the 75 (82.7 %) patients meningitis-associated pathologic imaging findings were evident on MRI. Overall, intraventricular signal alterations, i.e., signs of pyogenic ventriculitis, were present in 41 cases (54.7 %), while sulcal signal changes were found in 22 cases (29.3 %). Intraparenchymatous signal alterations affected the cortex in 15 cases (20 %), and the white matter in 20 patients (26.7 %). The diffusion-weighted imaging and fluid attenuated inversion recovery sequences were most sensitive in the detection of these changes and showed any pathologic findings in 67.6 and 79.6 %, respectively. Patients with streptococcal meningitis showed significantly more often (n = 29 of 34, 85.3 %) intraventricular and/or sulcal diffusion restrictions than patients with meningitis caused by other agents (n = 12 of 37, 32.4 %) (p< 0.0001).


Pathological MR findings are frequently found in patients with acute bacterial meningitis. Intraventricular diffusion restrictions, i.e., signs of pyogenic ventriculitis, are more often found in patients with streptococcal, especially pneumococcal, infection.


Acute bacterial meningitis Sulcal Ventriculitis DWI FLAIR Pneumococcal meningitis 


Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Castillo M. Imaging of meningitis. Semin Roentgenol. 2004;39(4):458–64.CrossRefPubMedGoogle Scholar
  2. 2.
    Hughes DC, Raghavan A, Mordekar SR, Griffiths PD, Connolly DJ. Role of imaging in the diagnosis of acute bacterial meningitis and its complications. Postgrad Med J. 2010;86(1018):478–85. doi:10.1136/pgmj.2010.097022.CrossRefPubMedGoogle Scholar
  3. 3.
    Kawaguchi T, Sakurai K, Hara M, Muto M, Nakagawa M, Tohyama J, et al. Clinico-radiological features of subarachnoid hyperintensity on diffusion-weighted images in patients with meningitis. Clin Radiol. 2012;67(4):306–12. doi:10.1016/j.crad.2011.10.001.CrossRefPubMedGoogle Scholar
  4. 4.
    Kiroglu Y, Karabulut N, Alkan A. The role of diffusion-weighted echo planar mri in central nervous system infections regarding etiopathogeneses. Diagn Interv Radiol. 2010;16(4):257–62. doi:10.4261/1305-3825.DIR.2564-09.1.PubMedGoogle Scholar
  5. 5.
    Upadhyayula S. Question 2 * is there a role for MRI as an adjunct for diagnosing bacterial meningitis? Arch Dis Child. 2013;98(5):388–90. doi:10.1136/archdischild-2013-303858.CrossRefPubMedGoogle Scholar
  6. 6.
    Kamra P, Azad R, Prasad KN, Jha S, Pradhan S, Gupta RK. Infectious meningitis: prospective evaluation with magnetization transfer MRI. Br J Radiol. 2004;77(917):387–94.CrossRefPubMedGoogle Scholar
  7. 7.
    Parmar H, Sitoh YY, Anand P, Chua V, Hui F. Contrast-enhanced FLAIR imaging in the evaluation of infectious leptomeningeal diseases. Eur J Radiol. 2006;58(1):89–95. doi:10.1016/j.ejrad.2005.11.012.CrossRefPubMedGoogle Scholar
  8. 8.
    Splendiani A, Puglielli E, De Amicis R, Necozione S, Masciocchi C, Gallucci M. Contrast-enhanced FLAIR in the early diagnosis of infectious meningitis. Neuroradiology. 2005;47(8):591–8. doi:10.1007/s00234-005-1383-7.CrossRefPubMedGoogle Scholar
  9. 9.
    Kamran S, Bener AB, Alper D, Bakshi R. Role of fluid-attenuated inversion recovery in the diagnosis of meningitis: comparison with contrast-enhanced magnetic resonance imaging. J Comput Assist Tomogr. 2004;28(1):68–72.CrossRefPubMedGoogle Scholar
  10. 10.
    Castillo M. Magnetic resonance imaging of meningitis and its complications. Top Magn Reson Imaging. 1994;6(1):53–8.PubMedGoogle Scholar
  11. 11.
    Fraser DW, Geil CC, Feldman RA. Bacterial meningitis in Bernalillo County, New Mexico: a comparison with three other American populations. Am J Epidemiol. 1974;100(1):29–34.PubMedGoogle Scholar
  12. 12.
    Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis In The United States, 1998–2007. N Engl J Med. 2011;364(21):2016–25. doi:10.1056/NEJMoa1005384.CrossRefPubMedGoogle Scholar
  13. 13.
    Kim YJ, Chang KH, Song IC, Kim HD, Seong SO, Kim YH, et al. Brain abscess and necrotic or cystic brain tumor: discrimination with signal intensity on diffusion-weighted MR imaging. AJR Am J Roentgenol. 1998;171(6):1487–90. doi:10.2214/ajr.171.6.9843275.CrossRefGoogle Scholar
  14. 14.
    Noguchi K, Watanabe N, Nagayoshi T, Kanazawa T, Toyoshima S, Shimizu M, et al. Role of diffusion-weighted echo-planar MRI in distinguishing between brain brain abscess and tumour: a preliminary report. Neuroradiology. 1999;41(3):171–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Guo AC, Provenzale JM, Cruz LC, Jr., Petrella JR. Cerebral abscesses: investigation using apparent diffusion coefficient maps. Neuroradiology. 2001;43(5):370–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Rana S, Albayram S, Lin DD, Yousem DM. Diffusion-weighted imaging and apparent diffusion coefficient maps in a case of intracerebral abscess with ventricular extension. AJNR Am J Neuroradiol. 2002;23(1):109–12.PubMedGoogle Scholar
  17. 17.
    Fujikawa A, Tsuchiya K, Honya K, Nitatori T. Comparison of MRI sequences to detect ventriculitis. AJR Am J Roentgenol. 2006;187(4):1048–53. doi:10.2214/AJR.04.1923.CrossRefGoogle Scholar
  18. 18.
    Han KT, Choi DS, Ryoo JW, Cho JM, Jeon KN, Bae KS, et al. Diffusion-weighted MR imaging of pyogenic intraventricular empyema. Neuroradiology. 2007;49(10):813–8. doi:10.1007/s00234–007-0264–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Abe M, Takayama Y, Yamashita H, Noguchi M, Sagoh T. Purulent meningitis with unusual diffusion-weighted MRI findings. Eur J Radiol. 2002;44(1):1–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Tsuchiya K, Inaoka S, Mizutani Y, Hachiya J. Fast fluid-attenuated inversion-recovery MR of intracranial infections. AJNR Am J Neuroradiol. 1997;18(5):909–13.PubMedGoogle Scholar
  21. 21.
    Noguchi K, Ogawa T, Inugami A, Toyoshima H, Sugawara S, Hatazawa J, et al. Acute subarachnoid hemorrhage: MR imaging with fluid-attenuated inversion recovery pulse sequences. Radiology. 1995;196(3):773–7. doi:10.1148/radiology.196.3.7644642.CrossRefPubMedGoogle Scholar
  22. 22.
    Essig M, Bock M. Contrast optimization of fluid-attenuated inversion-recovery (FLAIR) MR imaging in patients with high CSF blood or protein content. Magn Reson Med. 2000;43(5):764–7. doi:10.1002/(SICI)1522–2594(200005)43:5<764::AID-MRM21>3.0.CO;2–F.CrossRefPubMedGoogle Scholar
  23. 23.
    Tsuchiya K, Katase S, Yoshino A, Hachiya J. FLAIR MR imaging for diagnosing intracranial meningeal carcinomatosis. AJR Am J Roentgenol. 2001;176(6):1585–8. doi:10.2214/ajr.176.6.1761585.CrossRefGoogle Scholar
  24. 24.
    Griffiths PD, Coley SC, Romanowski CA, Hodgson T, Wilkinson ID. Contrast-enhanced fluid-attenuated inversion recovery imaging for leptomeningeal disease in children. AJNR Am J Neuroradiol. 2003;24(4):719–23.PubMedGoogle Scholar
  25. 25.
    Mathews VP, Kuharik MA, Edwards MK, D’Amour PG, Azzarelli B, Dreesen RG. Dyke award. Gd-DTPA-enhanced MR imaging of experimental bacterial meningitis: evaluation and comparison with CT. AJR Am J Roentgenol. 1989;152(1):131–6. doi:10.2214/ajr.152.1.131.CrossRefGoogle Scholar
  26. 26.
    Mittl RL, Jr., Yousem DM. Frequency of unexplained meningeal enhancement in the brain after lumbar puncture. AJNR Am J Neuroradiol. 1994;15(4):633–8.PubMedGoogle Scholar
  27. 27.
    Runge VM, Wells JW, Williams NM, Lee C, Timoney JF, Young AB. Detectability of early brain meningitis with magnetic resonance imaging. Invest Radiol. 1995;30(8):484–95.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • N. Lummel
    • 1
  • M. Koch
    • 1
  • M. Klein
    • 2
  • H. W. Pfister
    • 2
  • H. Brückmann
    • 1
  • J. Linn
    • 1
  1. 1.Department of Neuroradiology, Klinikum GrosshadernLudwig-Maximilian-UniversityMunichGermany
  2. 2.Department of Neurology, Klinikum GrosshadernLudwig-Maximilian-UniversityMunichGermany

Personalised recommendations