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Neuroradiology

, Volume 49, Issue 10, pp 813–818 | Cite as

Diffusion-weighted MR imaging of pyogenic intraventricular empyema

  • Kil-Tae Han
  • Dae Seob Choi
  • Jae Wook Ryoo
  • Jae Min Cho
  • Kyung Nyeo Jeon
  • Kyung-Soo Bae
  • Jin Jong You
  • Sung Hoon Chung
  • Eun Ha Koh
  • Ki-Jong Park
Diagnostic Neuroradiology

Abstract

Introduction

Pyogenic intraventricular empyema (PIE) is a potentially fatal CNS infection. However, it is sometimes difficult to diagnose PIE on the basis of clinical and conventional MRI findings. Diffusion-weighted imaging (DWI) has been accepted as a useful MR sequence for the diagnosis of various intracranial infections. The purpose of this study was to determine the DWI characteristics of PIE and the role of DWI in the diagnosis of PIE.

Methods

Eight patients with PIE underwent MRI including DWI. We assessed the presence and signal characteristics of PIE. In seven patients, the signal intensities of the PIE and cerebrospinal fluid (CSF) were measured and the contrast-to-noise ratio (CNR) percentage was calculated. ADC values of the PIE, CSF, and white matter were also determined.

Results

PIE was detected in all patients by DWI, in five (63%) by FLAIR imaging, and in two (25%) by T1- and T2-weighted imaging. The CNR percentages of the PIEs in relation to the CSF were highest for DWI, followed by FLAIR, T1-, and T2-weighted imaging. There were statistically significant differences between the images of each sequence. In all patients, PIE showed hyperintensities on DWI and hypointensities to the CSF and hypo- or isointensities to the white matter on ADC maps. The ADC values (mean±SD) of the PIE, CSF, and white matter were 0.60±0.27, 2.81±0.04, and 0.79±0.08 (×10−3 mm2/s). There was a statistically significant difference between PIE and the CSF.

Conclusion

PIE shows a bright intensity on DWI, and DWI is a sensitive MR sequence for the diagnosis of PIE.

Keywords

Magnetic resonance Diffusion MR Pyogenic intraventricular empyema 

References

  1. 1.
    Pezzullo JA, Tung GA, Mudigonda S, Rogg JM (2003) Diffusion-weighted MR imaging of pyogenic ventriculitis. AJR Am J Roentgenol 180:71–75PubMedGoogle Scholar
  2. 2.
    Fukui MB, Williams RL, Mudigonda S (2001) CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol 22:1510–1516PubMedGoogle Scholar
  3. 3.
    Salmon J (1972) Ventriculitis complicating meningitis. Am J Dis Child 124:35–40PubMedGoogle Scholar
  4. 4.
    Kanamalla US, Ibarra RA, Jinkins JR (2000) Imaging of cranial meningitis and ventriculitis. Neuroimaging Clin N Am 10:309–331PubMedGoogle Scholar
  5. 5.
    Barloon TJ, Yuh WT, Knepper LE, Biller J, Ryals TJ, Sato Y (1990) Cerebral ventriculitis: MR findings. J Comput Assist Tomogr 14:272–275PubMedCrossRefGoogle Scholar
  6. 6.
    Guo AC, Provenzale JM, Cruz LCH Jr, Petrella JR (2001) Cerebral abscesses: investigation using apparent diffusion coefficient maps. Neuroradiology 43:370–374PubMedCrossRefGoogle Scholar
  7. 7.
    Ketelslegers E, Duprez T, Ghariani S, Thauvoy C, Cosnard G (2000) Time dependence of serial diffusion-weighted imaging features in a case of pyogenic brain abscess. J Comput Assist Tomogr 24(3):478–481PubMedCrossRefGoogle Scholar
  8. 8.
    Noguchi K, Watanabe N, Nagayoshi T, Kanazawa T, Toyoshima S, Shimizu M et al (1999) Role of diffusion-weighted echo-planar MRI in distinguishing between brain abscess and tumour: a preliminary report. Neuroradiology 41:171–174PubMedCrossRefGoogle Scholar
  9. 9.
    Tsuchiya K, Osawa A, Katase S, Fujikawa A, Hachiya J, Aoki S (2003) Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology 45:220–223PubMedGoogle Scholar
  10. 10.
    Wong AM, Zimmerman RA, Simon EM, Pollock AN, Bilaniuk LT (2004) Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol 25:1016–1021PubMedGoogle Scholar
  11. 11.
    Rana S, Albayram S, Lin DD, Yousem DM (2002) Diffusion-weighted imaging and apparent diffusion coefficient maps in a case of intracerebral abscess with ventricular extension. AJNR Am J Neuroradiol 23:109–112PubMedGoogle Scholar
  12. 12.
    Fujikawa A, Tsuchiya K, Honya K, Nitatori T (2006) Comparison of MRI sequences to detect ventriculitis. AJR Am J Roentgenol 187:1048–1053PubMedCrossRefGoogle Scholar
  13. 13.
    Noguchi K, Ogawa T, Inugami A, Toyoshima H, Sugawara S, Hatazawa J et al (1995) Acute subarachnoid hemorrhage: MR imaging with fluid-attenuated inversion recovery pulse sequences. Radiology 196:773–777PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Kil-Tae Han
    • 1
    • 2
  • Dae Seob Choi
    • 1
    • 2
  • Jae Wook Ryoo
    • 1
    • 2
  • Jae Min Cho
    • 1
    • 2
  • Kyung Nyeo Jeon
    • 1
    • 2
  • Kyung-Soo Bae
    • 1
    • 2
  • Jin Jong You
    • 1
    • 2
  • Sung Hoon Chung
    • 1
    • 2
  • Eun Ha Koh
    • 3
  • Ki-Jong Park
    • 4
  1. 1.Department of Diagnostic RadiologyGyeongsang National University HospitalJinju-siSouth Korea
  2. 2.Gyeongsang Institute of Health ScienceGyeongsang National University Medical SchoolJinju-siSouth Korea
  3. 3.Department of Laboratory MedicineGyeongsang National University Medical SchoolJinju-siSouth Korea
  4. 4.Department of NeurologyGyeongsang National University Medical SchoolJinju-siSouth Korea

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