Different MRI Sequences and Spectrum of Findings in Pediatric Brain Infections in North Indian Population

Abstract

Introduction: Pediatric brain infections pose a significant challenge to health professionals in developing countries like India due to the high mortality and morbidity associated with them and delays in establishing an early diagnosis. This study was planned to establish the role of MRI and evaluate the spectrum of imaging findings in this group of patients of North India. Material and Methods: This study was performed on 70 children who were less than 14 years of age and had presenting complaints suggestive of brain infection from Nov 2016 to Nov 2018 at JN Medical College and Hospital, Aligarh. MRI was performed on 1.5 Tesla Siemens MAGNATOM Avantofit withT1 weighted, T2 weighted, Fluid Attenuated Inversion Recovery (FLAIR), Post Contrast T1 and newer sequences like Susceptibility Weighted Imaging (SWI), Constructive Interference in Steady State (CISS), Diffusion Weighted Imaging (DWI) and MR Spectroscopy. Results: Out of 70 patients evaluated -One was of congenital CMV infection (~1.4%), 11patients of acute pyogenic meningitis (~15.7%) and, 29 patients with tubercular meningitis and tuberculoma (~41.4%). 21 patients of Neurocysticercosis (~30%) and 8 of viral encephalitis out of which 2 patients were positive of Herpes simplex virus 1 infection(~2.9%) and 6 patients diagnosed with Japanese encephalitis (~8.6%).CISS sequence helped in identifying the scolex in neurocysticercosis, SWI was useful for evaluation of calcification in granulomatous lesions and hemorrhagic foci in Japanese encephalitis. Post contrast T1 weighted sequence was useful for accurate delineation of size of ring enhancing lesions and their follow up. Diffusion weighted Imaging and MR spectroscopy too had their specific utility in establishing the differential diagnosis. Conclusion: Combining the conventional MRI sequences with the newer ones gives a wide spectrum of imaging findings in pediatric brain infections with specific features of different etiology on different sequences thus establishing accurate diagnosis in majority of the cases or at least narrows down the differential for early management.