Han Kil-Tae, Choi Dae Seob, Ryoo Jae Wook, Cho Jae Min, Jeon Kyung Nyeo, Bae Kyung-Soo, You Jin Jong, Chung Sung Hoon, Koh Eun Ha, Park Ki-Jong
Department of Diagnostic Radiology, Gyeongsang National University Hospital, 90 Chilam-dong, Jinju-si, Gyeongsangnam-do 660-702, South Korea.
Neuroradiology. 2007 Oct;49(10):813-8. doi: 10.1007/s00234-007-0264-7. Epub 2007 Jul 24.
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.
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.
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 (x10(-3) mm(2)/s). There was a statistically significant difference between PIE and the CSF.
PIE shows a bright intensity on DWI, and DWI is a sensitive MR sequence for the diagnosis of PIE.
化脓性脑室积脓（PIE）是一种潜在致命的中枢神经系统感染。然而，有时根据临床和传统MRI表现很难诊断PIE。扩散加权成像（DWI）已被公认为是诊断各种颅内感染的有用MR序列。本研究的目的是确定PIE的DWI特征以及DWI在PIE诊断中的作用。
8例PIE患者接受了包括DWI在内的MRI检查。我们评估了PIE的存在情况和信号特征。对7例患者测量了PIE和脑脊液（CSF）的信号强度，并计算了对比噪声比（CNR）百分比。还测定了PIE、CSF和白质的表观扩散系数（ADC）值。
所有患者均通过DWI检测到PIE，5例（63%）通过液体衰减反转恢复（FLAIR）成像检测到，2例（25%）通过T1加权和T2加权成像检测到。PIE相对于CSF的CNR百分比在DWI上最高，其次是FLAIR、T1加权和T2加权成像。各序列图像之间存在统计学显著差异。所有患者的PIE在DWI上均表现为高信号，在ADC图上相对于CSF为低信号，相对于白质为低信号或等信号。PIE、CSF和白质的ADC值（平均值±标准差）分别为0.60±0.27、2.81±0.04和0.79±0.08（×10⁻³mm²/s）。PIE与CSF之间存在统计学显著差异。
PIE在DWI上表现为高信号，DWI是诊断PIE的敏感MR序列。
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