Positive Predictive Value of Contrast-Enhanced Fluid-Attenuated Inversion Recovery (FLAIR) Magnetic Resonance Imaging in Diagnosis of Meningitis Among Pediatrics Taking Cerebrospinal Fluid Analysis as Gold Standard.

BACKGROUND AND OBJECTIVE

Cerebrospinal fluid (CSF) analysis is the gold standard for meningitis diagnosis. It is invasive, time-consuming, and can inoculate infection. CSF analysis is not appropriate for many children without significant clinical suspicion, and delaying decision-making can have negative consequences. Therefore, medical research has long focused on speedy, non-invasive meningitis diagnosis. This study aimed to examine the positive predictive value (PPV) of contrast-enhanced fluid-attenuated inversion recovery magnetic resonance imaging (CE-FLAIR MRI) in meningitis diagnosis.

MATERIALS AND METHODS

It was a cross-sectional study that was conducted in the Department of Radiology, The Children's Hospital in Lahore, from December 29, 2017, to June 28, 2018. The 198 patients were included of either gender with an age of 1 to 15 years and underwent CE-FLAIR MRI due to suspicion of meningitis. The gold standard for meningitis diagnosis was cerebrospinal fluid analysis, while CE-FLAIR MRI results were graded as true positives and false positives. The chi-square test was used. The -value less than 0.05 was taken as statistically significant.

RESULTS

The mean age of the patients was 4.18±2.48 years. The majority, 116 (58.6%), of the patients were aged below 5 years. There were 125 (63.1%) male and 73 (36.9%) female patients with a male-to-female ratio of 1.7:1. The diagnosis of meningitis using CE-FLAIR MRI was made in 187 (94.4%) patients with a PPV of 94.4%, which was further confirmed on CSF analysis. The PPV of CE-FLAIR-MRI across various subgroups based on the patient's age and gender were statistically insignificant, which showed consistency across all included age and gender groups ( > 0.05).

CONCLUSION

The contrast-enhanced FLAIR magnetic resonance imaging was found to have a high positive predictive value of 94.4% in the diagnosis of meningitis, taking cerebrospinal fluid analysis as the gold standard. CE-FLAIR MRI's noninvasive and ionizing radiation-free characteristics advocate its preferred use in future clinical practice.