Neonatal Meningitis: Magnetic-resonance-imaging-

based Scores Analysis in Preterm and Term Newborns

Department of Radiology, Children Hospital of Fudan University, Shanghai 201102, China

ASNR 2015, Chicago, USAEP-123

Mingshu Yang, Zhongwei Qiao

Disclosures

I have no disclosure

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Purpose

To describe the magnetic resonance

imaging (MRI) patterns of brain

damage in neonatal meningitis and to

investigate the difference between

preterm and term newborn by using

MRI-based score analysis

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Materials and Methods (1)

65 newborns with meningitis

18 preterms

47 terms

clinical information

MRI dataset

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Materials and Methods (2)

Items MRI Abnormalities Score 1 Score 2 Score 3

1 Ventricular dilatation# Negative Mild Moderate, or severe2 Periventricular white matter volume loss Negative Positive /3 Cystic abnormality Negative Focal Extensive

4Abnormal myelination of the posterior limb of the

internal capsuleNegative

Positive at corrected age ≥37 wk

/

5 Cortical gray matter signal abnormality Negative Focal ≥ 2 lesions, or extensive6 Intracranial extracerebral space abnormality Negative Focal ≥ 2 lesions, or extensive7 Basal ganglia signal abnormality Negative Focal ≥ 2 lesions, or extensive8 Non-cystic white matter signal abnormality$ Negative Mild Moderate, or severe9 Intraventricular hemorrhage Negative Grade I, Grade II Grade III, or Grade IV

10 Pyocephalus Negative Focal ≥ 2 lesions, or extensive

11 Abnormal meningeal enhancement Negative Focal ≥ 2 lesions, or extensive

12 Abnormal ependymal enhancement Negative Focal Extensive

13 Encephalopyosis Negative Focal and diameter < 3 cmExtensive or diameter ≥3

cm

Table 1 The brain abnormalities identified on MRI and MRI-based grading scores

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Materials and Methods (3)

These 13 patterns were classified into

three groups

White matter abnormalities (WMA)

Gray matter abnormalities (GMA)

Non-parenchyma abnormalities

(NPA)

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Results (1)

Fig. 1 The brain regions involved by meningitis in newborns observed on magnetic resonance imaging (MRI). There were 60% (39/65) patients showed lesions in cerebra, 3% (2/65) in cerebra and cerebella, 2% (1/65) in brain stems, but 35% (23/65) did not demonstrate any abnormalities on MRI. 7ASNR 53rd Annual Meeting, 2015, Chicago, USA. EP-123

Results (2)

Fig. 2 & 3 The frequencies and MRI-based scores of abnormal myelination of the posterior limb of internal capsules, ventricular dilatation and periventricular white matter volume loss were higher in the preterm than the term.

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Results (3)

Fig. 4 Regarding the WMA, GMA and NPA, the score of WMA in the preterm was significantly higher than that of the term (p = .000). While the differences of GMA and NPA scores between the preterm and the term were not significant (p = .076, .224, respectively).

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Conclusions

• The preterm neonates with meningitis

were inclined to have white matter

abnormalities and resulted in much

more severe brain damages than the

term ones

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References

1. Woodward LJ, Anderson PJ, Austin NC, Howard K, Inder TE. Neonatal MRI to predict neurodevelopmental outcomes in preterm infants. N Engl J Med 2006;355:685.

2. Diffusion-weighted MR imaging of subdural empyemas in children. AJNR Am J Neuroradiol 2004;25:1016.

3. Mohan S, Jain KK, Arabi M, Shah GV. Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am 2012;22:557.

4. Shah DK, Daley AJ, Hunt RW, Volpe JJ, Inder TE. Cerebral white matter injury in the newborn following Escherichia coli meningitis. Eur J Paediatr Neurol 2005;9:13.

5. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, Higgins RD. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004;292:2357.

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Thank you for your attention!

Acknowledge

Dr. Li Wang & Mingshu Yang

Children Hospital of Fudan University

Shanghai, China

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