Objective CT criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis

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dc.contributor.authorPrzybojewski S.
dc.contributor.authorAndronikou S.
dc.contributor.authorWilmshurst J.
dc.date.accessioned2011-05-15T16:05:17Z
dc.date.available2011-05-15T16:05:17Z
dc.date.issued2006
dc.description.abstractBackground: There are no widely accepted objective criteria to determine the presence of basal enhancement on CT in children with suspected tuberculous meningitis (TBM). Objective: To test nine recently described objective CT criteria for the presence of abnormal basal enhancement in children with suspected TBM against the definite diagnosis as determined by cerebrospinal fluid (CSF) culture. Materials and methods: CT scans of patients with a clinical suspicion of TBM who had undergone lumbar puncture for CSF culture spanning a period of 4 years were reviewed for the presence of nine recently described criteria for the presence of abnormal basal enhancement. The radiologists were blinded to the final diagnosis based on CSF culture against which the criteria were tested. The criteria have been named: the 'Y-sign', 'linear enhancement', 'double lines', Iinfundibular recess of the third', 'ill-defined edge', 'nodular enhancement', 'join the dots', 'contrast filling the cisterns', and 'asymmetry'. Results: A total of 65 patients were included in the study, 34 with culture-proven TBM and 31 with other diagnoses. Four individual criteria had a specificity of 100%, but the sensitivities of these criteria ranged from 15% to 53% only. Three other criteria had specificities of 97% and sensitivities ranging from 62% to 82%. The presence of more than one criterion in the same patient showed a specificity of 97% and sensitivity of 91%. Conclusions: Very high specificity was demonstrated for all nine criteria, including 100% specificity for four individual criteria. Sensitivity was at best 82%, but improved to 91% when more than one criterion was present. These criteria need to be tested for inter- and intraobserver variability to prove their clinical usefulness. © Springer-Verlag 2006.
dc.description.versionReview
dc.identifier.citationPediatric Radiology
dc.identifier.citation36
dc.identifier.citation7
dc.identifier.issn3010449
dc.identifier.other10.1007/s00247-006-0160-z
dc.identifier.urihttp://hdl.handle.net/10019.1/13059
dc.subjectcontrast medium
dc.subjectcerebrospinal fluid culture
dc.subjectchild
dc.subjectcomputer assisted tomography
dc.subjectcontrast enhancement
dc.subjectcontrolled study
dc.subjectdiagnostic accuracy
dc.subjectdiagnostic value
dc.subjectfemale
dc.subjectgold standard
dc.subjecthuman
dc.subjectimage analysis
dc.subjectimage display
dc.subjectinfant
dc.subjectintermethod comparison
dc.subjectlumbar puncture
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectobserver variation
dc.subjectpriority journal
dc.subjectradiodiagnosis
dc.subjectreview
dc.subjectroc curve
dc.subjectsensitivity and specificity
dc.subjecttuberculous meningitis
dc.subjectvalidation process
dc.subjectChild
dc.subjectChild, Preschool
dc.subjectContrast Media
dc.subjectDiagnosis, Differential
dc.subjectFemale
dc.subjectHumans
dc.subjectInfant
dc.subjectMale
dc.subjectSensitivity and Specificity
dc.subjectSpinal Puncture
dc.subjectTomography, X-Ray Computed
dc.subjectTuberculosis, Meningeal
dc.titleObjective CT criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis
dc.typeReview
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