Year: 2016
Type: article
Abstract: AIM: To assess the role of imaging in the early management of encephalitis and the agreement on findings in a well-defined cohort of suspected encephalitis cases enrolled in the Prospective Aetiological Study of Encephalitis conducted by the Health Protection Agency (now incorporated into Public Health England). MATERIALS AND METHODS: Eighty-five CT examinations from 68 patients and 101 MRI examinations from 80 patients with suspected encephalitis were independently rated by three neuroradiologists blinded to patient and clinical details. The level of agreement on the interpretation of images was measured using the kappa statistic. The sensitivity, specificity, and negative and positive predictive values of CT and MRI for herpes simplex virus (HSV) encephalitis and acute disseminated encephalomyelitis (ADEM) were estimated. RESULTS: The kappa value for interobserver agreement on rating the scans as normal or abnormal was good (0.65) for CT and moderate (0.59) for MRI. Agreement for HSV encephalitis was very good for CT (0.87) and MRI (0.82), but only fair for ADEM (0.32 CT; 0.31 MRI). Similarly, the overall sensitivity of imaging for HSV encephalitis was ∼80% for both CT and MRI, whereas for ADEM it was 0% for CT and 20% for MRI. MRI specificity for HSV encephalitis between 3-10 days after symptom onset was 100%. CONCLUSION: There is a subjective component to scan interpretation that can have important implications for the clinical management of encephalitis cases. Neuroradiologists were good at diagnosing HSV encephalitis; however, agreement was worse for ADEM and other alternative aetiologies. Findings highlight the importance of a comprehensive and multidisciplinary approach to diagnosing the cause of encephalitis that takes into account individual clinical, microbiological, and radiological features of each patient.
Source: Clinical Radiology
Authors: J. Granerod, N.W.S. Davies, W. Mukonoweshuro, A. Mehta, K. Das, M. Lim, T. Solomon, S. Biswas, L. Rosella, D.W.G. Brown, N.S. Crowcroft, Helen E. Ambrose, Jonathan P. Clewley, Amanda L. Walsh, Dilys Morgan, Richard Cunningham, Mark Zuckerman, Kenneth J. Mutton, Katherine N. Ward, Michael P.T. Lunn, Sarosh R. Irani, Angela Vincent, Craig Ford, Emily Rothwell, William Tong, Jean-Pierre Lin, Javeed Ahmed, David Cubitt, Cheryl Hemingway, David Muir, Hermione Lyall, Ed Thompson, Geoff Keir, Viki Worthington, Paul Griffiths, Susan Bennett, Rachel Kneen, Paul Klapper
Institutions: Public Health England, Chelsea and Westminster Hospital, Derriford Hospital, Charing Cross Hospital, Walton Centre, Kings Health Partners, Evelina London Children's Healthcare, University of Liverpool, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Public Health Ontario, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, University of Toronto
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,530
Funders: CSL Behring Foundation for Research and Advancement of Patient Health, Bayer, Novartis, Biogen, Biogen Idec, CSL Behring, Wellcome Trust, Encephalitis Society, Action Medical Research, National Institute for Health and Care Research, Department of Health and Social Care, Multiple Sclerosis Society, Sparks, Great Ormond Street Hospital Charity, Department of Health and Aged Care, Australian Government, EMD Serono
Awards: G1423143640, DexEnceph- Dexamethasone in Herpes Simplex Virus Encephalitis Randomised Controlled Trial and NonHSV Cohort Study, Understanding and improving the outcome of viral encephalitis, NIHR Senior Investigator Award, G6080953568, The immunobiology of autoantibody-mediated diseases of the central nervous system.
OpenAlex ID: W2347397690