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Clin Radiol. 2016 Oct;71(10):1050-8. doi: 10.1016/j.crad.2016.03.015. Epub 2016 May 13.

Neuroimaging in encephalitis: analysis of imaging findings and interobserver agreement.

Author information

1
Virus Reference Department, Public Health England, London, UK. Electronic address: juliagranerod@hotmail.com.
2
Department of Neurology, Chelsea and Westminster Hospital, London, UK.
3
Department of Neuroradiology, Derriford Hospital, Plymouth, UK.
4
Department of Imaging, Charing Cross Hospital, London, UK.
5
Neuroradiology Department, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
6
Children Neurosciences Centre, Evelina London Children's Hospital, Kings Health Partners Academic Health Science Centre, London, UK.
7
Institute of Infection and Global Health, University of Liverpool, Walton Centre NHS Foundation Trust, and NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK.
8
Public Health Ontario, Toronto, Canada.
9
Virus Reference Department, Public Health England, London, UK; Influenza and Measles Laboratory, Instituto Oswaldo Cruz, Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil.
10
Public Health Ontario, Toronto, Canada; University of Toronto Dalla Lana School of Public Health and Laboratory Medicine and Pathobiology, Toronto, Canada.

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.

PMID:
27185323
PMCID:
PMC5021199
DOI:
10.1016/j.crad.2016.03.015
[Indexed for MEDLINE]
Free PMC Article

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