Diagnostic Value of Enhanced Computed Tomography and Magnetic Resonance Imaging in Intracranial Infections after Craniocerebral Surgery

Abstract

Objective

This study investigated the diagnostic value of enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in postoperative intracranial infections in patients undergoing craniocerebral surgery.

Methods

A total of 130 patients suspected of developing intracranial infection after cranial surgery were included in the study. All patients underwent MRI and CT examinations. The results of cerebrospinal fluid (CSF) culture were observed. The diagnostic efficacy of CT and MRI for intracranial infections was compared. In addition, univariate and multivariate logistic regression analyses were conducted to identify the factors influencing intracranial infections after surgery.

Results

By CSF culture, 45 intracranial infections were finally diagnosed in 130 patients with suspected intracranial infections, including 20 cases of Staphylococcus aureus infections (44.44%), 14 cases of Staphylococcus haemolyticus infections (31.11%), and 11 cases of Staphylococcus epidermidis infections (24.44%). The sensitivity, specificity, and accuracy of CT in diagnosing intracranial infections were 51.11, 89.41, and 76.15%, respectively. In comparison, MRI demonstrated a sensitivity of 77.78%, specificity of 92.94%, and accuracy of 87.69% in diagnosing intracranial infections. Logistic multifactorial regression analysis showed that surgical approach, surgical time, CSF leakage, and ventricular drainage were independent risk factors of postoperative intracranial infections (odds ratio > 1, p < 0.05).

Conclusion

MRI has a higher diagnostic accuracy for intracranial infections compared with CT. Various factors contribute to the development of intracranial infections following cranial surgery, which warrants careful attention and timely targeted interventions to reduce the risk of such infections.

Keywords

magnetic resonance imaging - computed tomography - risk factors - craniocerebral surgery - postoperative infection

Ethical Statement

This study was approved by the Ethics Committee of our hospital. All patients provided informed consent, and all procedures were conducted in accordance with the Declaration of Helsinki.

^* Wen Su and Honghui Luo are the co-first authors; contributed equally to this work.

Publication History

Received: 24 July 2024

Accepted: 13 March 2025

Article published online:
27 June 2025

• References

• 1 Lonjaret L, Guyonnet M, Berard E. et al. Postoperative complications after craniotomy for brain tumor surgery. Anaesth Crit Care Pain Med 2017; 36 (04) 213-218
• 2 Rubeli SL, D'Alonzo D, Mueller B. et al. Implementation of an infection prevention bundle is associated with reduced surgical site infections in cranial neurosurgery. Neurosurg Focus 2019; 47 (02) E3
• 3 Kobets AJ, Goodrich JT. The history of intracranial infections. Childs Nerv Syst 2018; 34 (10) 1849-1857
• 4 Swinburne NC, Bansal AG, Aggarwal A. et al. Neuroimaging in central nervous system infections. Curr Neurol Neurosci Rep 2017; 17 (06) 49
• 5 Seeram E. Computed tomography: a technical review. Radiol Technol 2018;89(03):
• 6 Sinclair AG, Scoffings DJ. Imaging of the post-operative cranium. Radiographics 2010; 30 (02) 461-482
• 7 Joy L, Sakalecha AK. Role of multiparametric magnetic resonance imaging of the brain in differentiating neurocysticercosis from tuberculoma. Cureus 2023; 15 (05) e39003
• 8 Sawlani V, Patel MD, Davies N. et al. Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions. Insights Imaging 2020; 11 (01) 84
• 9 Kural C, Kırmızıgoz S, Ezgu MC. et al. Intracranial infections: lessons learned from 52 surgically treated cases. Neurosurg Focus 2019; 47 (02) E10
• 10 Mashiko R, Taguchi S, Tobita T. et al. Intracranial infection caused by minor skin contusion associated with previous craniotomy. BMJ Case Rep 2017; 2017: x
• 11 Bahubali VKH, Vijayan P. et al. Methicillin-resistant Staphylococcus aureus intracranial abscess: an analytical series and review on molecular, surgical and medical aspects. Indian J Med Microbiol 2018; 36 (01) 97-103
• 12 Hussein K, Rabino G, Feder O. et al. Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study. Acta Neurochir (Wien) 2019; 161 (03) 517-524
• 13 Shahan B, Choi EY, Nieves G. Cerebrospinal fluid analysis. Am Fam Physician 2021; 103 (07) 422-428
• 14 Ramgopal S, Obeid R, Zuccoli G. et al. Lyme disease-related intracranial hypertension in children: clinical and imaging findings. J Neurol 2016; 263 (03) 500-507
• 15 Leonard JM. Central nervous system tuberculosis. Microbiol Spectr 2017;5(02):
• 16 da Silveira Filho LG, Correia D. Optimization of cranial computed tomography in patients with AIDS and clinical suspicion of a neural opportunistic pathology. Int J Infect Dis 2018; 67: 84-85
• 17 Kremer S, Abu Eid M, Bierry G. et al. Accuracy of delayed post-contrast FLAIR MR imaging for the diagnosis of leptomeningeal infectious or tumoral diseases. J Neuroradiol 2006; 33 (05) 285-291
• 18 Saigal G, Nagornaya N, Post MJD. Infection. Handb Clin Neurol 2016; 135: 365-397
• 19 Müller SJ, Khadhraoui E, Voit D. et al. Comparison of EPI DWI and STEAM DWI in early postoperative MRI controls after resection of tumors of the central nervous system. Clin Neuroradiol 2023; 33 (03) 677-685
• 20 Gu L, Yang XL, Yin HK. et al. Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery. World J Clin Cases 2020; 8 (23) 5894-5901
• 21 Patel J, Jenson M, Hernandez M. et al. Is contrast-enhanced computed tomography redundant for suspected intracranial infection in the emergency setting?. J Comput Assist Tomogr 2023; 47 (01) 102-107
• 22 Persson M. Airborne contamination and surgical site infection: could a thirty-year-old idea help solve the problem?. Med Hypotheses 2019; 132: 109351
• 23 Golebiowski A, Drewes C, Gulati S. et al. Is duration of surgery a risk factor for extracranial complications and surgical site infections after intracranial tumor operations?. Acta Neurochir (Wien) 2015; 157 (02) 235-240 , discussion 240
• 24 Fida B, Cutolo F, di Franco G. et al. Augmented reality in open surgery. Updates Surg 2018; 70 (03) 389-400
• 25 Pourmorteza A, Symons R, Reich DS. et al. Photon-counting CT of the brain: in vivo human results and image-quality assessment. AJNR Am J Neuroradiol 2017; 38 (12) 2257-2263
• 26 Bashir MR, Thomas KL. A new generation of gadolinium-based MRI contrast agents: higher relaxivity, lower dose. Radiology 2023; 308 (01) e231454
• 27 Sanchez Panchuelo RM, Mougin O, Turner R. et al. Quantitative T1 mapping using multi-slice multi-shot inversion recovery EPI. Neuroimage 2021; 234: 117976
• 28 Müller SJ, Khadhraoui E, Voit D. et al. First clinical application of a novel T1 mapping of the whole brain. Neuroradiol J 2022; 35 (06) 684-691