The Relationship Between Follow-up MRI and Clinical Outcome in Patients with Encephalitis in a Large Academic Hospital
Jorge Cervantes1, Shirin Jamal Omidi2, Rodrigo Hasbun3, Rajesh Gupta2
1McGovern Medical School - University of Texas Health Science Center at Houston, 2Department of Neurology, 3Department of Infectious Diseases, McGovern Medical School - University of Texas Health Science Center at Houston
Objective:
To examine the relationship between follow-up MRI findings and clinical outcome among patients with encephalitis.
Background:
Encephalitis is inflammation of the brain that can lead to serious morbidity and death. Neuroimaging is an important component in the diagnosis of encephalitis, but the role of follow-up MRI and its relation to patient outcome is not well established.
Design/Methods:
A retrospective chart review included adult and pediatric patients with encephalitis who underwent an initial and follow up MRI. The MRIs were analyzed for patterns in T2 FLAIR hyperintensity, contrast enhancement, and restricted diffusion in DWI. Both sets of images were compared and categorized as improved, equivocal, or worse. Clinical outcome was categorized as good or adverse. Good outcome included disposition home and acute rehabilitation; adverse outcome included LTAC, nursing home, hospice, and death. Etiologies were categorized as autoimmune, infectious, or unknown. The Fisher’s exact test was used to assess the association between a) MRI evolution and clinical outcome and b) MRI evolution and etiology.
Results:
We included 93 patients who had both initial and follow-up MRI scans available. Findings indicated a lack of significant correlation between clinical outcome and follow-up MRI findings in terms of T2 hyperintensity (p = 0.469), contrast enhancement (p = 0.999), and restricted diffusion (p = 0.291). Similarly, there was no correlation between etiology and follow-up MRI findings in relation to T2 hyperintensity (p = 0.222), contrast enhancement (p = 0.737), or restricted diffusion (p = 0.403).
Conclusions:
Follow-up MRI findings were not associated with clinical outcome or etiology among patients diagnosed with encephalitis. Our findings suggest that incorporating a follow-up MRI may not be necessary or suitable in the management processes of patients with encephalitis.