Journal article
CT and MR neuroimaging findings in patients with Lyme neuroborreliosis: A national prospective cohort study
Journal of the neurological sciences, Vol.419, pp.117176-117176
12/15/2020
DOI: 10.1016/j.jns.2020.117176
PMID: 33130434
Abstract
We aimed to describe the use and findings of cranial computerized tomography (CT-head), spine and brain magnetic resonance imaging (MRI-spine/MRI-brain) in Lyme neuroborreliose (LNB).
Patients with LNB were identified using a nationwide, population-based prospective cohort of all adults treated for neuroinfections at departments of infectious diseases in Denmark from 2015 to 2019. Multivariate logistic regression analyses assessed associations between clinical characteristics and MRI-findings consistent with LNB.
We included 368 patients (272 definite LNB and 96 probable LNB), 280 scans were performed in 198 patients. Neuroimaging was associated with older age (59 vs. 57, p = 0.03), suspicion of other diseases (77% vs. 37%, p < 0.0001), no history of tick bites (58% vs. 43%, p = 0.01), physical/cognitive deficits prior to admission (15% vs 5%, p = 0.006), peripheral palsy (10% vs. 2%, p = 0.0008), encephalitis (8% vs. 1%, p = 0.0007) and cognitive impairment (8% vs. 2%, p = 0.03) compared with those without neuroimaging.
Normal or incidental findings were common (93/98 CT-head and 154/182 MRI). 1/98 CT-head, 19/131 MRI-brain and 6/51 MRI-spine had findings consistent with LNB.
Symptoms ≥45 days was associated with MRI-findings consistent with LNB (adjusted odds ratio (aOR) 4.2, 95%confidence interval 1.2–14.4, p = 0.02).
In this Danish cohort including 368 LNB-patients, use of neuroimaging was common and often performed in older comorbid patients without previous tick-bite intended to investigate alternative diagnoses. The results were in general without pathology and neuroimaging cannot exclude LNB or replace lumbar puncture. MRI is of value when investigating alternative neurological diseases and may support suspicion of LNB in cases with meningeal/leptomeningeal/neural enhancement.
•Most patients with Lyme neuroborreliosis have neuroimaging without pathology.•MRI enhancement of meninges or nerves is consistent with Lyme neuroborreliosis.•More than half of patients with Lyme neuroborreliosis have neuroimaging performed.•Neuroimaging often investigate alternative diagnoses in older comorbid patients.
Details
- Title: Subtitle
- CT and MR neuroimaging findings in patients with Lyme neuroborreliosis: A national prospective cohort study
- Creators
- Mathilde Ørbæk - Copenhagen University HospitalJacob Bodilsen - Aalborg University HospitalRosa M. Møhring Gynthersen - Copenhagen University HospitalNitesh Shekhrajka - Copenhagen University HospitalCecilie Lerche Nordberg - Copenhagen University HospitalLykke Larsen - Odense University HospitalMerete Storgaard - Aarhus University HospitalChristian Brandt - University of CopenhagenLothar Wiese - Nordsjællands HospitalBirgitte Rønde Hansen - Hvidovre HospitalHans R. Luttichau - Gentofte HospitalAase Bengaard Andersen - Copenhagen University HospitalHelene Mens - Copenhagen University HospitalHenrik Nielsen - Aalborg University HospitalAnne-Mette Lebech - Copenhagen University HospitalDASGIB study group
- Resource Type
- Journal article
- Publication Details
- Journal of the neurological sciences, Vol.419, pp.117176-117176
- Publisher
- Elsevier B.V
- DOI
- 10.1016/j.jns.2020.117176
- PMID
- 33130434
- ISSN
- 0022-510X
- eISSN
- 1878-5883
- Language
- English
- Date published
- 12/15/2020
- Academic Unit
- Radiology
- Record Identifier
- 9984697729602771
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