Abstract
Aims: The study was undertaken with the objective to assess accuracy of spinal ultrasound in diagnosis of meningitis in infants younger than 6 months.
Material and Methods: our study is hospital based prospective diagnostic accuracy study, done over a period of 12 months, The nature and purpose of procedure was explained to parents / guardians and written informed consent from parents/guardians was taken in all cases. Infants more than 6 months of age, Infants having open spinal defects, Infants who had a prior lumbar puncture and parents of infant denying lumbar puncture were excluded from study.100 infants with clinical suspicion of meningitis and age less than 6 months were recruited for the study. Detailed history was taken from parents/guardians, and complete examination was done in all subjects. After base line investigations all the patients were subjected to spinal ultrasound.
Standard sagittal and axial sonography of thora-columbar spine was performed in all the 100 patients suspected of meningitis on the basis of history and clinical examination. Images were analysed for presence of echogenic debris or trabeculations in the posterior subarachnoid space within the thoraco-lumbar spine. Colour Doppler was used to differentiate subarachnoid vessels from echogenic debris. Presence or absence of spinal cord and nerve root pulsation in cine mode was also recorded. USG findings were analyzed as: 1.Echogenicity or trabeculations in subarachnoid space: present/absent.2.Pulsations of the spinal cord and nerve roots: present/reduced or absent. Following spinal USG all the infants were subjected to lumbar puncture for CSF analysis and confirmation of meningitis. Infants with echogenic debris/ trabeculations or abnormal pulsation of the spinal cord and nerve root were compared with those with echo-free subarachnoid space and normal pulsation of spinal cord and nerve roots with respect to their findings of CSF examination.
Statistical Analysis: Continuous variables were summarized as mean and standard deviation, categorical variables were summarized as frequency and percentage. Differences in the distribution of categorical variables among those with and without meningitis were analysed using chi-square test. McNemar chi-square was used to analyze the relationship between ultrasound findings and meningitis. The validity of ultrasound findings in the diagnosis of meningitis was reported as sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy along with their 95% confidence intervals. Data was analyzed using Microsoft Excel and Open Epi. A p value of <0.05 was taken as significant.
Result: Among 60 CSF positive patients USG spine findings (Echogenicity / Trabeculations or Reduced / Absent spinal cord and nerve root pulsations) were present in 32 cases whereas 28 patients had normal USG spine findings and only 4 patients out of 40 CSF negative patients had positive USG spine findings (Present Echogenicity / Trabeculation). Based on these findings the sensitivity , specificity , positive predictive value , negative predictive value , after combining both the sonographic findings of spinal USG in meningitis patients was 53.33% , 90% , 88.89% , 56.25% respectively with a diagnostic accuracy of 68%. These results were statistically significant with p value <0.001.
Conclusion: Our study demonstrates that the presence of echogenicity / trabeculations in posterior subarachnoid space on ultrasound spine or abnormal spinal cord and nerve root pulsations are significantly associated with meningitis with a high specificity and positive predictive value in its diagnosis. So spinal ultrasound can be used as a simple, inexpensive, non-invasive, rapid and fairly specific radiation free imaging modality to help in diagnosing meningitis.
Keywords: Meningitis, Spinal cord, USG, Nerve root pulsations and trabeculations .
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Corresponding Author
Saleem Jahangir
GMC Srinagar
SKIMS Srinagar, Kashmir, 190001
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.204
