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<meta name="DC.Title" content="Accuracy of MR Imaging for Detection of Sensorineural Hearing Loss in Infants with Bacterial Meningitis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A6539" />
<meta name="DC.Date" content="2020-06-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2020 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Bacterial meningitis most commonly affects young children and can result in critical adverse outcomes, including sensorineural hearing loss (SNHL). The purpose of this study is to determine the diagnostic accuracy of MR imaging for predicting the development of SNHL among infants with bacterial meningitis.

MATERIALS AND METHODS: A retrospective review was performed among infants (age &lt;365 days) with bacterial meningitis ( n  = 115). Independent and consensus blinded review of brain MRIs ( n  = 239) performed less than 90 days from presentation were conducted. Abnormal appearance of the inner ear was defined as enhancement on postcontrast T1-weighted (T1-weighted+C) sequence and FLAIR hyperintensity. The consensus MR imaging appearance of the inner ear on FLAIR, T1-weighted+C, and combined evaluation was compared with criterion standard audiometric testing to determine the sensitivity and specificity of MR imaging for detecting SNHL.

RESULTS: The mean age at diagnosis of bacterial meningitis was 50.6 days (range, 0–338 days) and 24.3% had SNHL. Sensitivity and specificity was 0.61/0.96, 0.50/0.94, and 0.61/0.94 for T1-weighted+C, FLAIR hyperintensity, and combined evaluation, respectively, for prediction of SNHL. There was excellent interobserver agreement for both the T1-weighted+C and FLAIR sequences and combined evaluation for presence of abnormal enhancement and hyperintense signal, respectively. Factors associated with abnormal MR imaging findings on T1-weighted+C and/or FLAIR in patients with SNHL included low CSF glucose ( P  = .04, .02) and high CSF protein ( P  = .04, .03).

CONCLUSIONS: Abnormal enhancement and/or FLAIR hyperintensity of the inner ear demonstrate high specificity and average sensitivity for prediction of SNHL among infants with bacterial meningitis.

WBC
:   white blood cell
SNHL
:   sensorineural hearing loss
GBS
:   Group B Streptococcus 
PPV
:   positive predictive value
NPV
:   negative predictive value
+C
:   postcontrast" />
<meta name="DC.Contributor" content="G. Orman" />
<meta name="DC.Contributor" content="M.K. Kukreja" />
<meta name="DC.Contributor" content="J.G. Vallejo" />
<meta name="DC.Contributor" content="N. Desai" />
<meta name="DC.Contributor" content="T.A.G.M. Huisman" />
<meta name="DC.Contributor" content="S.F. Kralik" />
<meta name="article:published_time" content="2020-06-01" />
<meta name="article:section" content="Pediatrics" />
<meta name="citation_title" content="Accuracy of MR Imaging for Detection of Sensorineural Hearing Loss in Infants with Bacterial Meningitis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Bacterial meningitis most commonly affects young children and can result in critical adverse outcomes, including sensorineural hearing loss (SNHL). The purpose of this study is to determine the diagnostic accuracy of MR imaging for predicting the development of SNHL among infants with bacterial meningitis.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A retrospective review was performed among infants (age &amp;lt;365 days) with bacterial meningitis (&lt;i&gt;n&lt;/i&gt; = 115). Independent and consensus blinded review of brain MRIs (&lt;i&gt;n&lt;/i&gt; = 239) performed less than 90 days from presentation were conducted. Abnormal appearance of the inner ear was defined as enhancement on postcontrast T1-weighted (T1-weighted+C) sequence and FLAIR hyperintensity. The consensus MR imaging appearance of the inner ear on FLAIR, T1-weighted+C, and combined evaluation was compared with criterion standard audiometric testing to determine the sensitivity and specificity of MR imaging for detecting SNHL.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The mean age at diagnosis of bacterial meningitis was 50.6 days (range, 0–338 days) and 24.3% had SNHL. Sensitivity and specificity was 0.61/0.96, 0.50/0.94, and 0.61/0.94 for T1-weighted+C, FLAIR hyperintensity, and combined evaluation, respectively, for prediction of SNHL. There was excellent interobserver agreement for both the T1-weighted+C and FLAIR sequences and combined evaluation for presence of abnormal enhancement and hyperintense signal, respectively. Factors associated with abnormal MR imaging findings on T1-weighted+C and/or FLAIR in patients with SNHL included low CSF glucose (&lt;i&gt;P &lt;/i&gt;= .04, .02) and high CSF protein (&lt;i&gt;P &lt;/i&gt;= .04, .03).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Abnormal enhancement and/or FLAIR hyperintensity of the inner ear demonstrate high specificity and average sensitivity for prediction of SNHL among infants with bacterial meningitis.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
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<meta name="citation_volume" content="41" />
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<meta name="citation_section" content="Pediatrics" />
<meta name="citation_firstpage" content="1081" />
<meta name="citation_lastpage" content="1086" />
<meta name="citation_author" content="G. Orman" />
<meta name="citation_author_institution" content="aFrom the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)" />
<meta name="citation_author_orcid" content="https://orcid.org/0000-0003-2684-3957" />
<meta name="citation_author" content="M.K. Kukreja" />
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<meta name="citation_author_institution" content="bDepartment of Pediatrics, Section of Infectious Diseases (J.G.V.), Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas." />
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<meta name="citation_author" content="N. Desai" />
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<meta name="twitter:title" content="Accuracy of MR Imaging for Detection of Sensorineural Hearing Loss in Infants with Bacterial Meningitis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Bacterial meningitis most commonly affects young children and can result in critical adverse outcomes, including sensorineural hearing loss (SNHL). The purpose of this study is to determine the diagnostic accuracy of MR imaging for predicting the development of SNHL among infants with bacterial meningitis.

MATERIALS AND METHODS: A retrospective review was performed among infants (age &lt;365 days) with bacterial meningitis ( n  = 115). Independent and consensus blinded review of brain MRIs ( n  = 239) performed less than 90 days from presentation were conducted. Abnormal appearance of the inner ear was defined as enhancement on postcontrast T1-weighted (T1-weighted+C) sequence and FLAIR hyperintensity. The consensus MR imaging appearance of the inner ear on FLAIR, T1-weighted+C, and combined evaluation was compared with criterion standard audiometric testing to determine the sensitivity and specificity of MR imaging for detecting SNHL.

RESULTS: The mean age at diagnosis of bacterial meningitis was 50.6 days (range, 0–338 days) and 24.3% had SNHL. Sensitivity and specificity was 0.61/0.96, 0.50/0.94, and 0.61/0.94 for T1-weighted+C, FLAIR hyperintensity, and combined evaluation, respectively, for prediction of SNHL. There was excellent interobserver agreement for both the T1-weighted+C and FLAIR sequences and combined evaluation for presence of abnormal enhancement and hyperintense signal, respectively. Factors associated with abnormal MR imaging findings on T1-weighted+C and/or FLAIR in patients with SNHL included low CSF glucose ( P  = .04, .02) and high CSF protein ( P  = .04, .03).

CONCLUSIONS: Abnormal enhancement and/or FLAIR hyperintensity of the inner ear demonstrate high specificity and average sensitivity for prediction of SNHL among infants with bacterial meningitis.

WBC
:   white blood cell
SNHL
:   sensorineural hearing loss
GBS
:   Group B Streptococcus 
PPV
:   positive predictive value
NPV
:   negative predictive value
+C
:   postcontrast" />
<meta name="og-title" property="og:title" content="Accuracy of MR Imaging for Detection of Sensorineural Hearing Loss in Infants with Bacterial Meningitis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/41/6/1081" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Bacterial meningitis most commonly affects young children and can result in critical adverse outcomes, including sensorineural hearing loss (SNHL). The purpose of this study is to determine the diagnostic accuracy of MR imaging for predicting the development of SNHL among infants with bacterial meningitis.

MATERIALS AND METHODS: A retrospective review was performed among infants (age &lt;365 days) with bacterial meningitis ( n  = 115). Independent and consensus blinded review of brain MRIs ( n  = 239) performed less than 90 days from presentation were conducted. Abnormal appearance of the inner ear was defined as enhancement on postcontrast T1-weighted (T1-weighted+C) sequence and FLAIR hyperintensity. The consensus MR imaging appearance of the inner ear on FLAIR, T1-weighted+C, and combined evaluation was compared with criterion standard audiometric testing to determine the sensitivity and specificity of MR imaging for detecting SNHL.

RESULTS: The mean age at diagnosis of bacterial meningitis was 50.6 days (range, 0–338 days) and 24.3% had SNHL. Sensitivity and specificity was 0.61/0.96, 0.50/0.94, and 0.61/0.94 for T1-weighted+C, FLAIR hyperintensity, and combined evaluation, respectively, for prediction of SNHL. There was excellent interobserver agreement for both the T1-weighted+C and FLAIR sequences and combined evaluation for presence of abnormal enhancement and hyperintense signal, respectively. Factors associated with abnormal MR imaging findings on T1-weighted+C and/or FLAIR in patients with SNHL included low CSF glucose ( P  = .04, .02) and high CSF protein ( P  = .04, .03).

CONCLUSIONS: Abnormal enhancement and/or FLAIR hyperintensity of the inner ear demonstrate high specificity and average sensitivity for prediction of SNHL among infants with bacterial meningitis.

WBC
:   white blood cell
SNHL
:   sensorineural hearing loss
GBS
:   Group B Streptococcus 
PPV
:   positive predictive value
NPV
:   negative predictive value
+C
:   postcontrast" />
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      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">Pediatrics</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Accuracy of MR Imaging for Detection of Sensorineural Hearing Loss in Infants with Bacterial Meningitis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">G. Orman</span>, <span class="highwire-citation-author" data-delta="1">M.K. Kukreja</span>, <span class="highwire-citation-author" data-delta="2">J.G. Vallejo</span>, <span class="highwire-citation-author" data-delta="3">N. Desai</span>, <span class="highwire-citation-author" data-delta="4">T.A.G.M. Huisman</span> and <span class="highwire-citation-author" data-delta="5">S.F. Kralik</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2020,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1081-1086; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A6539 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-75789--6826456728" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">G. Orman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BOrman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Orman%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BOrman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2684-3957" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Orman</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">M.K. Kukreja </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.K.%2BKukreja%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kukreja%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.K.%2BKukreja%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-8902-5236" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.K. Kukreja</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">J.G. Vallejo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Pediatrics, Section of Infectious Diseases (J.G.V.), Texas Children’s Hospital and Baylor College of Medicine, Houston, Texas.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.G.%2BVallejo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Vallejo%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.G.%2BVallejo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0002-0614-9629" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J.G. Vallejo</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">N. Desai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Edward B. Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=N.%2BDesai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Desai%20N&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AN.%2BDesai%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-9663-8655" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for N. 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Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=T.A.G.M.%2BHuisman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Huisman%20T&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AT.A.G.M.%2BHuisman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0003-2302-6724" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for T.A.G.M. 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Singleton Department of Radiology (G.O., M.K.K., N.D., T.A.G.M.H., S.F.K.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.F.%2BKralik%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kralik%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AS.F.%2BKralik%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="https://orcid.org/0000-0001-7213-1761" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for S.F. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 41</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jun 2020 </div></div>
      
      
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Orman</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">M.K.</span> <span class="nlm-surname">Kukreja</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">J.G.</span> <span class="nlm-surname">Vallejo</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">N.</span> <span class="nlm-surname">Desai</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">T.A.G.M.</span> <span class="nlm-surname">Huisman</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">S.F.</span> <span class="nlm-surname">Kralik</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jun 2020, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">41 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1081-1086; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A6539 </span></div>
  
  
  
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