TY - JOUR
T1 - CT and MR neuroimaging findings in patients with Lyme neuroborreliosis
T2 - A national prospective cohort study
AU - Ørbæk, Mathilde
AU - Bodilsen, Jacob
AU - Gynthersen, Rosa M Møhring
AU - Shekhrajka, Nitesh
AU - Nordberg, Cecilie Lerche
AU - Larsen, Lykke
AU - Storgaard, Merete
AU - Brandt, Christian
AU - Wiese, Lothar
AU - Hansen, Birgitte Rønde
AU - Luttichau, Hans R
AU - Andersen, Aase Bengaard
AU - Mens, Helene
AU - Nielsen, Henrik
AU - Lebech, Anne-Mette
AU - DASGIB study group
N1 - Copyright © 2020 Elsevier B.V. All rights reserved.
PY - 2020/12/15
Y1 - 2020/12/15
N2 - BACKGROUND: 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).METHODS: 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.RESULTS: 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).CONCLUSION: 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.
AB - BACKGROUND: 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).METHODS: 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.RESULTS: 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).CONCLUSION: 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.
KW - Borrelia burgdorferi sensu lato complex
KW - CT
KW - Lyme Neuroborreliosis
KW - MRI
KW - Neuroimaging
KW - Tick-borne diseases
UR - http://www.scopus.com/inward/record.url?scp=85094571476&partnerID=8YFLogxK
U2 - 10.1016/j.jns.2020.117176
DO - 10.1016/j.jns.2020.117176
M3 - Journal article
C2 - 33130434
SN - 0022-510X
VL - 419
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 117176
ER -