KORELASI GAMBARAN CEREBRITIS PADA PEMERIKSAAN CT DENGAN HASIL LUMBAL PUNGSI

ANGGITA PUTRI KANTIL, dr. Yana Supriatna, PhD, Sp.Rad.;dr. Henry Kusumo Husodoputro, Sp.Rad(K).

2016 | Tesis-Spesialis | SP RADIOLOGI

Latar belakang. Cerebritis merupakan kondisi awal infeksi piogenik di otak yang dapat berkembang menjadi abscess. Keluhan demam, nyeri kepala dan defisit neurologis hanya ditemukan pada kurang dari 50% pasien. Modalitas Computed Tomography (CT) banyak dilakukan di negara berkembang untuk mendiagnosis cerebritis. Sering ditemukan ketidaksesuaian hasil CT cerebritis dengan klinis penderita. Gambaran CT yang normal pada pasien dengan klinis cerebritis tidak dapat menyingkirkan kemungkinan cerebritis. Korelasi dengan hasil Lumbal Pungsi (LP) dianggap penting dalam diagnosis definitif cerebritis. Analisis Liquor Cerebro Spinal (LCS) dapat menilai warna LCS, jumlah sel, kadar protein dan glukosa dalam LCS. Tujuan. Penelitian ini bertujuan untuk mengetahui korelasi antara gambaran cerebritis pada CT dengan hasil LP. Bahan dan Metode. Penelitian ini merupakan penelitian observasional analitik korelatif yang dilakukan di Rumah Sakit Umum Pusat Dr. Sardjito. Dilakukan pembacaan hasil CT kepala dan diinterpretasikan sebagai cerebritis atau tidak cerebritis. Hasil interpretasi CT tersebut dikorelasikan dengan hasil LCS dan dianalisis menggunakan uji korelasi koefisien kontingensi. Hasil. Subjek penelitian terdiri dari 35 orang, cerebritis ditemukan pada 18 kasus (51,4%) dan tidak cerebritis 17 kasus (48,6%). Fase cerebritis awal ditemukan pada 14 (77,8%), cerebritis akhir 2 (11,2%), abscess awal 1 (5,5%) dan abscess akhir 1 (5,5%). Korelasi antara jumlah sel dalam LCS dengan cerebritis (r=0,097, p=0,848), kadar protein LCS dengan cerebritis (r=0,14, p=0,404), kadar glukosa LCS dengan cerebritis (r=0,016, p=0,927) dan gambaran cerebritis pada CT dengan hasil LP (r=0,154, p=0,358). Simpulan. Tidak didapat korelasi yang kuat antara gambaran cerebritis terutama fase awal pada CT dengan hasil LP. CT kurang sensitif dalam penentuan diagnosis cerebritis fase awal, sehingga pada fase tersebut lebih disarankan Magnetic Resonance Imaging (MRI).

Background. Cerebritis is the early stage of brain pyogenic infection that might be developed into brain abscess. Fever, headache and neurologic deficit only found in less than 50% of patient. Computed Tomography (CT) examination often performed in developing country to diagnose cerebritis. Discrepancy between imaging features of cerebritis in CT and its clinical presentation were frequently found. Normal CT imaging feature in patient with clinical sign of cerebritis can not exclude the possibility of cerebritis. Correlation with Lumbar Puncture (LP) analysis is considered to be essential in establishing a definitive diagnosis of cerebritis. Cerebrospinal Fluid (CSF) analysis can measure clarity, cells count, protein and glucose level. These parameters were needed especially in overlapping radiological findings on CT examination. Purpose. The aim of this study is to determine the correlation between imaging features of cerebritis in CT and LP analysis. Material and methods. This research was an observational analytic study conducted at Dr Sardjito Central General Hospital. CT scans were interpreted by one radiologist to decide whether cerebritis or not. The results were correlated with CSF analysis. Statistical analysis were conducted using contingency coefficient correlation test. Results. The subjects consisted of 35 subjects, 18 (51,4%) cerebritis and 17 (48,6%) non cerebritis. Cerebritis initial phase were found in 14 subjects (77.8%), late cerebritis in 2 subjects (11.2%), early abscess in 1 subject (5.5%) and late abscess in 1 subjects (5.5%). The contingency coefficient correlation test between cell counts on CSF and cerebritis, protein concentration on CSF and cerebritis, glucose concentration on CSF and cerebritis and imaging features of cerebritis in CT and LP analysis showed weak and not significant correlation (r = 0,097, p = 0,848), (r = 0,14, p = 0,404), (r = 0,016, p = 0,927) and (r = 0,154, p = 0,358) respectively. Conclusion. There was no strong correlation between imaging features of cerebritis in CT and LP analysis. CT was less sensitive than MRI in diagnosing cerebritis, therefore MRI was more recommended.

Kata Kunci : Cerebritis, CT, Lumbar Puncture