Advanced neuroimaging for central nervous system infections: when, where, how, and why?

Advanced neuroimaging should be applied to specific clinical questions rather than used indiscriminately. In meningitis and ventriculitis, MRI with DWI and contrast enhanced T1 weighted images are key to defining complications and guiding urgent intervention. For encephalitis, cerebritis and ring-enhancing lesions, DWI, perfusion and MRS help distinguish abscess from neoplasm, tumefactive demyelination, and atypical infections. In immunocompromised patients, combining structural MRI with SWI, MRS, and metabolic imaging is particularly helpful. Future work must integrate quantitative metrics and AI-driven pattern analysis into multidisciplinary diagnostic algorithms for accurate diagnosis and management of CNS infections.