Comparative Evaluation of Fungal, Tubercular, and Pyogenic Brain Abscesses with Conventional and Diffusion MR Imaging and Proton MR Spectroscopy
Open Access
- 1 August 2007
- journal article
- research article
- Published by American Society of Neuroradiology (ASNR) in American Journal Of Neuroradiology
- Vol. 28 (7), 1332-1338
- https://doi.org/10.3174/ajnr.a0548
Abstract
BACKGROUND AND PURPOSE: It is difficult to differentiate the cause of brain abscesses with the use of CT and MR imaging. We did a comparative evaluation of pyogenic, tubercular, and fungal brain abscesses by using conventional, diffusion-weighted imaging (DWI), and proton MR spectroscopy (PMRS) with an aim to define the unique features that may differentiate among the pyogenic, tubercular, and fungal brain abscesses. MATERIALS AND METHODS: We performed a retrospective analysis on 110 patients with surgically proved brain abscesses. Imaging studies included T2, T1, postcontrast T1, DWI, and PMRS. Apparent diffusion coefficient (ADC) of the wall and cavity of the abscesses were quantified. The morphologic, physiologic, and metabolite features of pyogenic (n = 91), tubercular (n = 11), and fungal (n = 8) abscesses were compared. RESULTS: The pyogenic abscesses had smooth (55/91) and lobulated (36/91) walls, whereas the tubercular abscesses had smooth (4/11), lobulated (6/11), or crenated walls (1/11) with no intracavitary projections. The fungal abscesses showed irregular walls (lobulated 4/8, crenated 4/8) with intracavitary projections (8/8). The wall as well as the cavity showed low ADC in the pyogenic and tubercular abscesses. In the fungal abscesses, the wall and projections showed low ADC (8/8); however, the cavity itself showed high ADC (8/8). PMRS showed cytosolic amino acids (89/91), acetate (25/91), and succinate (18/91) in the pyogenic abscesses, whereas lipid/lactate (11/11) was seen in the tubercular abscesses. The fungal abscesses showed lipid (4/8), lactate (7/8), amino acids (4/8), and multiple peaks between 3.6 and 3.8 ppm assigned to trehalose (5/8). CONCLUSION: Based on the morphologic, ADC, and metabolite information, it may be possible to differentiate among the pyogenic, tubercular, and fungal brain abscesses.This publication has 17 references indexed in Scilit:
- Role of diffusion weighted imaging in differentiation of intracranial tuberculoma and tuberculous abscess from cysticercus granulomas-a report of more than 100 lesionsEuropean Journal of Radiology, 2005
- Biological correlates of diffusivity in brain abscessMagnetic Resonance in Medicine, 2005
- Neuroimaging of infectionsNeuroRX, 2005
- Proton Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging Findings in a Patient with Central Nervous System ParacoccidioidomycosisJournal of Neuroimaging, 2004
- Brain Abscesses: Etiologic Categorization with in Vivo Proton MR SpectroscopyRadiology, 2004
- Role of Diffusion-Weighted Imaging and In Vivo Proton Magnetic Resonance Spectroscopy in the Differential Diagnosis of Ring-Enhancing Intracranial Cystic Mass LesionsJournal of Computer Assisted Tomography, 2004
- Cryptococcomas Distinguished from Gliomas with MR Spectroscopy: An Experimental Rat and Cell Culture StudyRadiology, 2001
- Cerebral mucormycosis: proton MR spectroscopy and MR imagingMagnetic Resonance Imaging, 2000
- Proton NMR chemical shifts and coupling constants for brain metabolitesNMR in Biomedicine, 2000
- Aspergillosis of the brain and paranasal sinuses in immunocompromised patients: CT and MR imaging findings.American Journal of Roentgenology, 1994