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Discrimination of an infected brain tumor from a cerebral abscess by combined MR perfusion and diffusion imaging
J H M Chan1, E Y K Tsui, L F Chau
1Department of Diagnostic Radiology, Tuen Mun Hospital, Tsing Chung Koon Road, Tuen Mun, NT, Hong Kong. jchm888@yahoo.com
Abstract:
The aim of this study was to investigate the signal characteristics of the abscess wall and tumor wall on diffusion-weighted and perfusion-weighted images and thus to evaluate the feasibility of using combined MR diffusion and perfusion imaging to differentiate pyogenic cerebral abscess from infected brain tumor. The tumor wall of various types of cystic or necrotic brain tumor was significantly hyperintense relative to that of cerebral abscess wall on both diffusion-weighted images and regional cerebral blood volume maps. Sixteen patients who had cerebral masses with large cystic or necrotic cavities were imaged to generate diffusion-weighted images and regional cerebral blood volume maps using single-shot echoplanar imaging (EPI) pulse sequences. Apart from qualitative analysis, apparent diffusion coefficients (ADC) as well as regional cerebral blood volume (rCBV) ratios were calculated from the abscess wall and peripheral tumor wall and comparison was made by using Student's t-test. The tumor wall of various types of cystic or necrotic brain tumor had significantly lower ADCs relative to those of the abscess wall (P<0.005) and thus appeared relatively hyperintense on diffusion-weighted images. The mean rCBV ratio relative to normal white matter (2.90+/-0.62) of the peripheral tumor wall of various types of cystic or necrotic brain tumor were significantly larger than the mean rCBV ratio (0.45+/-0.11) of the pyogenic cerebral abscess wall (P<0.001) by Student's t-test. It is concluded that the combined MR diffusion and perfusion imaging might be capable of differentiating an infected brain tumor from a pyogenic cerebral abscess.
Insights
Combined MR diffusion and perfusion imaging can differentiate pyogenic cerebral abscess from infected brain tumors. Tumor walls showed higher signal intensity on diffusion-weighted images and higher regional cerebral blood volume ratios than abscess walls.
Area of Science:
- Radiology
- Neuroimaging
- Medical Imaging Analysis
Background:
- Differentiating pyogenic cerebral abscess from infected brain tumors is clinically significant.
- Standard MRI sequences can sometimes be ambiguous in distinguishing these conditions.
Purpose of the Study:
- To evaluate the feasibility of combined MR diffusion and perfusion imaging.
- To differentiate pyogenic cerebral abscess from infected brain tumors based on signal characteristics.
Main Methods:
- Utilized single-shot echo-planar imaging (EPI) pulse sequences.
- Acquired diffusion-weighted images (DWI) and perfusion-weighted images (PWI) including regional cerebral blood volume (rCBV) maps.
- Calculated apparent diffusion coefficients (ADC) and rCBV ratios for abscess and tumor walls.
Main Results:
- Tumor walls were significantly hyperintense on DWI compared to abscess walls.
- Tumor walls exhibited significantly lower ADCs than abscess walls (P<0.005).
- Mean rCBV ratios were significantly higher for tumor walls (2.90+/-0.62) than for abscess walls (0.45+/-0.11) (P<0.001).
Conclusions:
- Combined MR diffusion and perfusion imaging shows potential for differentiating infected brain tumors from pyogenic cerebral abscesses.
- Distinct signal characteristics on DWI and PWI can aid in differential diagnosis.