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Diffusion MRI findings in neonatal brain abscess

R N Sener1

  • 1Department of Radiology, Ege University Hospital, Bornova, 35100, Izmir, Turkey. rnsener@med.ege.edu.tr

Journal of Neuroradiology = Journal De Neuroradiologie
|March 18, 2004
PubMed

Insights

Diffusion-weighted MRI reveals a rare bacterial brain abscess in an infant. This imaging technique identified characteristic findings, aiding diagnosis and monitoring treatment response in pediatric cases.

Area of Science:

  • Pediatric Neurology
  • Neuroradiology
  • Infectious Diseases

Background:

  • Bacterial brain abscesses are uncommon in neonates and infants.
  • Diffusion-weighted magnetic resonance (MR) imaging characteristics of these abscesses in this age group are not well-documented.
  • Early and accurate diagnosis is crucial for effective management and improved outcomes.

Observation:

  • A case study of a 25-day-old boy with a bacterial brain abscess is presented.
  • Initial diffusion-weighted MR imaging (b=1000 sec/mm(2)) showed a large cystic component with high-signal pyogenic material.
  • The apparent diffusion coefficient (ADC) value of the pyogenic material was low (0.59 x 10(-3) mm(2)/sec), contrasting with normal cerebellar parenchyma (0.78 x 10(-3) mm(2)/sec).
  • This initial presentation mimicked a cystic tumor.
  • High-signal changes suggestive of ischemia were observed in compressed brain parenchyma due to ventriculomegaly.
  • ADC values for perilesional vasogenic edema (1.74 x 10(-3) mm(2)/sec) and transependymal cerebrospinal fluid (CSF) resorption (1.56 x 10(-3) mm(2)/sec) were recorded.

Findings:

  • The brain abscess demonstrated a characteristic diffusion-weighted MR imaging appearance with restricted diffusion in the purulent center.
  • Antibiotic therapy led to a significant reduction in lesion size over 20 days, with persistent high-signal purulent material.
  • Diffusion-weighted imaging also identified associated ischemic changes and vasogenic edema, providing a comprehensive view of the intracranial complications.

Implications:

  • Diffusion-weighted MR imaging is a valuable tool for diagnosing and characterizing rare bacterial brain abscesses in neonates and infants.
  • Understanding these specific imaging findings can help differentiate abscesses from other pediatric brain lesions, such as cystic tumors.
  • This case highlights the utility of diffusion-weighted imaging in monitoring treatment response and assessing associated complications like ischemia and edema.

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