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Updated: Jul 17, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic
Djamil Fertikh1, Jaroslaw Krejza, Alain Cunqueiro
1Department of Radiology, Division of Neuroradiology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Object:
The authors' aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms.
Methods:
Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis. The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T2 hypointensity rim. The mean (+/- standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 +/- 0.91 compared with 1.12 +/- 0:53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 +/- 0.04 (mean +/- standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87%) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 +/- 0.03 (SEM). Using ADC ratios and T1 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3%).
Conclusions:
The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.
Insights
Apparent diffusion coefficient (ADC) ratios effectively distinguish brain abscesses from neoplasms. Combining ADC ratios with T2 rim characteristics further improves diagnostic accuracy for these brain lesions.
Area of Science:
- Neuroradiology
- Medical Imaging
- Diffusion-Weighted MRI
Background:
- Differentiating brain abscesses from cystic or necrotic neoplasms is crucial for appropriate patient management.
- Conventional MRI sequences can sometimes show overlapping appearances, necessitating advanced imaging techniques.
Purpose of the Study:
- To evaluate the efficacy of apparent diffusion coefficient (ADC) ratios in differentiating brain abscesses from cystic or necrotic neoplasms.
- To assess if combining ADC ratios with T2 rim characteristics enhances diagnostic performance.
Main Methods:
- A retrospective analysis of 53 patients with rim-enhancing brain masses was performed.
- ADC values were measured in the cystic component of lesions, and ADC ratios were calculated against contralateral white matter.
- Lesions were classified based on ADC ratios and T2 hypointensity rim characteristics.
Main Results:
- Mean ADC ratios were significantly higher in neoplasms (2.45 ± 0.91) than in abscesses (1.12 ± 0.53).
- ADC ratios demonstrated high accuracy (Az = 0.91 ± 0.04) in discriminating abscesses from neoplasms, with a threshold of 1.7 yielding 87% efficiency.
- The combined use of ADC ratios and T1 rim characteristics correctly classified 94.3% of lesions.
Conclusions:
- ADC ratios are highly accurate in differentiating brain abscesses from cystic or necrotic neoplasms.
- The diagnostic performance can be further improved by incorporating T2 rim characteristics.
Related Concept Videos
01:26Brain Abscess l: Introduction
01:24Magnetic Resonance Imaging