Positron emission tomographic findings in a tuberculous brain abscess

Area of Science:

• Neurology
• Infectious Diseases
• Nuclear Medicine

Background:

• Intracranial tuberculomas and bacterial brain abscesses have established positron emission tomographic (PET) findings.
• The specific PET pattern for tuberculous brain abscesses remains undescribed in existing literature.

Observation:

• A case study involving a diabetic patient with a history of heavy drinking presented with a left parietal tuberculous abscess.
• Magnetic resonance imaging (MRI) revealed contrast enhancement at the abscess periphery.
• (18)F-fluoro-2-deoxyglucose (FDG)-PET scans were performed.

Findings:

• PET scans demonstrated intense FDG uptake localized to the abscess periphery, correlating with MRI contrast enhancement.
• Reduced FDG uptake was observed within the abscess cavity and surrounding cerebral cortex.
• This distinct peripheral FDG accumulation pattern differentiates tuberculous abscesses.

Implications:

• The findings suggest that a tuberculous brain abscess should be considered in the differential diagnosis for ring-enhancing brain lesions.
• This diagnostic clue is particularly relevant in chronically ill or immunocompromised individuals.
• FDG-PET imaging can aid in the early and accurate diagnosis of tuberculous brain abscesses, guiding appropriate treatment.