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Comparative evaluation of fungal, tubercular, and pyogenic brain abscesses with conventional and diffusion MR imaging
1Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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.
Insights
Differentiating brain abscesses like pyogenic, tubercular, and fungal is challenging. Advanced MRI techniques, including diffusion-weighted imaging (DWI) and proton MR spectroscopy (PMRS), reveal unique features to distinguish these infections.
Area of Science:
- Radiology
- Neurology
- Infectious Diseases
Background:
- Distinguishing the etiology of brain abscesses using conventional CT and MR imaging is often difficult.
- Pyogenic, tubercular, and fungal infections present unique challenges in diagnosis.
Purpose of the Study:
- To comparatively evaluate pyogenic, tubercular, and fungal brain abscesses.
- To identify unique imaging features using conventional MRI, diffusion-weighted imaging (DWI), and proton MR spectroscopy (PMRS) for differentiation.
Main Methods:
- Retrospective analysis of 110 surgically confirmed brain abscess cases.
- Utilized T2, T1, postcontrast T1, DWI, and PMRS imaging.
- Quantified apparent diffusion coefficient (ADC) and compared morphologic, physiologic, and metabolite features.
Main Results:
- Pyogenic abscesses showed smooth or lobulated walls; tubercular abscesses had smooth, lobulated, or crenated walls without intracavitary projections.
- Fungal abscesses exhibited irregular walls with intracavitary projections, low ADC in the wall/projections, and high ADC in the cavity.
- PMRS revealed specific metabolites: amino acids, acetate, and succinate in pyogenic; lipid/lactate in tubercular; and lipid, lactate, amino acids, and trehalose in fungal abscesses.
Conclusions:
- Morphologic characteristics, ADC values, and specific metabolite profiles obtained from advanced MRI techniques can aid in differentiating pyogenic, tubercular, and fungal brain abscesses.
