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The difference in diffusion-weighted imaging with apparent diffusion coefficient between spontaneous and

Yeong-Jin Kim1, Kyung-Sub Moon, Seul Kee Kim

  • 1Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School , Hwasun-gun, Jeollanamdo , Republic of Korea.

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PubMed
Summary

Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) are useful for diagnosing spontaneous intracranial infections. However, negative results do not rule out postoperative infections, which require further investigation.

Keywords:
apparent diffusion coefficientbrain abscessdiagnosisdiffusion-weighted imagepostoperative infection

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Area of Science:

  • Neuroimaging
  • Radiology
  • Infectious Diseases

Background:

  • Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) are established tools for diagnosing spontaneous intracranial infections.
  • Their utility in diagnosing intracranial infections post-craniotomy remains under-investigated.
  • This study analyzes clinico-radiological features to identify factors affecting DWI/ADC accuracy in postoperative cases.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of DWI and ADC in intracranial infections following craniotomy.
  • To compare the characteristics of spontaneous versus postoperative intracranial infections.
  • To identify predictors of false-negative DWI/ADC results in intracranial infections.

Main Methods:

  • Retrospective analysis of 67 patients with intracranial infections confirmed by MR imaging (including DWI, ADC, and gadolinium-enhanced sequences) and peroperative pus drainage.
  • Comparison of clinico-radiological findings between spontaneous and postoperative infection groups.

Main Results:

  • No or uncertain diffusion restriction on DWI/ADC was observed in 9 cases (13%), all showing peripheral enhancement on Gd-enhanced images.
  • Postoperative infection was significantly associated with false-negative DWI/ADC findings (62.5% vs. 6.8%, p=0.001).
  • Multivariate analysis identified postoperative infection as a strong predictor of false-negative DWI/ADC results (HR: 41.2, p=0.01).

Conclusions:

  • While DWI and ADC are highly effective for spontaneous intracranial infections, negative findings do not exclude postoperative infections.
  • Postoperative intracranial infections may present without characteristic diffusion restriction on DWI/ADC.
  • Clinical correlation and further diagnostic steps are crucial when suspecting postoperative intracranial infection despite negative DWI/ADC.