Precision Treatment of Cryptogenic Brain Abscesses: Metagenomic Next-generation Sequencing and Imaging for Recurrence...

Area of Science:

• Neurosurgery
• Infectious Diseases
• Medical Imaging
• Genomics

Background:

• Cryptogenic brain abscesses present diagnostic and therapeutic challenges.
• Optimizing treatment strategies is crucial to minimize recurrence and improve patient outcomes.
• Multimodal imaging and advanced molecular techniques offer potential for improved management.

Purpose of the Study:

• To evaluate the efficacy of integrating multimodal imaging and metagenomic next-generation sequencing (mNGS) for diagnosing cryptogenic brain abscesses.
• To compare the outcomes of different treatment strategies, including medication, surgical puncture, and surgical resection.
• To identify factors influencing treatment success and recurrence risk in cryptogenic brain abscesses.

Main Methods:

• Retrospective analysis of 88 patients with cryptogenic brain abscesses (January 2014 - August 2023).
• Integration of 320-slice computed tomography and 3.0 T magnetic resonance imaging with mNGS.
• Comparison of treatment groups: medication (16), surgical puncture (15), and surgical resection (57).
• Statistical analysis using Fisher's exact test, Kruskal-Wallis test, and multivariate logistic regression.

Main Results:

• Surgical resection achieved a significantly higher cure rate (98.2%) compared to puncture (86.7%) and medication (68.8%) (P < 0.001).
• Recurrence rates were lowest with surgical resection (0%), followed by puncture (13.3%) and medication (43.8%) (P < 0.001).
• mNGS increased pathogen detection to 84.1%, significantly higher than traditional cultures (44.3%) (P < 0.001).
• Abscess diameter ≤2.5 cm and mixed infections were independent risk factors for recurrence.

Conclusions:

• Multimodal imaging and mNGS are essential for early diagnosis of cryptogenic brain abscesses.
• Surgical resection is the preferred treatment for improved cure rates and reduced recurrence, especially for larger abscesses (>2.5 cm) or mixed infections.
• Integrated diagnostic and therapeutic approaches enhance patient management and outcomes.