Related Experiment Video
Updated: May 5, 2026
Co-analysis of Brain Structure and Function using fMRI and Diffusion-weighted Imaging
Published on: November 8, 2012
Diagnostic Performance of DWI and ADC Parameter in Differentiating Brain Abscess from Malignant Ring-Enhancing Brain
Zahra Moradi1, Saeed Mohammadzadeh1, Alisa Mohebbi1
1Universal Scientific Education and Research Network (USERN), Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Purpose:
To assess the performance of diffusion-weighted imaging (DWI) and apparent diffusion coefficients (ADC) in the differentiation of brain abscesses (BA) from malignant ring-enhancing brain lesions (REBL).
Methods:
The protocol was pre-registered at (https://osf.io/mjwek). We conducted a comprehensive search in PubMed, Embase, and Web of Science until April 5, 2025, for studies that used DWI for differentiation of malignant REBLs from BAs. The risk of bias in the included studies was evaluated using QUADAS-2. ADC were compared between malignant REBLs and BAs using a random-effects model. Diagnostic values of area under the curve (AUC), sensitivity, and specificity were calculated. Sensitivity analysis, publication bias tests, and subgroup analysis were performed.
Results:
Thirty-four studies were included with 1382 malignant REBL and 1061 abscesses. The pooled ADC values of malignant REBL and BA were 1797.17 × 10-6 mm2/s (95 % CI: 1446.55-2147.80) and 852.07 × 10-6 mm2/s (95 % CI: 786.52-917.61). Malignant REBLs had 116 % higher ADCs than BAs with a significant pooled standardized mean difference of 3.12 (95 % CI: 2.32-3.91, I2 = 96.8 %, p < 0.001). Qualitative assessment of DWI and ADC parameter demonstrated a pooled sensitivity of 92 % (95 % CI: 89 %-95 %), specificity of 92 % (95 % CI: 89 %-94 %), and AUC of 0.97 (95 % CI: 0.95-0.98) for differentiating BAs from malignant REBLs.
Conclusion:
DWI provides a valuable diagnostic tool for differentiating BAs from malignant REBLs, demonstrating high sensitivity, specificity, and significant ADC difference between the two groups.
Insights
Diffusion-weighted imaging (DWI) effectively differentiates brain abscesses (BA) from malignant ring-enhancing brain lesions (REBL). Significant differences in apparent diffusion coefficients (ADC) and high diagnostic accuracy confirm DWI
Area of Science:
- Radiology
- Neuroimaging
- Oncology
Background:
- Differentiating brain abscesses (BA) from malignant ring-enhancing brain lesions (REBL) is clinically crucial.
- Diffusion-weighted imaging (DWI) and apparent diffusion coefficients (ADC) show promise in distinguishing these entities.
Purpose of the Study:
- To evaluate the diagnostic performance of DWI and ADC in differentiating BAs from malignant REBLs.
- To synthesize existing evidence on the utility of DWI in this diagnostic challenge.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Web of Science.
- Meta-analysis of 34 studies (1382 REBLs, 1061 BAs) was performed using a random-effects model.
- Risk of bias was assessed using QUADAS-2, and diagnostic values (AUC, sensitivity, specificity) were calculated.
Main Results:
- Pooled ADC values were significantly higher in malignant REBLs (1797.17 × 10-6 mm2/s) compared to BAs (852.07 × 10-6 mm2/s).
- DWI demonstrated high diagnostic accuracy with a pooled sensitivity of 92%, specificity of 92%, and AUC of 0.97.
- A standardized mean difference of 3.12 indicated a substantial ADC elevation in REBLs versus BAs.
Conclusions:
- DWI is a valuable non-invasive tool for differentiating brain abscesses from malignant ring-enhancing lesions.
- The significant difference in ADC values provides a robust imaging biomarker for improved diagnostic confidence.
- High sensitivity and specificity underscore the clinical utility of DWI in neuroimaging diagnostics.
