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Radiology of intracranial empyemas, with special reference to computed tomography
Abstract:
Intracranial empyemas are collections of pus, which usually develop in the subdural or extradural space; the former is more frequent. They are not common lesions, forming about one fifth to one third of reported series of intracranial abscesses [1, 2]. In the preantibiotic era, they were commonly fatal [3], but a review of series reported since widespread use of antibiotics indicated a continuing mortality rate of 25% [4]. Their radiological interest resides not only in their importance, but also in the problems of early diagnosis. Negative results have been reported with a number of techniques, including radionuclide imaging [5], computed tomography (CT) [2, 4, 6, 7] and cerebral angiography [8, 9]. A recent neurosurgical review concluded balefully that "no reassurance can be obtained from negative investigations". The present study is an examination of the possible ways in which such negative studies, particularly CT, can be avoided.
Insights
Intracranial empyemas, pus collections in the brain, pose diagnostic challenges. This study examines methods to avoid false-negative computed tomography (CT) scans for earlier diagnosis and improved patient outcomes.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Intracranial empyemas are pus collections in subdural or extradural spaces, less common than intracranial abscesses.
- Historically associated with high mortality, even with antibiotics, mortality remains around 25%.
- Early diagnosis is challenging, with various imaging techniques yielding negative results.
Purpose of the Study:
- To investigate methods for avoiding false-negative computed tomography (CT) scans in diagnosing intracranial empyemas.
- To improve the early detection rate of these serious intracranial infections.
Main Methods:
- Review of diagnostic imaging techniques, focusing on computed tomography (CT).
- Analysis of factors contributing to negative or inconclusive imaging results.
- Examination of potential strategies to enhance CT sensitivity for empyema detection.
Main Results:
- Computed tomography (CT) scans can produce false-negative results in diagnosing intracranial empyemas.
- Certain imaging parameters or protocols may be suboptimal for detecting these lesions.
- The study aims to identify ways to overcome these diagnostic limitations.
Conclusions:
- Avoiding negative investigations is crucial for timely intracranial empyema diagnosis.
- Further research is needed to refine CT protocols for improved sensitivity.
- Enhanced diagnostic accuracy can lead to earlier treatment and potentially reduced mortality.