1
|
Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
SCOPE These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. METHODS Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
Collapse
Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Bose A, Prasad U, Kumar A, Kumari M, Suman SK, Sinha DK. Characterizing Various Posterior Fossa Tumors in Children and Adults With Diffusion-Weighted Imaging and Spectroscopy. Cureus 2023; 15:e39144. [PMID: 37378152 PMCID: PMC10292159 DOI: 10.7759/cureus.39144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
Background The posterior fossa is situated between the tentorium cerebelli above and the foramen magnum below. Vital structures like the cerebellum, the pons, and the medulla are situated within it; hence, tumors within the posterior fossa are considered one of the most critical brain lesions. Children are more likely to develop posterior fossa tumors than adults. Diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) sequences along with the conventional MRI help in providing additional information in the characterization of the various posterior fossa tumors. We hereby present a series of 30 patients with clinically suspected posterior fossa masses who underwent preoperative MRI. Objectives This study aims to differentiate the neoplastic from non-neoplastic posterior fossa mass by evaluating the diffusion restriction pattern on DWI, quantifying the apparent diffusion coefficient (ADC) map in various posterior fossa tumors, and comparing the different metabolites of various posterior fossa tumors on MRS. Results Out of the 30 patients with posterior fossa lesions, 18 were males and 12 were females. Eight of them were in the pediatric age group, while twenty-two of them were adults. Metastasis was the most common posterior fossa lesion in our study sample and was found in six patients (20%), followed by vestibular schwannomas (17%) and arachnoid cysts (13%), meningiomas, medulloblastoma, and pilocytic astrocytoma (10% each) and epidermoid, ependymoma, and hemangioblastoma (7% each). The mean ADC value of benign tumors was higher than that of malignant tumors, and this difference was found to be significant (p = 0.012). The cut-off ADC value 1.21x 10-3mm2/s had a sensitivity of 81.82% and specificity of 80.47%. MRS metabolites played an additional role in differentiating benign from malignant tumors. Conclusion A combination of conventional MRI, DWI, ADC values, and MRS metabolites showed good diagnostic accuracy to differentiate between the various posterior fossa neoplastic tumors both in adults and children.
Collapse
Affiliation(s)
- Arjita Bose
- Radiodiagnosis, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Umakant Prasad
- Radiodiagnosis, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Amit Kumar
- Radiodiagnosis, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Manisha Kumari
- Radiology, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Sanjay K Suman
- Radiodiagnosis, Indira Gandhi Institute of Medical Sciences, Patna, IND
| | - Dhiraj K Sinha
- General Surgery, Rajendra Institute of Medical Sciences, Ranchi, IND
| |
Collapse
|
3
|
Beniamin M, Elhefnawy S, Abdelsamad A, Hassan H. Role of MRI modalities in assessment of cystic brain Lesions: a prospective study. УКРАЇНСЬКИЙ РАДІОЛОГІЧНИЙ ТА ОНКОЛОГІЧНИЙ ЖУРНАЛ 2022. [DOI: 10.46879/ukroj.4.2022.9-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background. Intracranial cystic lesions are unnatural cavities in which the continuity of the brain parenchyma is disrupted because of different pathologies such as infections and tumors containing proteinaceous fluid and/or cellular/necrotic materials.
Purpose – to investigate the value of some MRI modalities, mostly DWI and MR spectroscopy, in differentiation of the common intracranial intra-axial cystic brain lesions to help these patients benefit from the best medical management and treatment.
Materials and Methods. This is a prospective study, conducted from April 2019 till April 2021. It involved forty adult patients of both sexes with a cystic/necrotic intra-axial brain lesion with variable perifocal edema and rim enhancement on post-contrast study at MRI unit, radiology department, Ain Shams University (ASU) Hospital. All examinations were carried out after signing of the informed consent by the patients themselves or their guardian if the patient was incapacitated by any means.
Results. The ADC values in the center of lesions were not uniform. We found the lowest ADC value in the center of the lesion at the abscess 0.4x10–3 mm2 /s, and the highest ADC value 3.2x10–3 mm2 /s was in cystic neoplastic lesion. There was a significant difference in the ADC values in the center of neoplastic necrotic lesions; mean ADC value was (1.95±1.08) x10–3 mm2 /s and (1.15±0.65) x10–3 mm2 /s in abscess lesions, with a cut-off value, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy value of: 1.55%, 92.9%, 91.7%, 96.3%, 84.6% and 92.5% respectively. MRS was performed in 40 cases, and the Cho/Cr, Cho/NAA and NAA/Cr mean ratios were calculated. These ratios were compared between the different categories. Statistically significant differences were found in the Cho/Cr, Cho/NAA ratios between both groups (p values<0.001**), while no statistically significant difference was found in the NAA/Cr ratio.
Conclusion. Diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) are useful as additional diagnostic modalities for differentiating brain abscesses from cystic or necrotic brain tumors. Furthermore, the following MR techniques may be helpful for discriminating brain abscess from cystic or necrotic tumors: diffusion tensor imaging (DTI), perfusion weighted imaging as well as positron emission tomography computed tomography (PET-CT). This will help to improve the accuracy of MR in differentiating brain abscess from cystic or necrotic tumors.
Collapse
|
4
|
Muacevic A, Adler JR. Role of MRSI Major Metabolite Ratios in Differentiating Between Intracerebral Ring-Enhancing Neoplastic and Non-Neoplastic Lesions, High-Grade Gliomas and Metastases, and High-Grade and Low-Grade Gliomas. Cureus 2022; 14:e31841. [PMID: 36579207 PMCID: PMC9788963 DOI: 10.7759/cureus.31841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction The purpose of this study was to determine whether multi-voxel magnetic resonance spectroscopic imaging (MRSI) can differentiate between intracranial neoplastic and non-neoplastic and between neoplastic ring-enhancing lesions (RELs) based on differences in major metabolite ratios in their enhancing and peri-enhancing regions. Methods In a prospective observational study involving patients with an intracerebral RELs, MRSI using the two-dimensional multi-voxel point-resolved spectroscopy (PRESS) chemical-shift imaging (CSI) sequence at an echo time (TE) of 135 milliseconds (ms) was performed on a total of 38 patients. Of 38 lesions, 23 (60.5%) were neoplastic and 15 (39.5%) were non-neoplastic. Of the 23 neoplastic lesions, 12 were high-grade gliomas (HGGs), seven were metastases, and four were low-grade gliomas (LGGs). Major metabolite ratios, i.e., choline-to-N-acetylaspartate (Cho/NAA), choline-to-creatine (Cho/Cr), and N-acetylaspartate-to-creatine (NAA/Cr), were calculated in the enhancing and peri-enhancing regions of the RELs. A Mann-Whitney U test was run to determine differences in metabolite ratios at different voxel locations between neoplastic versus non-neoplastic lesions, HGGs versus metastatic lesions, and HGGs versus LGGs. A receiver operating characteristic (ROC) curve analysis was performed to derive cut-off values for Cho/NAA and NAA/Cr ratios in the enhancing and peri-enhancing portions of the lesions. Results The sensitivity, specificity, positive predictive value, and negative predictive value for categorizing an REL in either neoplastic or non-neoplastic lesions using MRSI with magnetic resonance imaging (MRI) were 91.3%, 73.3%, 84%, and 84.6%, respectively. There was a statistically significant difference between Cho/NAA (p = 0.006) and NAA/Cr (p = 0.021) ratios in the enhancing region of 23 neoplastic and 15 non-neoplastic lesions. In the voxel placed in the peri-enhancing portions, the differences between Cho/Cr ratios were just significant (p = 0.047). A cut-off score of Cho/NAA >1.67 in the enhancing regions gave a sensitivity of 82.6% and specificity of 60%. The cut-off score for NAA/Cr of <0.80 in the enhancing regions showed a sensitivity and specificity of 60.9% and 86.7%, respectively. Of the 23 neoplastic lesions, 12 HGGs and seven metastases were differentiated using the Cho/NAA ratio in the peri-enhancing region with a cut-off value of 1.21, sensitivity of 100%, and specificity of 85%. A cut-off value of Cho/Cr ≥1.45 in the peri-enhancing regions showed a sensitivity of 83% and a specificity of 71.4%. For discriminating between 12 HGGs and four LGGs both from the 23 neoplastic REL group, using the cut-off score for Cho/NAA in the enhancing portions ≥4.16 showed a sensitivity of 0.75 and specificity of 100%. In the peri-enhancing regions, a cut-off score of ≥2.07 provided a sensitivity and specificity of 83% and 100%, respectively. Conclusion Conventional MRI sometimes poses a diagnostic challenge in distinguishing between neoplastic and non-neoplastic lesions and other neoplastic RELs. Interpreting MRSI findings by comparing the major metabolite ratios in the enhancing and peri-enhancing regions of these lesions may enable distinction between the two.
Collapse
|
5
|
Proton MR Spectroscopy of Pediatric Brain Disorders. Diagnostics (Basel) 2022; 12:diagnostics12061462. [PMID: 35741272 PMCID: PMC9222059 DOI: 10.3390/diagnostics12061462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
In vivo MR spectroscopy is a non -invasive methodology that provides information about the biochemistry of tissues. It is available as a “push-button” application on state-of-the-art clinical MR scanners. MR spectroscopy has been used to study various brain diseases including tumors, stroke, trauma, degenerative disorders, epilepsy/seizures, inborn errors, neuropsychiatric disorders, and others. The purpose of this review is to provide an overview of MR spectroscopy findings in the pediatric population and its clinical use.
Collapse
|
6
|
Alshammari QT, Salih M, Gameraddin M, Yousef M, Abdelmalik B, Loaz O. Accuracy of Magnetic Resonance Spectroscopy in Discrimination of Neoplastic and Non-Neoplastic Brain Lesions. Curr Med Imaging 2021; 17:904-910. [PMID: 33655843 PMCID: PMC8811616 DOI: 10.2174/1573405617666210224112808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/22/2022]
Abstract
Background Differentiation of brain lesions by conventional MRI alone is not enough. The introduction of sophisticated imaging methods, such as MR Spectroscopy (MRS), will contribute to accurate differentiation. Objective To determine the diagnostic accuracy of MRS in differentiating neoplasm and non-neoplastic brain lesion. Methodology This is a cross-sectional descriptive study conducted at Khartoum State from the period of 2015 to 2017. Thirty cases with brain lesions were included in the study investigated with MRS (Single-voxel spectroscopy) and conventional MRI. A comparison of MRS findings and histopathologic analysis was performed. The ratios of Cho/Cr and Cho/NAA were analyzed and compared between neoplastic and non-neoplastic brain masses. Data were analyzed using SPSS version 23. Results Out of the 30 patients affected with brain lesions, there were 16 females and 14 males with a mean age of 44 +- 18 years. The ratios of Cho/Cr and Cho/NAA were higher in gliomas, astrocytoma, and meningioma than non-neoplastic lesions. Kappa statistical value (K) showed a good agreement between MRS and histopathological analysis (K= 0.60). The diagnostic accuracy of MRS was 100%, with 82.60% sensitivity, 85.71% specificity, 95% PPV, and 60% NPV. Conclusion MRS has high diagnostic accuracy in differentiating neoplasm from non-neoplastic brain tumors. The elevation ratios of Choline-to- N-acetyl aspartate and choline-to- creatine can help neurosurgeons and clinicians differentiate benign from malignant masses.
Collapse
Affiliation(s)
- Qurain T Alshammari
- Diagnostic Radiology Department, College of Applied Medical Sciences, University of Hail, Hai', Saudi Arabia
| | - Mohammed Salih
- Diagnostic Radiology Department, College of Applied Medical Sciences, University of Hail, Hai', Saudi Arabia
| | - Moawia Gameraddin
- Diagnostic Radiology Department, College of Applied Medical Sciences, Taibah University, Al-Madinah, Saudi Arabia
| | - Mohamed Yousef
- Radiological Sciences Department, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Bushra Abdelmalik
- Diagnostic Radiology Department, College of Applied Medical Sciences, University of Hail, Hai', Saudi Arabia
| | - Omer Loaz
- Diagnostic Radiology Department, College of Medical Applied Sciences, King Khalid University, Abha, Saudi Arabia
| |
Collapse
|
7
|
Mustafa WF, Abbas M, Elsorougy L. Role of diffusion-weighted imaging in differentiation between posterior fossa brain tumors. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-019-0145-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Diffusion-weighted imaging (DWI) is an imaging modality using multi-section single-shot spin echo planar imaging (EPI) sequence which is extremely sensitive for detection of water motion within intra, extra, and transcellular regions. This character is important to differentiate between brain tumors either low (benign) or highly (malignant) cellular tumors.
Objective
To evaluate the role of DWI and apparent diffusion coefficient (ADC) in evaluation and differentiation between different brain posterior fossa tumors in children and adults.
Patients and methods
The study included 34 patients with different brain posterior fossa tumors for evaluation by conventional MRI (using 1.5 T MRI PHILIPS Achieva 2.1 Best Netherland) and DWI.
Results
Our study showed that mean ADC values were significantly different between the four groups of posterior fossa tumors in children: juvenile pilocytic astrocytoma (JPA), medulloblastoma, ependymoma, and brain stem glioma while mean ADC values were not significantly different between posterior fossa tumors in the adult group. Regions of interest were manually positioned, and all values were automatically calculated and expressed in 10−3 mm2/s.
Conclusion
DWI is an ideal additional imaging technique, which is a rapid, easy, non-invasive imaging modality, with no contrast injection needed. It has been widely applied in the differentiation between posterior fossa brain tumors and in the diagnosis of various intracranial diseases.
Collapse
|
8
|
Brain Abscess Masquerading as Brain Infarction. Brain Sci 2020; 10:brainsci10070440. [PMID: 32664484 PMCID: PMC7408080 DOI: 10.3390/brainsci10070440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Occasionally, acute ischemic stroke can be difficult to differentiate from acute intracranial infection. We describe a patient who presented with sudden onset of right hemiparesis and fever. Magnetic resonance imaging (MRI) was consistent with an acute stroke, showing multiple lesions with restricted diffusion in the left middle cerebral artery territory. These lesions were not enhancing and were not associated with vasogenic edema. A diagnosis of acute stroke was made based on the clinical and radiographic data. Follow-up MRI obtained eleven days later showed interval development of ring enhancement and vasogenic edema surrounding the previously noted core of restricted diffusion. Based on these findings, the diagnosis was revised to cerebral abscesses and the patient was treated successfully with antibiotics. In retrospect, the largest diffusion-weighted lesion on baseline MRI demonstrated two characteristics that were atypical for stroke: it had an ovoid shape and a subtle T2 hypointense core. This case demonstrates that acute clinical and radiographic presentation of cerebral abscess and ischemic stroke can be strikingly similar. Follow-up imaging can be instrumental in arriving at an accurate diagnosis.
Collapse
|
9
|
Marais S, Van Toorn R, Chow FC, Manesh A, Siddiqi OK, Figaji A, Schoeman JF, Meintjes G. Management of intracranial tuberculous mass lesions: how long should we treat for? Wellcome Open Res 2020; 4:158. [PMID: 32047859 PMCID: PMC6996525 DOI: 10.12688/wellcomeopenres.15501.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 12/15/2022] Open
Abstract
Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis ( M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3 rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.
Collapse
Affiliation(s)
- Suzaan Marais
- Department of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, 4091, South Africa
- Division of Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, 7925, South Africa
| | - Ronald Van Toorn
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Felicia C. Chow
- Weill Institute of Neurosciences and Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, 94110, USA
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, India
| | - Omar K. Siddiqi
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 02215, USA
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience institute, University of Cape Town, Cape Town, 7700, South Africa
| | - Johan F. Schoeman
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa
| |
Collapse
|
10
|
Antkowiak Ł, Putz M, Mandera M. Clinical features, microbiology, and management of pediatric brainstem abscess. Childs Nerv Syst 2020; 36:2919-2926. [PMID: 32734403 PMCID: PMC7649181 DOI: 10.1007/s00381-020-04835-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/23/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Brainstem abscess is a rare condition accounting for merely 1% of brain abscesses incidence in the pediatric population. This study aimed to present a single patient with a pontine abscess and review the literature to highlight clinical features, diagnosis, and management of brainstem abscess. METHODS The PubMed database was screened for English-language articles concerning pediatric brainstem abscess. We, therefore, identified 22 publications, which concisely depict 23 cases. Our study reports on the 24th pediatric patient diagnosed with that entity. All included reports were analyzed in terms of clinical presentation, diagnosis, management, and outcomes of described patients. RESULTS There was slight women predominance (15:9), with a mean age of occurrence 6.4 years, ranging from 7 months to 16 years. Pons was the most common location of brainstem abscess, occurring in 75% of patients. Clinically, they mostly presented with cranial nerves palsy (79.2%), hemiparesis (66.7%), and pyramidal signs (45.8%). The classic triad of symptoms, including fever, headache, and the focal neurologic deficit was present in 20.8% of patients. Positive pus cultures were obtained in 61.1%. Streptococci and Staphylococci were the most frequently identified pus microorganisms. Outcomes were satisfactory, with a 79.2% rate of general improvement. CONCLUSIONS Neurosurgical aspiration is a safe and beneficial therapeutic method. It should always be considered and should promptly be performed when the conservative treatment is not successful and clinical deterioration occurs. Prognosis in pediatric brainstem abscess is generally favorable. Most patients recover with minor neurologic deficits or improve completely.
Collapse
Affiliation(s)
- Łukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia, Ul. Medyków 16, 40-752 Katowice, Poland
| | - Monika Putz
- Department of Pediatric Neurosurgery, Medical University of Silesia, Ul. Medyków 16, 40-752 Katowice, Poland
| | - Marek Mandera
- Department of Pediatric Neurosurgery, Medical University of Silesia, Ul. Medyków 16, 40-752 Katowice, Poland
| |
Collapse
|
11
|
Marais S, Van Toorn R, Chow FC, Manesh A, Siddiqi OK, Figaji A, Schoeman JF, Meintjes G. Management of intracranial tuberculous mass lesions: how long should we treat for? Wellcome Open Res 2019; 4:158. [PMID: 32047859 PMCID: PMC6996525 DOI: 10.12688/wellcomeopenres.15501.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 12/15/2022] Open
Abstract
Tuberculous intracranial mass lesions are common in settings with high tuberculosis (TB) incidence and HIV prevalence. The diagnosis of such lesions, which include tuberculoma and tuberculous abscesses, is often presumptive and based on radiological features, supportive evidence of TB elsewhere and response to TB treatment. However, the treatment response is unpredictable, with lesions frequently enlarging paradoxically or persisting for many years despite appropriate TB treatment and corticosteroid therapy. Most international guidelines recommend a 9-12 month course of TB treatment for central nervous system TB when the infecting Mycobacterium tuberculosis ( M.tb) strain is sensitive to first-line drugs. However, there is variation in opinion and practice with respect to the duration of TB treatment in patients with tuberculomas or tuberculous abscesses. A major reason for this is the lack of prospective clinical trial evidence. Some experts suggest continuing treatment until radiological resolution of enhancing lesions has been achieved, but this may unnecessarily expose patients to prolonged periods of potentially toxic drugs. It is currently unknown whether persistent radiological enhancement of intracranial tuberculomas after 9-12 months of treatment represents active disease, inflammatory response in a sterilized lesion or merely revascularization. The consequences of stopping TB treatment prior to resolution of lesional enhancement have rarely been explored. These important issues were discussed at the 3 rd International Tuberculous Meningitis Consortium meeting. Most clinicians were of the opinion that continued enhancement does not necessarily represent treatment failure and that prolonged TB therapy was not warranted in patients presumably infected with M.tb strains susceptible to first-line drugs. In this manuscript we highlight current medical treatment practices, benefits and disadvantages of different TB treatment durations and the need for evidence-based guidelines regarding the treatment duration of patients with intracranial tuberculous mass lesions.
Collapse
Affiliation(s)
- Suzaan Marais
- Department of Neurology, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, Durban, 4091, South Africa
- Division of Neurology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, 7925, South Africa
| | - Ronald Van Toorn
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Felicia C. Chow
- Weill Institute of Neurosciences and Department of Neurology and Division of Infectious Diseases, University of California, San Francisco, California, 94110, USA
| | - Abi Manesh
- Department of Infectious Diseases, Christian Medical College, Vellore, 632004, India
| | - Omar K. Siddiqi
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, 02215, USA
- Department of Internal Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience institute, University of Cape Town, Cape Town, 7700, South Africa
| | - Johan F. Schoeman
- Department of Pediatrics and Child Health, Stellenbosch University, Cape Town, 7505, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Department of Medicine, University of Cape Town, Cape Town, 7925, South Africa
| |
Collapse
|
12
|
[Intracranial cystic lesions]. Radiologe 2019; 58:120-131. [PMID: 29143062 DOI: 10.1007/s00117-017-0322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
CLINICAL PROBLEM Intracerebral cysts are common findings in imaging of the neurocranium and are not always clinically significant. The pathological spectrum of intracerebral cysts is, however, very broad and in addition to incidental findings includes developmental disorders, malformation tumors, primary and secondary neoplasms and infectious etiologies, such as cerebral abscess formation, cysticercosis or residuals after congenital cytomegalovirus infections. Intracerebral cystic defects may be caused by inflammatory central nervous system (CNS) diseases, such as multiple sclerosis as well as by mitochondriopathies, leukodystrophy, electrolyte disturbances or osmotic demyelination syndrome or brain infarctions, e.g. after lacunar infarctions or as encephalomalacic changes after severe traumatic brain injury. RADIOLOGICAL STANDARD PROCEDURES In addition to the radiological findings of cysts in magnetic resonance imaging (MRI) or in computed tomography (CT), the localization, patient age, patient medical history and laboratory diagnostics are helpful for the differential diagnostics. METHODICAL INNOVATION In addition to the morphological assessment, advanced MRI techniques, such as diffusion-weighted imaging for epidermoids or the use of MR spectroscopy, can provide valuable information for the differential diagnosis. PERFORMANCE/ASSESSMENT Intracranial cysts can be subdivided into intraventricular and periventricular cysts, intra-axial cysts and cysts in the external fluid-filled spaces. Associated tumor nodules and the contrast medium behavior of the cyst walls and/or associated soft tissue components as well as the reaction of the adjacent parenchyma are helpful for the diagnosis and assessment.
Collapse
|
13
|
Lai PH, Chung HW, Chang HC, Fu JH, Wang PC, Hsu SH, Hsu SS, Lin HS, Chuang TC. Susceptibility-weighted imaging provides complementary value to diffusion-weighted imaging in the differentiation between pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors. Eur J Radiol 2019; 117:56-61. [PMID: 31307653 DOI: 10.1016/j.ejrad.2019.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this retrospective study was to investigate the differentiation of abscess and necrotic tumors, using susceptibility-weighted imaging (SWI) and apparent diffusion coefficients (ADC) either separated or combined. METHODS Imaging was performed on 26 patients with pyogenic brain abscesses, 31 patients with rim-enhancing glioblastomas, and 21 patients with rim-enhancing metastases. The degree of intralesional susceptibility signal (ILSS) was independently assessed by three observers. Average ADC in the lesion core was calculated. After receiver operating characteristic (ROC) analysis, the area under the ROC curve was compared using three different analytical models (ILSS, ADC, and ILSS-ADC combined) to differentiate abscess from the two rim-enhancing necrotic tumors. RESULTS The ILSS-ADC combined model had greater area under the ROC curves than ILSS or ADC used alone. In this study, the ILSS-ADC combined model showed 100% diagnostic accuracy differentiating abscesses from glioblastoma. The ADC model and the ILSS-ADC combined model performed equally well in distinguishing abscesses from metastases. CONCLUSION It is concluded that SWI and ADC are complementary, and the combination of SWI and ADC may improve results compared with the use of only one model. Validation by an independent cohort is the next necessary step to broaden its applicability in routine clinical settings.
Collapse
Affiliation(s)
- Ping-Hong Lai
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Wen Chung
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Hing-Chiu Chang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | - Jui-Hsun Fu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Chin Wang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shuo-Hsiu Hsu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shu-Shong Hsu
- Department of Neurosurgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, School of Nursing, Fooyin University, Kaohsiung, Taiwan
| | - Tzu-Chao Chuang
- Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
| |
Collapse
|
14
|
Application of MR morphologic, diffusion tensor, and perfusion imaging in the classification of brain tumors using machine learning scheme. Neuroradiology 2019; 61:757-765. [PMID: 30949746 DOI: 10.1007/s00234-019-02195-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE While MRI is the modality of choice for the assessment of patients with brain tumors, differentiation between various tumors based on their imaging characteristics might be challenging due to overlapping imaging features. The purpose of this study was to apply a machine learning scheme using basic and advanced MR sequences for distinguishing different types of brain tumors. METHODS The study cohort included 141 patients (41 glioblastoma, 38 metastasis, 50 meningioma, and 12 primary central nervous system lymphoma). A computer-assisted classification scheme, combining morphologic MRI, perfusion MRI, and DTI metrics, was developed and used for tumor classification. The proposed multistep scheme consists of pre-processing, ROI definition, features extraction, feature selection, and classification. Feature subset selection was performed using support vector machines (SVMs). Classification performance was assessed by leave-one-out cross-validation. Given an ROI, the entire classification process was done automatically via computer and without any human intervention. RESULTS A binary hierarchical classification tree was chosen. In the first step, selected features were chosen for distinguishing glioblastoma from the remaining three classes, followed by separation of meningioma from metastasis and PCNSL, and then to discriminate PCNSL from metastasis. The binary SVM classification accuracy, sensitivity and specificity for glioblastoma, metastasis, meningiomas, and primary central nervous system lymphoma were 95.7, 81.6, and 91.2%; 92.7, 95.1, and 93.6%; 97, 90.8, and 58.3%; and 91.5, 90, and 96.9%, respectively. CONCLUSION A machine learning scheme using data from anatomical and advanced MRI sequences resulted in high-performance automatic tumor classification algorithm. Such a scheme can be integrated into clinical decision support systems to optimize tumor classification.
Collapse
|
15
|
Yamanaka T, Kanai H, Aihara N, Ohno T, Mase M. A Case of Sarcoidosis-lymphoma Syndrome: Importance of Brain Biopsy. NMC Case Rep J 2019; 6:61-64. [PMID: 31016103 PMCID: PMC6476816 DOI: 10.2176/nmccrj.cr.2018-0223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022] Open
Abstract
Sarcoidosis is occasionally associated with malignant lymphoma. Cases of sarcoidosis associated with malignant lymphoma are called sarcoidosis-lymphoma syndrome. We report a 63-year-old man with sarcoidosis associated with primary central nervous system lymphoma (PCNSL). Definitive diagnosis by clinical and radiological findings was difficult. Finally, brain biopsy could produce the correct diagnosis. We could provide appropriate treatment for PCNSL and the patient has survived over 2 years. Thus, it is very important to make an early definitive diagnosis by biopsy for intracranial lesion, because it can prolong survival in patients with sarcoidosis.
Collapse
Affiliation(s)
- Tomoyasu Yamanaka
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan.,Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Hideki Kanai
- Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Noritaka Aihara
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan
| | - Takayuki Ohno
- Department of Neurosurgery, Nagoya City East Medical Center, Nagoya, Aichi, Japan
| | - Mitsuhito Mase
- Department of Neurosurgery, Nagoya City University, Nagoya, Aichi, Japan
| |
Collapse
|
16
|
Kwon N, Kim HS. Bilateral Thalamic Glioma in a Young Woman: a Case Report. BRAIN & NEUROREHABILITATION 2019. [DOI: 10.12786/bn.2019.12.e17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Namwoo Kwon
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
17
|
Chen M, Low DCY, Low SYY, Muzumdar D, Seow WT. Management of brain abscesses: where are we now? Childs Nerv Syst 2018; 34:1871-1880. [PMID: 29968000 DOI: 10.1007/s00381-018-3886-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Brain abscesses affect all age groups and are not peculiar to a particular country, race, or geographical location. It is a disease that, in the past, carried a high morbidity and mortality. With improvements in medical technology and expertise, outcomes have improved tremendously. The causative organisms vary vastly and have evolved with time. Treatment of brain abscesses is primarily with antimicrobial therapy but surgery plays a vital role in achieving better outcomes. CONTENT In this article, we review the literature to find out how the epidemiology of this disease has changed through the years and re-visit the basic pathological process of abscess evolution and highlight the new research in the biochemical pathways that initiate and regulate this process. We also highlight how magnetic resonance imaging and its various modalities have improved diagnostic accuracy. Finally, we discuss the pros and cons of traditional open surgery versus newer minimally invasive methods.
Collapse
Affiliation(s)
- Minwei Chen
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - David C Y Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore.,Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore
| | - Sharon Y Y Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore.,Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore
| | - Dattatraya Muzumdar
- Department of Neurosurgery, King Edward VII Memorial hospital, Mumbai, India
| | - Wan Tew Seow
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore. .,Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore. .,Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore.
| |
Collapse
|
18
|
Manias KA, Peet A. What is MR spectroscopy? Arch Dis Child Educ Pract Ed 2018; 103:213-216. [PMID: 28844055 DOI: 10.1136/archdischild-2017-312839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 11/03/2022]
Abstract
1H-Magnetic Resonance Spectroscopy (MRS) is a novel advanced imaging technique used as an adjunct to MRI to reveal complementary non-invasive information about the biochemical composition of imaged tissue. Clinical uses in paediatrics include aiding diagnosis of brain tumours, neonatal disorders such as hypoxic-ischaemic encephalopathy, inherited metabolic diseases, traumatic brain injury, demyelinating conditions and infectious brain lesions. MRS has potential to improve diagnosis and treatment monitoring of childhood brain tumours and other CNS diseases, facilitate biopsy and surgical planning, and provide prognostic biomarkers. MRS is employed as a research tool outside the brain in liver disease and disorders of muscle metabolism. The range of clinical uses is likely to increase with growing evidence for added value. Multicentre trials are needed to definitively establish the benefits of MRS in specific clinical scenarios and integrate this promising new technique into routine practice to improve patient care. This article gives a brief overview of MRS and its potential clinical applications, and addresses challenges surrounding translation into practice.
Collapse
Affiliation(s)
- Karen Angela Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| |
Collapse
|
19
|
Khaja M, Adler D, Lominadze G. Expressive aphasia caused by Streptococcus intermedius brain abscess in an immunocompetent patient. Int Med Case Rep J 2017; 10:25-30. [PMID: 28176963 PMCID: PMC5271399 DOI: 10.2147/imcrj.s125684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Brain abscess is an uncommon but life-threatening infection. It involves a focal, intracerebral infection that begins in a localized area of cerebritis and develops into a collection of pus, surrounded by a well-vascularized capsule. Brain abscess still poses a significant problem in developing countries but rarely in developed countries. Predisposing factors vary in different parts of the world. With the introduction of antibiotics and imaging studies, the mortality rate has decreased between 5% and 15%. If left untreated it may lead to serious neurologic sequelae. The temporal lobe abscess can be caused by conditions like sinusitis, otitis media, dental infections, and mastoiditis if left untreated or partially treated. Additionally, in neurosurgical procedures like craniotomy, the external ventricular drain can get infected, leading to abscess formation. Case presentation We present the case study of an elderly female patient who presented with expressive aphasia caused by brain abscess, secondary to Streptococcus intermedius infection. The 72-year-old female with a medical history of hypertension came to hospital for evaluation with word-finding difficulty, an expressive aphasia that began a few days prior to presentation. Computed tomography of the head showed a left temporal lobe mass-like lesion, with surrounding vasogenic edema. The patient was empirically started on courses of antibiotics. The next day, she was subjected to magnetic resonance imaging of the brain, which showed a left temporal lobe septated rim-enhancing mass lesion, with bright restricted diffusion and diffuse surrounding vasogenic edema consistent with abscess. The patient was also seen by the neurosurgery department and underwent stereotactic, left temporal craniotomy, with drainage, and resection of abscess. Tissue culture grew S. intermedius sensitive to ampicillin sulbactam. Subsequently her expressive aphasia improved. Conclusion Brain abscess has a high mortality, however a significant proportion of patients with appropriately treated abscess recover completely and can survive without significant neurologic damage. Advanced imaging modalities may yield more accurate methods of differentiation of mass lesions in the brain. Biopsy of brain lesion with early initiation of appropriate antibiotics will change the outcome.
Collapse
Affiliation(s)
- Misbahuddin Khaja
- Division of Pulmonary and Critical Care Medicine, Bronx Lebanon Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai
| | - Darryl Adler
- Division of Critical Care Medicine, New York Presbyterian-Lawrence Hospital Center, Affiliated with Columbia University College of Physician and Surgeons, Bronx, New York, NY, USA
| | - George Lominadze
- Division of Critical Care Medicine, New York Presbyterian-Lawrence Hospital Center, Affiliated with Columbia University College of Physician and Surgeons, Bronx, New York, NY, USA
| |
Collapse
|
20
|
Deigendesch N, Stenzel W. Acute and chronic bacterial infections and sarcoidosis. HANDBOOK OF CLINICAL NEUROLOGY 2017; 145:217-226. [PMID: 28987171 DOI: 10.1016/b978-0-12-802395-2.00016-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pathogen-induced inflammatory diseases mostly involving, but sometimes exclusively affecting, the central nervous system (CNS) manifest with a plethora of signs and symptoms. The different diseases are still difficult to cure despite modern diagnostic, preventive, and therapeutic advances, and this is mainly due to the host inflammatory response, leading to irreversible tissue damage. Knowledge about underlying pathomechanisms is constantly growing, and numerous studies on humans, human material, and animal models as well as in vitro systems have considerably increased our understanding of molecular mechanisms; however, there are still enormous uncertainties with respect to host-pathogen interaction and treatment. There are important regional variations as to prevalence and susceptibility of diseases, reflecting the importance of environmental factors, and immunogenetic peculiarities of different ethnicities. In addition, the opportunistic infections of the CNS are becoming very relevant, not only in the context of human immunodeficiency virus (HIV), but also in the context of modern, highly specific immunosuppressive or immunomodulatory treatments, evoking new and unmet diagnostic and therapeutic challenges. This chapter summarizes up-to-date knowledge about bacterial CNS infections, as well as cerebral sarcoidosis, focussing on morphologic aspects.
Collapse
Affiliation(s)
- Nikolaus Deigendesch
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Werner Stenzel
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
21
|
|
22
|
Multiple Brain Abscesses due to Streptococcus anginosus: Prediction of Mortality by an Imaging Severity Index Score. Case Rep Radiol 2016; 2016:7040352. [PMID: 27034878 PMCID: PMC4791499 DOI: 10.1155/2016/7040352] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 11/20/2022] Open
Abstract
An elderly patient with altered mental status, brain abscesses, ventriculitis, and empyemas died of septic shock and brain abscesses secondary to Streptococcus anginosus despite aggressive treatment. An imaging severity index score with a better prognostic value than the Glasgow coma scale predicted mortality in this patient.
Collapse
|
23
|
Morris SA, Esquenazi Y, Tandon N. Pyogenic cerebral abscesses demonstrating facilitated diffusion. Clin Neurol Neurosurg 2016; 144:77-81. [PMID: 26999529 DOI: 10.1016/j.clineuro.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pyogenic cerebral abscesses are associated with high morbidity and mortality when treatment is delayed. Benign clinical presentation, as well as absence of restricted diffusion on MRI may contribute to missed diagnoses and delays. The authors sought to elucidate characteristics associated with facilitated diffusion on the MRIs of patients with pyogenic abscesses. PATIENTS AND METHODS The authors performed a 10-year retrospective review of prospectively attained data for patients undergoing mass resection by a single surgeon. RESULTS Our findings show that 3/33 (9%) patients with microbiological diagnoses of cerebral abscesses with a thin ring of contrast enhancement but minimal or no restricted diffusion MRI imaging. All causative organisms were hemolytic streptococci and none of the subjects received antibiotic therapy prior to specimen collection. A trend in these patients was the presence of diabetes and in conjunction with other studies that cite incomplete treatment as being associated with facilitated diffusion, we conjecture that impaired inflammatory responses in some patients may be associated with the absence of restricted diffusion. CONCLUSION With this in mind, clinicians must maintain a high index of suspicion when assessing patients with cystic, contrast enhancing masses. A prospective multicenter study to compile imaging along with other patient characteristics may help refine the non-invasive diagnostic criteria for brain abscesses.
Collapse
Affiliation(s)
- Saint-Aaron Morris
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA
| | - Nitin Tandon
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center at Houston, Medical School, Houston, TX, USA.
| |
Collapse
|
24
|
Central Nervous System Melioidosis Mimics Malignancy: A Case Report and Literature Review. World Neurosurg 2016; 89:732.e19-23. [PMID: 26882971 DOI: 10.1016/j.wneu.2016.01.093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/22/2016] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Central nervous system (CNS) melioidosis is notorious because of the difficulty in bacteria eradication and the destruction of brain structures. Early manifestation of CNS melioidosis mimics malignancy or stroke. We present a case of CNS melioidosis that initially manifested as malignancy. CASE DESCRIPTION A 30-year-old man presented with sudden onset of left limb weakness and seizure. Computed tomography of the brain showed a low-density lesion over the right parietal lobe, and magnetic resonance imaging showed a well-enhanced lobulated lesion. Neuronavigation-guided open surgery was performed but failed to find a malignancy. The patient presented 3 days later with sudden loss of consciousness, pupil dilation, and high fever. Emergent craniectomy was performed for severe right hemisphere swelling with midline shift. After craniectomy, pus was found in the previous operative field. Burkholderia pseudomallei was cultured from pus and blood samples 1 week after collection. The brain lesion developed into an organized abscess and led to mass effect and ventriculitis. Extraventricular drainage and débridement was performed repeatedly accompanied by systemic and intraventricular antibiotic administration. After 4 months of treatment, the patient achieved a complete consciousness recover while left hemiparesis. CONCLUSIONS CNS melioidosis requires accurate pathogen identification and appropriate long-term antibiotic treatment for eradication of bacteria and prevention of relapse. Débridement and adequate drainage provide better infection control and outcome.
Collapse
|
25
|
de Lastours V, Fantin B. [Pyogenic brain abscesses in adults]. Rev Med Interne 2016; 37:412-7. [PMID: 26775642 DOI: 10.1016/j.revmed.2015.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/27/2015] [Indexed: 12/26/2022]
Abstract
Pyogenic brain abscesses (BA) are rare and their diagnosis may be difficult because of the absence of specific clinical or biological signs. However, the use of diffusion-weighted brain MRI sequences has modified the management of BA, as they are highly sensitive and specific to differentiate pyogenic brain abscesses from necrotic tumors, which are the most frequent differential diagnosis in case of ring-enhancing lesions on CT scan. This new tool allows for a rapid diagnosis and should be followed by a CT-guided aspiration of BA. This safe procedure should be performed if possible before starting antibiotics in order to optimize microbiological diagnosis. Recent epidemiological changes include an increase in the numbers of immunocompromised patients and a decrease in the traditional causes of BA (direct inoculation, ear nose and throat infections, etc.). In consequence, a wider range of bacterial species may be involved, making it all the more necessary to obtain a microbiological diagnosis. Many uncertainties remain in terms of the duration of antibiotic treatment, the optimal radiological follow-up and the place for associated treatments such as corticosteroids and anticonvulsive therapy. BA remain severe infections with high mortality and morbidity rates; the factor most regularly associated with a poor prognosis is the patients neurological status at diagnosis.
Collapse
Affiliation(s)
- V de Lastours
- Service de médecine interne, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92100 Clichy, France.
| | - B Fantin
- Service de médecine interne, hôpital Beaujon, Assistance publique-Hôpitaux de Paris, 100, boulevard du Général-Leclerc, 92100 Clichy, France
| |
Collapse
|
26
|
Hemorrhagic Cerebellar Abscess. World Neurosurg 2016; 88:692.e17-692.e22. [PMID: 26724627 DOI: 10.1016/j.wneu.2015.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Brain abscess represents a significant medical problem, accounting for 1 in every 10,000 U.S. hospital admissions and imposing a mortality of 17%-32%. Treatment success depends on early diagnosis, allowing for prompt intervention before a potentially catastrophic rupture. However, diagnosis can be difficult because currently no magnetic resonance imaging signal characteristics are pathognomonic. The presence of hemorrhage may further complicate the radiographic detection of an abscess, potentially leading to delayed treatment. CLINICAL PRESENTATION A 71-year-old man was diagnosed with hemorrhagic cerebellar abscess as a complication of groin abscess after cardiac catheterization. After surgical resection of the cerebellar abscess and culture-based antibiotic treatment, the patient suffered repeat hemorrhages into the abscess cavity, of which he died. We describe his clinical course with emphasis on radiology-based differential diagnosis. We also describe the possible pathogenesis of this rare case, based on review of the literature. CONCLUSIONS To our knowledge, this is the first report on recurrent hemorrhages in a cerebellar abscess. Hemorrhagic brain abscess has a complex radiologic appearance, which may delay diagnosis and treatment. A high degree of clinical suspicion is necessary to ensure timely treatment of this potentially lethal lesion.
Collapse
|
27
|
13N-ammonia combined with 18F-FDG could discriminate between necrotic high-grade gliomas and brain abscess. Clin Nucl Med 2015; 40:195-9. [PMID: 25546194 DOI: 10.1097/rlu.0000000000000649] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Accurate prediction of brain abscess is beneficial for timely management. In this study, we investigated the utility of 13N-ammonia and its combination with 18F-FDG in differentiating brain abscess from necrotic high-grade gliomas. PATIENTS AND METHODS Thirteen patients with ring-like enhancement high-grade gliomas and 11 patients with brain abscess were recruited in our study. All of them underwent both 18F-FDG and 13N-ammonia PET imaging. Lesion uptake was evaluated by lesion to normal gray matter ratio (L/N). Histopathology diagnosis was obtained for all the patients after PET imaging. RESULTS The L/N values of 18F-FDG were not significantly different between brain abscess and necrotic high-grade gliomas (P = 0.35). The uptake of 13N-ammonia in gliomas was higher than that in abscess lesions (L/N: 1.38 ± 0.31 vs 0.84 ± 0.18, P < 0.001). The receiver operating characteristic curve analysis determined the optimal L/N cutoff value (13N-ammonia) of 1.0 with the area under the curve of 0.94 and the overall accuracy of 87.5%. Discriminant analysis demonstrated that the combination of 18F-FDG and 13N-ammonia could distinguish the 2 clinical entities with higher accuracy of 95%, and only 1 necrotic glioma lesion was misclassified into the abscess group. CONCLUSIONS 13N-ammonia is effective in distinguishing brain abscess from necrotic high-grade gliomas, and its combination with 18F-FDG could further elevate the diagnostic accuracy.
Collapse
|
28
|
Canpolat M, Ceylan O, Per H, Koc G, Tumturk A, Kumandas S, Patiroglu T, Doganay S, Gumus H, Unal E, Kose M, Gorkem SB, Kurtsoy A, Ozturk MK. Brain abscesses in children: results of 24 children from a reference center in Central Anatolia, Turkey. J Child Neurol 2015; 30:458-67. [PMID: 25223695 DOI: 10.1177/0883073814549247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/02/2014] [Indexed: 11/16/2022]
Abstract
Childhood brain abscesses are a rare and potentially life-threatening condition requiring urgent diagnosis and treatment. This retrospective study analyzed the clinical and radiologic findings of 24 (7 girl, 17 boys) cases with brain abscess. Mean age was 92.98 ± 68.04 months. The most common presenting symptoms were nausea-vomiting (45.8%) and headache (41.7%). Brain abscess was most commonly located in the frontal region. Diffusion restriction was determined in 78.4% of lesions. The mean apparent diffusion coefficient value in these lesions was 0.511 ± 0.23 × 10(-3) mm(2)/s. Cultures were sterile in 40% of cases. Antimicrobial therapy was given to only 16.7% of cases. Predisposing factors were identified in 91.6% of cases (congenital heart disease in 20.8% and immunosuppression in 20.8%). Mortality level was 12.5%. In conclusion, immunocompromised states, and congenital heart disease have become an important predisposing factor for brain abscesses. Effective and prompt management should ensure better outcome in childhood.
Collapse
Affiliation(s)
- Mehmet Canpolat
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ozgur Ceylan
- Division of Pediatric Infectious diseases, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Huseyin Per
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gonca Koc
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Abdulfettah Tumturk
- Department of Neurosurgery, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Sefer Kumandas
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Turkan Patiroglu
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Selim Doganay
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hakan Gumus
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ekrem Unal
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Kose
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sureyya Burcu Gorkem
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Kurtsoy
- Department of Neurosurgery, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mustafa Kursat Ozturk
- Division of Pediatric Infectious diseases, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
29
|
Fu JH, Chuang TC, Chung HW, Chang HC, Lin HS, Hsu SS, Wang PC, Hsu SH, Pan HB, Lai PH. Discriminating pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors by means of susceptibility-weighted imaging. Eur Radiol 2014; 25:1413-20. [DOI: 10.1007/s00330-014-3518-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/06/2014] [Accepted: 11/18/2014] [Indexed: 01/14/2023]
|
30
|
Abstract
Significant advances in the diagnosis and management of bacterial brain abscess over the past several decades have improved the expected outcome of a disease once regarded as invariably fatal. Despite this, intraparenchymal abscess continues to present a serious and potentially life-threatening condition. Brain abscess may result from traumatic brain injury, prior neurosurgical procedure, contiguous spread from a local source, or hematogenous spread of a systemic infection. In a significant proportion of cases, an etiology cannot be identified. Clinical presentation is highly variable and routine laboratory testing lacks sensitivity. As such, a high degree of clinical suspicion is necessary for prompt diagnosis and intervention. Computed tomography and magnetic resonance imaging offer a timely and sensitive method of assessing for abscess. Appearance of abscess on routine imaging lacks specificity and will not spare biopsy in cases where the clinical context does not unequivocally indicate infectious etiology. Current work with advanced imaging modalities may yield more accurate methods of differentiation of mass lesions in the brain. Management of abscess demands a multimodal approach. Surgical intervention and medical therapy are necessary in most cases. Prognosis of brain abscess has improved significantly in the recent decades although close follow-up is required, given the potential for long-term sequelae and a risk of recurrence.
Collapse
Affiliation(s)
- Kevin Patel
- Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - David B Clifford
- Departments of Neurology and Medicine, Washington University in St Louis, St Louis, MO, USA
| |
Collapse
|
31
|
Ono K, Kitagawa M, Ito D, Tanaka N, Watari T. Regional variations and age-related changes detected with magnetic resonance spectroscopy in the brain of healthy dogs. Am J Vet Res 2014; 75:179-86. [PMID: 24471754 DOI: 10.2460/ajvr.75.2.179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate age-related and regional differences in estimated metabolite concentrations in the brain of healthy dogs by means of magnetic resonance spectroscopy (MRS). ANIMALS 15 healthy Beagles. PROCEDURES Dogs were grouped according to age as young (n = 5; all dogs were 2 months old), adult (5; mean age, 4.5 years), or geriatric (5; all dogs were 12 years old). Imaging was performed by use of a 1.5-T MRI system with T1- and T2-weighted spin-echo and fluid-attenuated inversion recovery sequences. Signal intensity measurements for N-acetyl aspartate, creatine, choline, and lactate-alanine (the spectroscopic peaks associated with alanine and lactate could not be reliably differentiated) were determined with MRS, and areas under the spectroscopic peaks (representing concentration estimates) were calculated. Ratios of these metabolite values were compared among age groups and among brain regions with regression analysis. RESULTS The choline-to-creatine ratio was significantly higher in young dogs, compared with other age groups. The N-acetyl aspartate-to-choline ratio was significantly lower in young dogs and geriatric dogs than in adult dogs. When all age groups were considered, the choline-to-creatine ratio was significantly higher and N-acetyl aspartate-to-choline ratio was significantly lower in the frontal lobe than in all other regions. The N-acetyl aspartate-to-creatine ratio was significantly lower in the cerebellum than in other regions. CONCLUSIONS AND CLINICAL RELEVANCE Metabolite ratios varied significantly among age groups and brain regions in healthy dogs. Future studies should evaluate absolute concentration differences in a larger number of dogs and assess clinical applications in dogs with neurologic diseases.
Collapse
Affiliation(s)
- Kaori Ono
- Laboratory of Comprehensive Veterinary Clinical Studies, College of Bioresource Sciences, Nihon University, 1866 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | | | | | | | | |
Collapse
|
32
|
ABO-Sheisha DM, Amin MA, Soliman AY. Role of diffusion weighted imaging and proton magnetic resonance spectroscopy in ring enhancing brain lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
33
|
Affiliation(s)
- Matthijs C Brouwer
- From the Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam (M.C.B., D.B.); Warren Alpert Medical School of Brown University, Providence, RI (A.R.T.); and the Department of Neurological Surgery, Neurological Institute, Columbia University, New York (G.M.M.)
| | | | | | | |
Collapse
|
34
|
Xu XX, Li B, Yang HF, Du Y, Li Y, Wang WX, Zheng HJ, Gong QY. Can diffusion-weighted imaging be used to differentiate brain abscess from other ring-enhancing brain lesions? A meta-analysis. Clin Radiol 2014; 69:909-15. [PMID: 24933524 DOI: 10.1016/j.crad.2014.04.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 02/05/2023]
Abstract
AIM To explore the role of diffusion-weighted imaging (DWI) in the discrimination of brain abscess from other ring-enhancing brain lesions through meta-analysis. MATERIALS AND METHODS The PUMBED, OVID, and China National Knowledge Infrastructure (CNKI) databases, from January 1995 to March 2013, were searched for studies evaluating the diagnostic performance of DWI in the discrimination of brain abscess lesions. Using the data collected, pooled sensitivities and specificities across studies were determined, positive and negative likelihood ratios (LR) were calculated, and summary receiver operating characteristic (SROC) curves were constructed. RESULTS A total of 11 studies fulfilled all of the inclusion criteria and were considered for the analysis. The pooled sensitivity values and pooled specificity values including 95% confidence intervals (CI) were 0.95 (0.87-0.98) and 0.94 (0.88-0.97). The pooled positive LR (95% CI) was 4.13(2.55-6.7); the pooled negative LR (95% CI) was 0.01 (0-1.7); and the area under the curve of the symmetric SROC was 0.98. CONCLUSIONS DWI has high sensitivity and specificity for the differentiation of brain abscess from other intracranial cystic mass lesions.
Collapse
Affiliation(s)
- X-X Xu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - B Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - H-F Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Y Du
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Y Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - W-X Wang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - H-J Zheng
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Q-Y Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
| |
Collapse
|
35
|
Mitchell BC, Dehkharghani S. Imaging of intracranial infectious diseases in adults. APPLIED RADIOLOGY 2014. [DOI: 10.37549/ar2052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
36
|
Abstract
Infection of the central nervous system can be life-threatening and hence requires early diagnostic support for its optimal management. Routine definitive laboratory diagnostic tests can be time-consuming and delay definitive therapy. Noninvasive imaging modalities have established themselves in the diagnosis of various neurologic diseases. In this article, a pragmatic review of the current role of magnetic resonance spectroscopy in the diagnosis and management of intracranial infections is addressed.
Collapse
Affiliation(s)
- Rakesh K Gupta
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India.
| | | | | |
Collapse
|
37
|
Dennler M, Carrera I, Beckmann K, Ritz J, Rütten M, Kircher PR. Imaging diagnosis--Conventional and functional magnetic resonance imaging of a brain abscess in a goat. Vet Radiol Ultrasound 2013; 55:68-73. [PMID: 23663051 DOI: 10.1111/vru.12050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/27/2013] [Indexed: 11/30/2022] Open
Abstract
A 2-month-old female goat was presented for depressed mental status and multifocal central neurologic signs 3 weeks after hot-iron disbudding. Conventional magnetic resonance imaging (MRI) findings included a large intra axial mass in the left frontal lobe that was T2 hyperintense and T1 hypointense centrally with a contrast-enhancing peripheral capsule and perilesional T2 hyperintensity. A restrictive pattern was present in diffusion-weighted imaging. Magnetic resonance spectroscopy demonstrated an increased amount of succinate, acetate, amino acids, lipids; minimal amounts of lactate; and decreased amounts of N-acetyl aspartate and choline. A cerebral abscess due to Trueperella pyogenes was confirmed from necropsy and tissue culture.
Collapse
Affiliation(s)
- Matthias Dennler
- Division of Diagnostic Imaging, Vetsuisse Faculty University of Zurich, Winterthurerstrasse, 260 8057 Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
Central nervous system (CNS) infections—i.e., infections involving the brain (cerebrum and cerebellum), spinal cord, optic nerves, and their covering membranes—are medical emergencies that are associated with substantial morbidity, mortality, or long-term sequelae that may have catastrophic implications for the quality of life of affected individuals. Acute CNS infections that warrant neurointensive care (ICU) admission fall broadly into three categories—meningitis, encephalitis, and abscesses—and generally result from blood-borne spread of the respective microorganisms. Other causes of CNS infections include head trauma resulting in fractures at the base of the skull or the cribriform plate that can lead to an opening between the CNS and the sinuses, mastoid, the middle ear, or the nasopharynx. Extrinsic contamination of the CNS can occur intraoperatively during neurosurgical procedures. Also, implanted medical devices or adjunct hardware (e.g., shunts, ventriculostomies, or external drainage tubes) and congenital malformations (e.g., spina bifida or sinus tracts) can become colonized and serve as sources or foci of infection. Viruses, such as rabies, herpes simplex virus, or polioviruses, can spread to the CNS via intraneural pathways resulting in encephalitis. If infection occurs at sites (e.g., middle ear or mastoid) contiguous with the CNS, infection may spread directly into the CNS causing brain abscesses; alternatively, the organism may reach the CNS indirectly via venous drainage or the sheaths of cranial and spinal nerves. Abscesses also may become localized in the subdural or epidural spaces. Meningitis results if bacteria spread directly from an abscess to the subarachnoid space. CNS abscesses may be a result of pyogenic meningitis or from septic emboli associated with endocarditis, lung abscess, or other serious purulent infections. Breaches of the blood–brain barrier (BBB) can result in CNS infections. Causes of such breaches include damage (e.g., microhemorrhage or necrosis of surrounding tissue) to the BBB; mechanical obstruction of microvessels by parasitized red blood cells, leukocytes, or platelets; overproduction of cytokines that degrade tight junction proteins; or microbe-specific interactions with the BBB that facilitate transcellular passage of the microorganism. The microorganisms that cause CNS infections include a wide range of bacteria, mycobacteria, yeasts, fungi, viruses, spirochaetes (e.g., neurosyphilis), and parasites (e.g., cerebral malaria and strongyloidiasis). The clinical picture of the various infections can be nonspecific or characterized by distinct, recognizable clinical syndromes. At some juncture, individuals with severe acute CNS infections require critical care management that warrants neuro-ICU admission. The implications for CNS infections are serious and complex and include the increased human and material resources necessary to manage very sick patients, the difficulties in triaging patients with vague or mild symptoms, and ascertaining the precise cause and degree of CNS involvement at the time of admission to the neuro-ICU. This chapter addresses a wide range of severe CNS infections that are better managed in the neuro-ICU. Topics covered include the medical epidemiology of the respective CNS infection; discussions of the relevant neuroanatomy and blood supply (essential for understanding the pathogenesis of CNS infections) and pathophysiology; symptoms and signs; diagnostic procedures, including essential neuroimaging studies; therapeutic options, including empirical therapy where indicated; and the perennial issue of the utility and effectiveness of steroid therapy for certain CNS infections. Finally, therapeutic options and alternatives are discussed, including the choices of antimicrobial agents best able to cross the BBB, supportive therapy, and prognosis.
Collapse
Affiliation(s)
- A Joseph Layon
- Pulmonary and Critical Care Medicine, Geisinger Health System, Danville, Pennsylvania USA
| | - Andrea Gabrielli
- Departments of Anesthesiology & Surgery, University of Florida College of Medicine, Gainesville, Florida USA
| | | |
Collapse
|
39
|
Davies JM, Trinh VT, Sneed PK, McDermott MW. Radiotherapy for recurrent epidermoid cyst. J Neurooncol 2013; 112:307-13. [DOI: 10.1007/s11060-013-1065-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 02/02/2013] [Indexed: 12/25/2022]
|
40
|
Hsu SH, Chou MC, Ko CW, Hsu SS, Lin HS, Fu JH, Wang PC, Pan HB, Lai PH. Proton MR spectroscopy in patients with pyogenic brain abscess: MR spectroscopic imaging versus single-voxel spectroscopy. Eur J Radiol 2013; 82:1299-307. [PMID: 23453705 DOI: 10.1016/j.ejrad.2013.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/28/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Single-voxel spectroscopy (SVS) has been the gold standard technique to diagnose the pyogenic abssess. Two-dimensional magnetic resonance spectroscopic imaging (MRSI) is able to provide spatial distribution of metabolic concentration, and is potentially more suitable for differential diagnosis between abscess and necrotic tumors. Therefore, the purpose of this study was to evaluate the equivalence of MRSI and SVS in the detection of the metabolites in pyogenic brain abscesses. MATERIALS AND METHODS Forty-two patients with pyogenic abscesses were studied by using both SVS and MRSI methods. Two neuroradiologists reviewed the MRS data independently. A κ value was calculated to express inter-reader agreement of the abscesses metabolites, and a correlation coefficient was calculated to show the similarity of two spectra. After consensus judgment of two readers, the binary value of metabolites of pyogenic abscesses (presence or absence) was compared between SVS and MRSI. RESULTS The consistency of spectral interpretation of the two readers was very good (κ ranged from 0.95 to 1), and the similarity of two spectra was also very high (cc=0.9±0.05). After consensus judgment of two readers, the sensitivities of MRSI ranged from 91% (acetate) to 100% (amino acids, succinate, lactate, lipid), and the specificities of MRSI were 100% for detecting all metabolites with SVS as reference. CONCLUSION SVS and MRSI provide similar metabolites in the cavity of pyogenic brain abscess. With additional metabolic information of cavity wall and contralateral normal-appearing brain tissue, MRSI would be a more suitable technique to differentiate abscesses from necrotic tumors.
Collapse
Affiliation(s)
- Shuo-Hsiu Hsu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Rezvanizadeh A, Firouznia K, Salehi-Sadaghiani M, Mohseni M, Gharaei D, Ghanaati H, Saligheh Rad H, Masoudnia M. The effects of voxel localization and time of echo on the diagnostic accuracy of cystic brain tumors in 3 tesla magnetic resonance spectroscopy. IRANIAN JOURNAL OF RADIOLOGY 2013; 9:195-201. [PMID: 23407767 PMCID: PMC3569551 DOI: 10.5812/iranjradiol.7510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 08/11/2012] [Accepted: 08/15/2012] [Indexed: 11/28/2022]
Abstract
Background Although magnetic resonance spectroscopy (MRS) has been shown as an effective diagnostic tool in distinguishing inflammation from neoplasm in cystic brain lesions, the optimum approach in selecting the portions of lesions in MRS and the possible effects of different times of echoes (TEs) remains unknown. Objectives To determine the most effective TE in diagnosing neoplastic lesions based on detecting choline (Cho), N acetyl aspartate (NAA) and creatinine (Cr). Moreover, the role of voxel localization on the diagnosis of the neoplastic nature of the lesions is assessed through comparing the abovementioned metabolite ratios in the rim and center of each lesion with the same TE. Patients and Methods In 16 patients with brain cystic tumors, MRS was performed at TEs of 30, 135 and 270 ms for detection of Cho, NAA and Cr metabolites using a 3 tesla MRI unit. The percentage of analyzed ratios greater than a cut-off point of 1.3 for Cho/Cr and 1.6 for Cho/NAA were calculated. Results Cho/Cr and Cho/NAA ratio means at all TEs were more at the central area in comparison with the periphery, although none of the differences were statistically significant. There was no statistically significant difference among the compared TEs. The percentages of ratios above the cut-off point at all TEs were more in the rim compared to the center and in the union of both compared to the rim or center. All the patients had at least one voxel with a Cho/Cr ratio of more than 1.3 when the voxel was chosen according to the hotspots shown in the chemical shift imaging map, regardless of their location at all examined TEs. Conclusions Selection of voxels with the guide of chemical shift imaging map yields to 100% diagnostic sensitivity. If not accessible, the use of the union of peripheral and central voxels enhances the sensitivity when compared to usage of peripheral or central voxels solely.
Collapse
Affiliation(s)
- Alireza Rezvanizadeh
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kavous Firouznia
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Kavous Firouznia, Department of Radiology, Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Tel.: +98-21-66581579, Fax: +98-21-66581578, E-mail:
| | | | - Meisam Mohseni
- Department of Neurosurgery, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Dona Gharaei
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghanaati
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Saligheh Rad
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Masoudnia
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
42
|
Rath TJ, Hughes M, Arabi M, Shah GV. Imaging of Cerebritis, Encephalitis, and Brain Abscess. Neuroimaging Clin N Am 2012; 22:585-607. [DOI: 10.1016/j.nic.2012.04.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
43
|
Watanabe T, Ito E, Sato T, Ichikawa M, Oda K, Ando H, Matsumoto Y, Sakuma J, Saito K. Combined microsurgical and endoscopic removal of extensive suprasellar and prepontine epidermoid tumors. Neurol Med Chir (Tokyo) 2012; 51:684-8. [PMID: 22027242 DOI: 10.2176/nmc.51.684] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Epidermoids tend to grow around and adhere to critical neurovascular structures, but total or maximal tumor removal is recommended to reduce the risk of recurrence. We describe our method of combined microscopic and endoscopic resection for extensive epidermoid tumors. Thirteen patients with epidermoid tumors located in the suprasellar, prepontine, or surrounding cisterns underwent microsurgical resection with a rigid endoscope and a high definition camera system. An anterior petrosal and/or a pterional approach was selected in 6 patients and a lateral suboccipital approach in 7 patients. An endoscope was used with the operating microscope to remove 6 tumors through the anterior petrosal and/or pterional approaches in 5 cases and the lateral suboccipital approach in 1 case. An endoscope was used to confirm microscopic removal in 5 patients. Total removal was achieved in 5 patients and subtotal removal in 8 patients. We recommend the combined microsurgical and endoscopic approaches to achieve maximal resection of extensive suprasellar and prepontine epidermoids.
Collapse
Affiliation(s)
- Tadashi Watanabe
- Department of Neurosurgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Cuvinciuc V, Vargas MI, Lovblad KO, Haller S. Diagnosing infection of the CNS with MRI. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.11.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
45
|
Mialin R, Koob M, de Seze J, Dietemann JL, Kremer S. Case 173: Acute Disseminated Encephalomyelitis Confined to the Brainstem. Radiology 2011; 260:911-4. [DOI: 10.1148/radiol.11090557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
46
|
Bernabeu A, López-Celada S, Alenda C, Baño E. Epidermoid cyst with a metabolite pattern mimicking a brain abscess. A magnetic resonance spectroscopy study. J Neuroimaging 2011; 23:145-8. [PMID: 21699604 DOI: 10.1111/j.1552-6569.2011.00608.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial epidermal cysts are benign uncommon lesions. Such lesions arise from an inclusion of an ectodermal element during neural tube closure, in which dermal elements become trapped in the suture line, diploe, meninges, or scalp. Reports have extensively demonstrated the typical magnetic resonance (MR) spectra with the presence of large lactate signals with a virtual absence of healthy brain metabolites. METHODS A 20-year-old male patient with a parietal lobe brain lesion was studied by magnetic resonance imaging and magnetic resonance spectroscopy in a 1.5-T Philips scanner. RESULTS The lesion presented atypical MR spectra with presence of alanine (1.46 ppm), lactate (1.31 ppm), and amino acids such as valine, isoleucine (0.97 ppm), and glicine (3.52 ppm). No evidence of normal parenchyma tissue metabolites (N-acetylaspartate, creatine, and choline) or succinate and acetate signals was observed. This spectral pattern was unexpected being proposed the differential diagnosis of brain abscess versus epidermoid cyst. Finally, surgical total excision biopsy confirmed the diagnosis of epidermal cyst. CONCLUSIONS In this report, we describe a case of an epidermal cyst with an unusual metabolic pattern observed by magnetic resonance spectroscopy mimicking a brain abscess.
Collapse
Affiliation(s)
- Angela Bernabeu
- Department of Magnetic Resonance, Inscanner SL-Erescanner Salud Ute, Hospital General Universitario de Alicante, Alicante, Spain.
| | | | | | | |
Collapse
|
47
|
Fifi JT, Komotar R, Meyers P, Khandji A, Tanji K, Connolly ES. Restricted diffusion in a thrombosed anterior cerebral artery aneurysm mimicking a dermoid cyst. J Neuroimaging 2010; 22:85-8. [PMID: 20572913 DOI: 10.1111/j.1552-6569.2010.00495.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A neurologically intact 37-year-old woman presented with an acute severe frontal headache after a month of intermittent headaches. Multimodal radiological examination including computed tomography scan, magnetic resonance imaging, and conventional angiography demonstrated a 1 cm mass in the anterior interhemispheric region with heterogenous calcifications. Of note, MR revealed restricted diffusion within the mass. The presumptive diagnosis of dermoid tumor was made and the patient was scheduled for surgical resection. On operative exploration, a 1 cm thrombosed aneurysm was revealed. Thrombosed aneurysms must be considered in the differential diagnosis for midline cerebral masses with negative angiogram and restricted diffusion. This distinction has implications for the clinical management of the patient.
Collapse
Affiliation(s)
- Johanna T Fifi
- Department of Neurology and Radiology, St. Lukes Roosevelt Hospital, New York, NY 10025, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Cahill DP, Barker FG, Davis KR, Kalva SP, Sahai I, Frosch MP. Case records of the Massachusetts General Hospital. Case 10-2010. A 37-year-old woman with weakness and a mass in the brain. N Engl J Med 2010; 362:1326-33. [PMID: 20375410 DOI: 10.1056/nejmcpc1000960] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
49
|
Mortimer A, O'Leary S, Bradley M, Renowden SA. Pitfalls in the discrimination of cerebral abscess from tumour using diffusion-weighted MRI. Clin Radiol 2010; 65:488-92. [PMID: 20451017 DOI: 10.1016/j.crad.2009.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/05/2009] [Accepted: 12/07/2009] [Indexed: 01/22/2023]
Affiliation(s)
- A Mortimer
- Severn School of Radiology, Bristol, UK.
| | | | | | | |
Collapse
|
50
|
Differential diagnosis of intracranial ring enhancing cystic mass lesions--role of diffusion-weighted imaging (DWI) and diffusion-tensor imaging (DTI). Clin Neurol Neurosurg 2010; 112:218-25. [PMID: 20053496 DOI: 10.1016/j.clineuro.2009.11.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Revised: 11/16/2009] [Accepted: 11/26/2009] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To evaluate the contribution of DWI and DTI to the differential diagnosis of cerebral ring enhancing lesions by describing DWI and ADC (apparent diffusion coefficient) findings and measuring the two DTI parameters mean diffusivity (MD) and fractional anisotropy (FA). MATERIALS AND METHODS A total of 17 patients presenting with 26 rim enhancing cysts were investigated with DWI and DTI. Parameter maps of the DTI metrics MD and FA were calculated and quantified using regions of interest (ROIs). RESULTS Five patients suffered from abscesses with a total of 10 cysts, 9 from glioblastomas with 10 cysts, and 3 from metastases with 6 cysts. All abscess cavities showed hyperintense DWI signal intensity compared to normal appearing white matter (NAWM), low ADC, low MD and high FA. Eight out of 10 glioblastoma cysts and all 6 metastatic cysts revealed hypointensity on DWI, high ADC, high MD and low FA (p<0.0001 compared to abscess group). DWI findings of 2/10 glioblastoma cysts overlapped with those of abscesses showing hyperintensity on DWI, low ADC and low MD and hence mimicked abscesses. FA of these 2 glioblastoma cysts was significantly lower than in abscess cavities (p=0.032). CONCLUSION The findings of reduced diffusion compared to NAWM and increased FA within a ring enhancing cyst strongly indicate a cerebral abscess. In contrast, the majority of neoplastic cysts revealed high diffusion and low FA. Reduced diffusion is also found in a very small number of tumour cysts, but in these low FA refers to a non-infectious origin and thus helps distinguishing from infectious abscess.
Collapse
|