Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Cartes-Zumelzu, F. W. Articles by Thurnher, M. M. Search for Related Content PubMed PubMed Citation Articles by Cartes-Zumelzu, F. W. Articles by Thurnher, M. M.

American Journal of Neuroradiology 25:1310-1317, September 2004
© 2004 American Society of Neuroradiology

BRAIN

Diffusion-Weighted Imaging in the Assessment of Brain Abscesses Therapy

Fabiola W. Cartes-Zumelzu^a, Ioannis Stavrou^b, Mauricio Castillo^c, Edith Eisenhuber^a, Engelbert Knosp^b and Majda M. Thurnher^a

^a Department of Radiology, Neuroradiology Section, University Hospital, Vienna
^b the Department of Neurosurgery, University Hospital, Vienna
^c the Department of Neuroradiology, University of North Carolina School of Medicine, Chapel Hill

Address reprint requests to Majda M. Thurnher MD, Professor of Radiology, University Hospital Vienna, Department of Radiology, Neuroradiology Section, Waehringer Guertel 18–20,1090-Vienna, Austria

BACKGROUND AND PURPOSE: Surgically or conservatively treated brain abscesses may resolve, or pus may re-accumulate, requiring further intervention or treatment change. We hypothesized that diffusion-weighted (DW) imaging is useful in depicting features of abscesses related to therapeutic success or failure.

METHODS: Conventional contrast-enhanced T1- and T2-weighted imaging and DW imaging were performed in seven patients (aged 30–69 years) with proved pyogenic brain abscesses. The center of the abscess was qualitatively and quantitatively analyzed at initial and follow-up imaging in all patients. We correlated the signal intensity on trace DW images and the apparent diffusion coefficients (ADCs) with the clinical and laboratory data, particularly with respect to treatment failure and repeat therapy.

RESULTS: Surgical drainage was performed in six patients; one patient was treated with only antibiotics. All abscess cavities initially had high signal intensity (restricted diffusion) on DW images, with a mean ADC value of 0.52 x 10 ^–3mm ²/s. Low signal intensity at DW imaging with high ADC were seen on follow-up images in the patient receiving medication and in four patients in whom the abscesses were drained; this correlated with a good therapeutic response. Two patients underwent drainage; their second follow-up DW images showed areas of high signal intensity and low ADC values suggesting re-accumulation of pus. Increased C-reactive protein level and WBC count correlated well with DW image findings.

CONCLUSION: DW imaging was superior to conventional MR imaging in evaluating the success or failure of abscess therapy. Restricted diffusion in a drained abscess corresponded to pus.

This article has been cited by other articles:

				R.K. Gupta, K. Nath, A. Prasad, K.N. Prasad, M. Husain, R.K.S. Rathore, N. Husain, C. Srivastava, P. Khetan, R. Trivedi, et al. In Vivo Demonstration of Neuroinflammatory Molecule Expression in Brain Abscess with Diffusion Tensor Imaging AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 326 - 332. [Abstract] [Full Text] [PDF]

				M. J. D. Post A New Era in Neuroradiology: Ex Vivo Validation of In Vivo Imaging Research AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 212 - 213. [Full Text] [PDF]

				G. Luthra, A. Parihar, K. Nath, S. Jaiswal, K.N. Prasad, N. Husain, M. Husain, S. Singh, S. Behari, and R.K. Gupta Comparative Evaluation of Fungal, Tubercular, and Pyogenic Brain Abscesses with Conventional and Diffusion MR Imaging and Proton MR Spectroscopy AJNR Am. J. Neuroradiol., August 1, 2007; 28(7): 1332 - 1338. [Abstract] [Full Text] [PDF]

				Z. Rumboldt, C. Moses, U. Wieczerzynski, and R. Saini Diffusion-Weighted Imaging, Apparent Diffusion Coefficients, and Fluid-Attenuated Inversion Recovery MR Imaging in Endophthalmitis AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1869 - 1872. [Abstract] [Full Text] [PDF]

				T. P. Duprez, G. Cosnard, and D. Hernalsteen Diffusion-weighted Monitoring of Conservatively Treated Pyogenic Brain Abscesses: A Marker for Antibacterial Treatment Efficacy AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1296 - 1298. [Full Text] [PDF]

				I. Khramor The Promises and Challenges of Rigorous Research AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1298 - 1298. [Full Text] [PDF]

				A. J. Holz Conventional T1-Weighted Imaging in the Diagnosis and Assessment of Brain Abscesses AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1298 - 1300. [Full Text] [PDF]