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In Vivo Proton MR Spectroscopy of Untreated and Treated Brain AbscessesGo,Go

Isabella M. BurtscherGo,a and Stig Holtåsa

a From the Department of Radiology, University Hospital, S-22185 Lund, Sweden.



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  		FIG 1. MR images of patient 1 with a brain abscess.

A–C, T1-weighted axial spin-echo images (630/17/2) before (A) and after (B) contrast injection, and T2-weighted axial fast spin-echo image (3710/90/1) (C).

D, The proton spectrum (2D chemical-shift PRESS sequence, 1500/270/2) from the abscess cyst, obtained 40 days after the start of initial antibiotic treatment and 12 days after the start of high-dose antibiotic treatment for suspected brain abscess, shows a single lactate peak at 1.3 ppm.



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  		FIG 2. MR images of patient 2 with a brain abscess.

A–C, T1-weighted axial spin-echo images (630/17/2) before (A) and after (B) contrast injection, and T2-weighted axial fast spin-echo image (3710/90/1) (C).

D, The proton spectrum (2D chemical-shift PRESS sequence, 1500/270/2) from the abscess cyst, obtained 1 day after the start of antibiotic treatment, shows succinate (Succ), acetate (Ac), alanine (Ala), lactate (Lac), and amino acids (AA).

E, At a TE of 135, the resonances at 1.5, 1.3, and 0.9 ppm are inverted, which confirms the assignment to alanine, lactate, and amino acids, respectively.



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  		FIG 3. MR images of patient 3.

A–C, T1-weighted axial spin-echo images (630/17/2) before (A) and after (B) contrast injection, and T2-weighted axial fast spin-echo image (3710/90/1) (C).

D, Image shows the area of the spectroscopy measurement and the placement of the voxel representing the spectrum (see E).

E, The proton spectrum (2D chemical-shift PRESS sequence, 1500/270/2) from the abscess cyst shows resonances representing succinate (Succ), acetate (Ac), alanine (Ala), lactate (Lac), and amino acids (AA). Visible small resonances of Cho, Cr, and NAA were interpreted to be caused by partial volume effects. A follow-up examination 2 weeks after the first MR spectroscopic measurement and the institution of high-dose antibiotic therapy revealed a dramatic change in the spectrum from the abscess cyst.

F and G, All resonances but lactate disappeared (F), a finding that was confirmed by another two follow-up examinations 9 days (G) and 84 days later.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X