Use of Diffusion-Weighted MR Imaging in Differential Diagnosis Between Intracerebral Necrotic Tumors and Cerebral Abscesses
Brigitte Desprechins
,a,
Tadeusz Stadnika,
Guus Koertsa,
Wael Shabanaa,
Catherine Breucqa and
Michel Osteauxa
a From the Departments of Radiology and Medical Imaging (B.D., T.S., W.S., C.B., M.O.) and Neurosurgery (G.K.), University Hospital V.U.B., Brussels, Belgium.
View larger version (150K):
[in a new window]
|
FIG 1. 51-year-old man with cerebral abscess.
A—C, T2-weighted fast spin-echo (5000/128/2/6 [TR/TE/excitations/slice thickness]) (A) and T1-weighted spin-echo without (600/14/2/6) (B) and with (C) gadolinium injection show nonspecific "ring-enhancing" mass.
D—E, Diffusion-weighted ("z" sensitising direction) multishot echo-planar sequence (D) (800/123/5/6) and corresponding ADC map (E) show central hyperintensity on diffusion-weighted image with very low ADC values (.25—.33 x 10-3 mm2/sec).
| |
View larger version (149K):
[in a new window]
|
FIG 2. 70-year-old man with cerebral abscess.
A—C, T2-weighted fast spin-echo (5300/128/2/6) (A) and T1-weighted spin-echo images without (600/14/2/6) (B) and with (C) gadolinium injection show nonspecific "ring-enhancing" mass. Initial radiologic and clinical diagnosis was necrotic glioblastoma.
D—E, Diffusion-weighted ("z" sensitizing direction) multishot echo-planar image (D) (800/123/5/6) and corresponding ADC map (E) show important decrease of diffusion with very low ADC values (.21—.34 x 10-3 mm2/sec) suggesting diagnosis of abscess.
| |
View larger version (193K):
[in a new window]
|
FIG 3. 60-year-old man with glioblastoma multiforme.
A—B, Using T2-weighted fast spin-echo (A)(6000/128/2/6) and enhanced T1-weighted spin-echo (B) (600/14/2/6) imaging, differential diagnosis between glioblastoma and abscess is impossible.
C—D, Diffusion-weighted ("z" sensitizing direction) multishot echo-planar images (800/123/5/6) (C) and corresponding ADC map (D) show central hypointensity on diffusion-weighted image and hyperintensity on ADC map consistent with diagnosis of tumor.
| |
View larger version (188K):
[in a new window]
|
FIG 4. 57-year-old woman with cerebral metastasis.
A—B, On T2-weighted fast spin-echo (A)(6000/128/1/6) and enhanced T1-weighted spin-echo images (B) (600/14/2/6) the differential diagnosis between metastasis and abscess is impossible.
C—D, Diffusion-weighted ("z" sensitizing direction) multishot echo-planar image (800/123/5/6) (C) and corresponding ADC map (D) show central hypointensity on diffusion-weighted image and hyperintensity on ADC map consistent with diagnosis of tumor.
| |
