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Diffusion-Weighted Imaging of Cerebritis

Glenn A. Tunga and Jeffrey M. Rogga

a From the Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, Providence, RI



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  		FIG 1. Images acquired on hospital day 5 during the early stage of left orbitofrontal cerebritis.

A, FLAIR image (8000/105 [TR/TE]; TI, 2500) shows hyperintense subcortical white matter of left frontal lobe (arrow).

B, Postcontrast T1-weighted image (650/17) shows no contrast enhancement around an ill-defined hypointense area (arrow). Note mucosal enhancement in left frontal sinus (white arrow).

C, DW image (b = 1000 s/mm2) shows hyperintense signal (arrow) in frontal cerebritis.

D, ADC map shows hypointense signal intensity (arrow) indicating restricted water diffusion. Mean ADC is 0.41 ± 0.04 (10-3mm2/s).



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  		FIG 2. MR images acquired on hospital day 9 during the late stage of cerebritis or early stage of abscess.

A, Contrast-enhanced T1-weighted image (650/17) shows thin, faint peripheral contrast enhancement around a left frontal mass (arrow).

B, DW image (b = 1,000 s/mm2) demonstrates marked hyperintensity with a rim of even higher signal intensity (arrow).

C, Restricted diffusion is indicated by hypointensity (arrow) on this ADC map. Mean ADC is 0.59 ± 0.03 (10-3mm2/s).



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  		FIG 3. Images acquired before abscess aspiration on hospital day 15.

A, FLAIR image (9000/105; TI; 2500) shows a poorly defined left frontal mass (arrow).

B and C, Postcontrast axial (B) and coronal (C) T1-weighted images show a thin, well-defined enhancing wall, consistent with cerebral abscess.

D, DW image (b = 1000 s/mm2) shows marked increased signal intensity is present in this mass (arrow).

E, Marked hypointensity (arrow) on ADC map is consistent with restricted diffusion. Mean ADC is 0.56 ± 0.05 (10-3mm2/s).



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  		FIG 4. Images acquired after surgical aspiration and antifungal therapy; cerebral abscess has resolved, leaving focal gliosis.

A, FLAIR (7000/105; TI, 2500) shows hyperintense signal in the left frontal lobe (arrow).

B, Postcontrast T1-weighted image (650/17) shows a band of contrast enhancement at the site of treated abscess (arrow).

C, DW image (b = 1000 s/mm2) shows symmetric signal intensities in frontal lobes.

D, ADC map shows minimal hyperintensity (arrow) in left frontal lobe, a finding consistent with gliosis. Mean ADC is 1.87 ± 0.08 (10-3 m2/s).





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