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T2*-weighted MR angiography substantially increases the detection of hemorrhage in the wall of brain abscess: implications in clinical interpretation

  • Diagnostic Neuroradiology
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Abstract

Introduction

The purpose of the present study was to identify the true prevalence of hemorrhage in the abscess using T2*-weighted angiography (SWAN) imaging and to study its influence on diffusion tensor imaging (DTI) metrics.

Methods

Fifteen patients of brain abscess underwent conventional, SWAN, and DT imaging on a 3-T MRI followed by its confirmation with histology. DTI metrics were quantified by region-of-interest analysis on hemorrhagic and non-hemorrhagic regions of the abscess wall. Prussian blue staining was performed on excised abscess walls to confirm hemorrhage on histology.

Results

Eleven of 15 patients showed evidence of hemorrhage on both Prussian blue staining as well as SWAN imaging. Fractional anisotropy (FA) and linear anisotropy (CL) values were significantly higher, while spherical anisotropy was significantly lower in hemorrhagic compared to non-hemorrhagic regions of the abscess wall.

Conclusion

Hemorrhage in the abscess wall is a common feature and may not always indicate neoplasm. The presence of intracellular iron in addition to concentrically laid collagen fibers may have synergistic effect on FA and CL values in the abscess wall. Inclusion of SWAN to MRI protocol will define the true prevalence of hemorrhage in brain abscess.

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Acknowledgments

RA received financial assistance from the Indian Council of Medical Research, New Delhi, India.

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India

    Vaishali Tomar, Rishi Awasthi & Abhishek Yadav

  2. Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

    Kashi N. Prasad

  3. Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

    Sanjay Behari

  4. Department of Neurosurgery, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

    Vikas Bharadwaj & Bal K. Ojha

  5. Department of Pathology, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

    Nuzhat Husain

  6. Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, Uttar Pradesh, India

    Ram Kishore Singh Rathore

  7. MR Section, Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India

    Rakesh Kumar Gupta

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  1. Rakesh Kumar Gupta
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  2. Vaishali Tomar
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Correspondence to Rakesh Kumar Gupta.

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Gupta, R.K., Tomar, V., Awasthi, R. et al. T2*-weighted MR angiography substantially increases the detection of hemorrhage in the wall of brain abscess: implications in clinical interpretation. Neuroradiology 54, 565–572 (2012). https://doi.org/10.1007/s00234-011-0952-1

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  • DOI: https://doi.org/10.1007/s00234-011-0952-1

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