Cerebral abscesses and necrotic cerebral tumours: differential diagnosis by perfusion-weighted magnetic resonance imaging

Ascessi cerebrali e tumori cerebrali necrotici: diagnosi differenziale mediante risonanza magnetica con tecnica di perfusione

La radiologia medica volume 113, pages747–757(2008)Cite this article

Abstract

Purpose

This study was undertaken to evaluate the usefulness of perfusion-weighted imaging (PWI) in the differential diagnosis of ring-enhancing cerebral lesions, including abscesses, high-grade gliomas and metastases.

Materials and methods

Nine cerebral abscesses (five pyogenic, four from Toxoplasma gondii), ten glioblastomas and five cerebral metastases in 19 patients were studied with gadolinium-enhanced magnetic resonance imaging, diffusion-weighted imaging (DWI) including calculation of mean apparent diffusion coefficient (ADC) of the lesion core, and PWI. At PWI, the mean of the maximum regional cerebral blood volume (rCBV) was calculated in the gadolinium-enhancing peripheral solid areas and compared with that of the contralateral normal-appearing white matter [ratio=rCBV (lesion)/rCBV (contralateral normal-appearing white matter)].

Results

DWI achieved the differential diagnosis in all cases except for the four Toxoplasma abscesses. At PWI, the mean ratio of the rCBV of the capsular portion was 0.72±0.08 (range 0.60–0.82) in the pyogenic abscesses, 0.84±0.07 (range 0.75–0.91) in the Toxoplasma abscesses, 4.45±1.5 (range 2.9–8.0) in the high-grade gliomas and 3.58±0.68 (range 3.28–4.27) in the metastases.

Conclusions

PWI seems to be useful in the differential diagnosis of ring-enhancing cerebral lesions. High rCBV values in the peripheral areas appear to indicate the possibility of a necrotic tumour, whereas low values tend to indicate an abscess.

Riassunto

Obiettivo

Valutare l’utilità della perfusione-RM nella diagnosi differenziale delle lesioni cerebrali con “ringenhancement”, quali ascessi, gliomi di alto grado e metastasi.

Materiali e metodi

Nove ascessi cerebrali (5 da piogeni, 4 da Toxoplasma gondii), 10 glioblastomi e 5 metastasi cerebrali in 19 pazienti sono stati studiati con risonanza magnetica con gadolinio endovena, diffusione-RM con calcolo del valore medio del coefficiente di diffusione apparente (DWI-ADC) del centro della lesione e perfusione-RM. Alla perfusione-RM, il valore medio del massimo volume ematico cerebrale regionale (rCBV) è stato calcolato nelle aree solide periferiche e confrontato con quelli della sostanza bianca controlaterale di aspetto normale [ratio=rCBV(lesione)/rCBV(sostanza bianca controlaterale)].

Risultati

La DWI-ADC ha consentito la diagnosi differenziale in tutti i casi, ad eccezione dei 4 ascessi da Toxoplasma gondii. Alla perfusione-RM, la ratio media del rCBV della porzione capsulare è stata di 0,72±0,08 (range: 0,6–0,82) negli ascessi da piogeni, 0,84±0,07 (range: 0,75–0,91) negli ascessi da Toxoplasma gondii, 4,45±1,5 (range: 2,9–8) nei gliomi di alto grado e 3,58±0,68 (range: 3,28–4,27) nelle metastasi.

Conclusioni

La perfusione-RM fornisce utili elementi alla diagnosi differenziale delle lesioni cerebrali con “ringenhancement”. Alti valori del rCBV nelle aree periferiche dovrebbero indurre al sospetto di tumore necrotico, mentre bassi valori del rCBV possono orientare verso l’ascesso.

This is a preview of subscription content, access via your institution.

References/Bibliografia

  1. 1.

    Haimes AD, Zimmerman RD, Morgello S et al (1989) MR imaging of brain abscesses. AJR Am J Roentgenol 152:1073–1085

    PubMed  CAS  Google Scholar 

  2. 2.

    Schwartz KM, Erickson BJ, Lucchinetti C (2006) Pattern of T2 hypointensity associated with ring-enhancing brain lesion can help to differentiate pathology. Neuroradiology 48:143–149

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Mascalchi M, Filippi M, Floris R et al (2005) Diffusion weighted MR of the brain: methodology and clinical applications. Radiol Med 109:155–197

    Google Scholar 

  4. 4.

    Krabbe K, Gideon P, Wagn P et al (1997) MR diffusion imaging of human intracranial tumours. Neuroradiology 39:483–489

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Piattella MC, Caramia F, Pantano P et al (2001) Diffusion weighted MR imaging in differential diagnosis between brain tumor and abscess: two cases and revision of the literature. Radiol Med 102:278–280

    CAS  Google Scholar 

  6. 6.

    Batra A, Tripathi RP (2004) Atypical diffusion-weighted magnetic resonance findings in glioblastoma multiforme. Australias Radiol 48:388–391

    Article  CAS  Google Scholar 

  7. 7.

    Hakyemez B, Erdogan C, Yildirim N et al (2005) Glioblastoma multiforme with atypical diffusion weighted MR finding. Br J Radiol 78:989–992

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Holtas S, Geijer B, Stromblad LG et al (2000) A ring-enhancing metastasis with central high signal on diffusionweighted imaging and low apparent diffusion coefficient. Neuroradiology 42:824–827

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Hartmann M, Jansen O, Heiland S et al (2001) Restricted diffusion within ring enhancement is not pathognomonic for brain abscess. AJNR Am J Neuroradiol 22:1738–1742

    PubMed  CAS  Google Scholar 

  10. 10.

    Tung GA, Evangelista P, Rogg JM et al (2001) Diffusion-weighted MR imaging of rim enhancing brain masses: is markedly decreased water diffusion specific for brain abscess? AJR Am J Roentgenol 177:709–712

    PubMed  CAS  Google Scholar 

  11. 11.

    Camacho DLA, Smith JK, Castillo M (2003) Differentiation of toxoplasmosis and lymphoma in AIDS patients by using apparent diffusion coefficients. AJNR Am J Neuroradiol 24:633–637

    PubMed  Google Scholar 

  12. 12.

    Chong-Han, Cortez SC, Tung GA (2003) Diffusion-weighted MRI of cerebral toxoplasma abscess. AJR Am J Roentgenol 181:1711–1714

    PubMed  Google Scholar 

  13. 13.

    Batra A, Tripathi RP, Gorthi SP (2004) Magnetic resonance evaluation of cerebral toxoplasmosis in patients with the acquired immunodeficiency syndrome. Acta Radiol 45:121–221

    Google Scholar 

  14. 14.

    Lai PH, Ho JT, Chen WL et al (2002) Brain abscess and necrotic brain tumor: discrimination with proton MR spectroscopy and diffusion-weighted imaging. AJNR Am J Neuroradiol 23:1369–1377

    PubMed  Google Scholar 

  15. 15.

    Kimura T, Sako K, Gotoh T et al (2001) In vivo single-voxel proton MR spectroscopy in brain lesion with ringlike enhancement. NMR Biomed 14:339–349

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Nakaiso M, Uno M, Harada M et al (2002) Brain abscess and glioblastoma identified by combined proton magnetic resonance spectroscopy and diffusion weighted magnetic resonance imaging. Two cases report. Neurol Med Chir (Tokyo) 42:346–348

    Article  Google Scholar 

  17. 17.

    Cha S, Knopp EA, Johnson G et al (2002) Intracranial mass lesion: dynamic contrast-enhancement susceptibility-weighted echo-planar perfusion MR imaging. Radiology 223:11–29

    PubMed  Article  Google Scholar 

  18. 18.

    Calli C, Kitis O, Yunten N et al (2006) Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors. Eur J Radiol 58:394–403

    PubMed  Article  Google Scholar 

  19. 19.

    Hakyemez B, Erdogan C, Bolca N et al (2006) Evaluation of different cerebral mass lesions by perfusion-weighted MR imaging. J Magn Reson Imaging 24:817–824

    PubMed  Article  Google Scholar 

  20. 20.

    Provenzale JM, Mukundan S, Barboriak DP (2006) Diffusion-weighted and perfusion MR imaging for brain tumor characterization and assessment of treatment response. Radiology 239:632–649

    PubMed  Article  Google Scholar 

  21. 21.

    Rollin N, Guyotat J, Streichenbergr N et al (2006) Clinical relevance of diffusion and perfusion magnetic resonance imaging in assessing intraaxial brain tumors. Neuroradiology 48:150–159

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Ernst TM, Chang L, Witt MD et al (1998) Cerebral toxoplasmosis and lymphoma in AIDS: perfusion MR imaging experience in 13 patients. Radiology 208:663–669

    PubMed  CAS  Google Scholar 

  23. 23.

    Chan JH, Tsui EY, Chau LF et al (2002) Discrimination of an infected brain tumor froma a cerebral abscess by combined MR perfusion and diffusion imaging. Comput Med Imaging Graph 26:19–23

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Holmes TM, Petrella JR, Provenzale JM (2004) Distinction between cerebral abscesses and high-grade neoplasms by dynamic susceptibility contrast perfusion MRI. AJR Am J Roentgenol 183:1247–1252

    PubMed  Google Scholar 

  25. 25.

    Erdogan C, Hakyemez B, Yildirim N et al (2005) Brain abscess and cystic brain tumor. Discrimination with dynamic susceptibility contrast perfusionweighted MRI. J Comput Assist Tomogr 29:663–667

    PubMed  Article  Google Scholar 

  26. 26.

    Cartes-Zumelzu FW, Stavrou I, Castillo M et al (2004) Diffusion weighted imaging in the assessment of brain abscesses therapy. AJNR Am J Neuroradiol 25:1310–1317

    PubMed  Google Scholar 

  27. 27.

    Chinn RJ, Wilkinson ID, Hall-Craggs MA et al (1995) Toxoplasmosis and primary central nervous system lymphoma in HIV infection: diagnosis with MR spectroscopy. Radiology 197:649–654

    PubMed  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. U.O. Neuroradiologia, Dipartimento di Neuroscienze, A.O. “G. Rummo”, Via dell’Angelo 1, 82100, Benevento, Italy

    C. F. Muccio, G. Esposito & A. Bartolini

  2. U.O.C. Neuroradiologia Diagnostica e Terapeutica, Azienda Ospedaliera Universitaria Senese, Policlinico “Santa Maria alle Scotte”, Viale Mario Bracci, 53100, Siena, Italy

    A. Cerase

Authors
  1. C. F. Muccio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Esposito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Bartolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Cerase
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. F. Muccio.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Muccio, C.F., Esposito, G., Bartolini, A. et al. Cerebral abscesses and necrotic cerebral tumours: differential diagnosis by perfusion-weighted magnetic resonance imaging. Radiol med 113, 747–757 (2008). https://doi.org/10.1007/s11547-008-0254-9

Download citation

Keywords

  • Cerebral abscess
  • Cerebral tumours
  • Diffusion-weighted imaging
  • Perfusion-weighted imaging Ring-enhancement

Parole chiave

  • Ascesso cerebrale
  • “Ring-enhancement”
  • Diffusione-RM
  • Perfusione-RM
  • Tumori cerebrali