Abstract
Introduction
The aim of this study was to investigate the appearance of fungal brain abscesses on diffusion-weighted (DW) images, and to evaluate whether the imaging characteristics and apparent diffusion coefficient (ADC) values associated with fungal abscesses were distinct from those of bacterial abscesses.
Methods
We retrospectively reviewed the MR images from nine patients with fungal brain infections, and 17 patients with pyogenic brain abscesses. All patients underwent conventional MR sequences and DW imaging on 1.5-T clinical MR scanners. ADC values of 20 fungal and 20 bacterial brain abscesses were calculated and compared using a random factor analysis of variance.
Results
Multiple lesions were present in 6 of 9 patients (67%) with fungal abscesses and in 5 of 17 patients (29%) with bacterial abscesses. On DW images, all but one bacterial brain abscess showed a homogeneous high signal, whereas the appearance of fungal abscesses on DW images was more variable: in five of nine patients with fungal abscesses, the lesions were homogeneously hyperintense, while in the remaining four patients, the lesions were of mixed signal intensity. Mean ADC values were 0.74 × 10−3 mm2/s in the fungal group and 0.486 × 10−3 mm2/s in the bacterial group (P≤0.05).
Conclusion
Our results indicate that there is a trend towards higher ADC values in fungal lesions. Additional findings that support fungal rather than bacterial cerebral infection are multiplicity, signal heterogeneity on T2-weighted and DW imaging, and involvement of deep grey-matter nuclei.
Similar content being viewed by others
References
Calfee DP, Wispelwey B (2000) Brain abscess. Semin Neurol 20:353–360
Falcone S, Post MJ (2000) Encephalitis, cerebritis, and brain abscess: pathophysiology and imaging findings. Neuroimaging Clin N Am 10:333–353
Thurnher MM, Castillo M (2005) Imaging in acute stroke. Eur Radiol 15:408–415
Dorenbeck U, Butz B, Schlaier J, Bretschneider T, Schuierer G, Feuerbach S (2003) Diffusion-weighted echo-planar MRI of the brain with calculated ADCs: a useful tool in the differential diagnosis of tumor necrosis from abscess? J Neuroimaging 13:330–338
Cartes-Zumelzu FW, Stavrou I, Castillo M, Eisenhuber E, Knosp E, Thurnher MM (2004) Diffusion-weighted imaging in the assessment of brain abscesses therapy. AJNR Am J Neuroradiol 25:1310–1317
Mishra AM, Gupta RK, Jaggi RS, Reddy JS, Jha DK, Husain N, Prasad KN, Behari S, Husain M (2004) Role of diffusion-weighted imaging and in vivo proton magnetic resonance spectroscopy in the differential diagnosis of ring-enhancing intracranial cystic mass lesions. J Comput Assist Tomogr 28:540–547
Lai PH, Ho JT, Chen WL, Hsu SS, Wang JS, Pan HB, Yang CF (2002) Brain abscess and necrotic brain tumor: discrimination with proton MR spectroscopy and diffusion-weighted imaging. AJNR Am J Neuroradiol 23:1369–1377
Mishra AM, Gupta RK, Saksena S, Prasad KN, Pandey CM, Rathore D, Purwar A, Rathore RK, Husain N, Jha DK, Jaggi RS, Husain M (2005) Biological correlates of diffusivity in brain abscess. Magn Reson Med 54:878–885
Gaviani P, Schwartz RB, Hedley-Whyte ET, Ligon KL, Robicsek A, Schaefer P, Henson JW (2005) Diffusion-weighted imaging of fungal cerebral infection. AJNR Am J Neuroradiol 26:1115–1121
Keyik B, Edguer T, Hekimoglu B (2005) Conventional and diffusion-weighted MR imaging of cerebral aspergillosis. Diagn Interv Radiol 11:199–201
Ho TL, Lee HJ, Lee KW, Chen WL (2005) Diffusion-weighted and conventional magnetic resonance imaging in cerebral cryptococcoma. Acta Radiol 46:411–414
Stadnik TW, Chaskis C, Michotte A, Shabana WM, van Rompaey K, Luypaert R, Budinsky L, Jellus V, Osteaux M (2001) Diffusion-weighted MR imaging of intracerebral masses: comparison with conventional MR imaging and histologic findings. AJNR Am J Neuroradiol 22:969–976
Guo AC, Provenzale JM, Cruz LC Jr, Petrella JR (2001) Cerebral abscesses: investigation using apparent diffusion coefficient maps. Neuroradiology 43:370–374
Noguchi K, Watanabe N, Nagayoshi T, Kanazawa T, Toyoshima S, Shimizu M, Seto H (1999) Role of diffusion-weighted echo-planar MRI in distinguishing between brain abscess and tumour: a preliminary report. Neuroradiology 41:171–174
Leuthardt EC, Wippold FJ 2nd, Oswood MC, Rich KM (2002) Diffusion-weighted MR imaging in the preoperative assessment of brain abscesses. Surg Neurol 58:395–402
Guzman R, Barth A, Lovblad KO, El-Koussy M, Weis J, Schroth G, Seiler RW (2002) Use of diffusion-weighted magnetic resonance imaging in differentiating purulent brain processes from cystic brain tumors. J Neurosurg 97:1101–1107
Tsui EY, Chan JH, Cheung YK, Lai KF, Fong D, Ng SH (2002) Evaluation of cerebral abscesses by diffusion-weighted MR imaging and MR spectroscopy. Comput Med Imaging Graph 26:347–351
Desprechins B, Stadnik T, Koerts G, Shabana W, Breucq C, Osteaux M (1999) Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. AJNR Am J Neuroradiol 20:1252–1257
Miaux Y, Ribaud P, Williams M, Guermazi A, Gluckman E, Brocheriou C, Laval-Jeantet M (1995) MR of cerebral aspergillosis in patients who have had bone marrow transplantation. AJNR Am J Neuroradiol 16:555–562
Yuh WT, Nguyen HD, Gao F, Tali ET, Fisher DJ, Mayr NA, Mueller DP, Sato Y, Trigg ME, Gingrich R (1994) Brain parenchymal infection in bone marrow transplantation patients: CT and MR findings. AJR Am J Roentgenol 162:425–430
Kami M, Shirouzu I, Mitani K, Ogawa S, Matsumura T, Kanda Y, Masumoto T, Saito T, Tanaka Y, Maki K, Honda H, Chiba S, Ohtomo K, Hirai H, Yazaki Y (1999) Early diagnosis of central nervous system aspergillosis with combination use of cerebral diffusion-weighted echo-planar magnetic resonance image and polymerase chain reaction of cerebrospinal fluid. Intern Med 38:45–48
Yamada K, Zoarski GH, Rothman MI, Zagardo MT, Nishimura T, Sun CC (2001) An intracranial aspergilloma with low signal on T2-weighted images corresponding to iron accumulation. Neuroradiology 43:559–561
Cox J, Murtagh FR, Wilfong A, Brenner J (1992) Cerebral aspergillosis: MR imaging and histopathologic correlation. AJNR Am J Neuroradiol 13:1489–1492
Schwartz KM, Erickson BJ, Lucchinetti C (2006) Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology. Neuroradiology 48:143–149
Dietrich U, Hettmann M, Maschke M, Doerfler A, Schwechheimer K, Forsting M (2001) Cerebral aspergillosis: comparison of radiological and neuropathologic findings in patients with bone marrow transplantation. Eur Radiol 11:1242–1249
Conflict of interest statement
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mueller-Mang, C., Castillo, M., Mang, T.G. et al. Fungal versus bacterial brain abscesses: is diffusion-weighted MR imaging a useful tool in the differential diagnosis?. Neuroradiology 49, 651–657 (2007). https://doi.org/10.1007/s00234-007-0242-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-007-0242-0