Diagnostic Accuracy of Diffusion Weighted MRI in the Diagnosis of Brain Abscess

Muhammad Saad Ahmed; Muhammad kashif shazlee; Rahila Usman; Kamran Hamid; Junaid Iqbal; Imaas Hussain

Diagnostic Accuracy of Diffusion Weighted MRI in the Diagnosis of Brain Abscess

Muhammad Saad Ahmed, Muhammad kashif shazlee, Rahila Usman, Kamran Hamid, Junaid Iqbal, Imaas Hussain

Abstract

ABSTRACT

INTRODUCTION: Brain abscess is a serious life threatening infection of brain parenchyma. There is a high mortality rate of approximate 10% and may reach up to 80%. Due to its high morbidity and mortality, there is a need of early diagnosis and prompt treatment.MRI plays an important role to differentiate various brain lesions due to its multiplaner capability and high resolution. Diffusion-weighted MRI (DWI) has been reported to be very sensitive and efficient tool than conventional MRI in diagnosing brain abscess by virtue of restricted diffusion. To our knowledge, no local data is focused on Diffusion-weighted MRI sensitivity in the diagnosis of brain abscess.. Early diagnosis through Diffusion-weighted MRI would eliminate the need for invasive diagnostic and surgical procedures and lead to earlier starting of treatment and hence will substantially reduce the morbidity of this condition.

The objective of this study was to determine the diagnostic accuracy of Diffusion-Weighted MRI in the diagnosis of brain abscesses taking histopathological findings as gold standard.

material and methods:

This descriptive study was conducted in radiology department of ziauddin university hospital during a period of six months from May 2013 to october 2013.136 patients were selected through non probability purposive sampling.

RESULT: A group of 136 patients in which 90 patients were males and 46 patients were females with clinical suspicion of brain abscess were included in this study. Out of 136 patients, 86 patients diagnosed as brain abscess on histopathology. Out of 86 patients, 85 were positive on Diffusion weighted images. Therefore, Diffusion Weighted MRI had 98.83% sensitivity, 94.0% specificity and 97.05% diagnostic accuracy for the diagnosis of brain abscess.

CONCLUSION: Diffusion weighted sequence in MRI examination has an important role in the diagnosis of brain abscess. The overall diagnostic accuracy of diffusion weighted MRI in the diagnosis of brain abscess in patients with clinical signs and symptoms are very close to histopathological findings. Diffusion weighted MRI should be recommended as a routine method in patients with clinical suspicion of brain abscess..

KEY WORDS: Magnetic resonance imaging, Diffusion weighted sequence, abscess and histopathology.

Full Text:

PDF

References

Mehnaz A, Syed AU, Saleem AS, Khalid CN. Clinical features and outcome of cerebral abscess in congenital heart disease. J Ayub Med Coll Abbottabad. 2006;18(2):21-4.

Qasim M, Razaq MN, Saddiqe M, Ilyas M, Khattak A. Management of supratentorial brain abscess. J Postgrad Med Inst. 2010;24(02):91-4.

Thomas LE, Goldstein JN. Brain abscess in emergency medicine. Medscape reference. Drugs, diseases & procedures. [Online]. 2010 [cited 2010 May 13]; Available from: URL: http://emedicine.medscape.com/article/781021-overview

Honda H, Warren DK. Central nervous system infections: meningitis and brain abscess. Infect Dis Clin North Am. 2009;23(3):609-23.

Chiang IC, Hsieh TJ, Chiu ML, Liu GC, Kuo YT, Lin WC. Distinction between pyogenic brain abscess and necrotic brain tumour using 3-tesla MR spectroscopy, diffusion and perfusion imaging. Br J Radiol. 2009;82(982):813-20.

Kamran S, Bener AB, Alper D, Bakshi R. Role of fluid-attenuated inversion recovery in the diagnosis of meningitis: comparison with contrast-enhanced magnetic resonance imaging. J Comput Assist Tomogr. 2004;28(1):68-72.

Fertikh D, Krejza J, Cunqueiro A, Danish S, Alokaili R, Melhem ER. Discrimination of capsular brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging. J Neurosurg. 2007;106(1):76-81.

Reddy JS, Mishra AM, Behari S, Husain M, Gupta V, Rastogi M, et al. The role of diffusion-weighted imaging in the differential diagnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol. 2006;66(3):246-51.

Mueller-Mang C, Castillo M, Mang TG, Cartes-Zumelzu F, Weber M, Thurner MM. Fungal versus bacterial brain abscesses: is diffusion weighted MR imaging a useful tool in differentiating diagnosis? Neuroradiology. 2007;49(8):651-7.

Lai PH, Hsu SS, Ding SW, Ko CW, Fu JH, Weng MG. Proton magnetic resonance spectroscopy and diffusion-weighted imaging in intracranial cystic mass lesions. Surg Neurol. 2007;68:25-36.

Lu CH, Chang WN, Lui CC. Strategies for the management of bacterial brain abscess. J Clin Neurosci. 2006;13(10):979-85.

Sharma R, Mohandas K, Cooke RP. Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection. 2009;37(1):39-43.

Menon S, Bharadwaj R, Chowdhary A, Kaundinya DV, Palande DA. Current epidemiology of intracranial abscesses: a prospective 5 year study. J Med Microbiol. 2008;57(Pt 10):1259-68.

Gallitelli M, Lepore V, Pasculli G, Di Gennaro L, Logroscino G, Carella A et al. Brain abscess: a need to screen for pulmonary arteriovenous malformations. Neuroepidemiology. 2005;24(1-2):76-8.

Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis. 2007;26(1):1-11.

Seydoux C, Francioli P. Bacterial brain abscesses: factors influencing mortality and sequelae. Clin Infect Dis. 1992;15(3):394-401.

Vidal JE, Penalva de Oliveira AC, Bonasser Filho F, Schiavon Nogueira R, Dauar RF, Leite AG, et al. Tuberculous brain abscess in AIDS patients: report of three cases and literature review. Int J Infect Dis. 2005;9(4):201-7.

Lakshmi V, Umabala P, Anuradha K, Padmaja K, Padmasree C, Rajesh A et al. Microbiological spectrum of brain abscess at a tertiary care hospital in south India: 24-year data and review. Patholog Res Int. 2011;2011:583139.

Prasad KN, Mishra AM, Gupta D, Husain N, Husain M, Gupta RK. Analysis of microbial etiology and mortality in patients with brain abscess. J Infect. 2006;53(4):221-7.

Menon S, Bharadwaj R, Chowdhary A, Kaundinya DV, Palande DA. Current epidemiology of intracranial abscesses: a prospective 5 year study. J Med Microbiol. 2008;57(Pt 10):1259-68.

Chong-Han CH, Cortez SC, Tung GA. Diffusion-weighted MRI of cerebral toxoplasma abscess. AJR Am J Roentgenol. 2003;181(6):1711-4.

Nadal Desbarats L, Herlidou S, de Marco G, Gondry-Jouet C, Le Gars D, Deramond H et al. Differential MRI diagnosis between brain abscesses and necrotic or cystic brain tumors using the apparent diffusion coefficient and normalized diffusion-weighted images. Magn Reson Imaging. 2003;21(6):645-50.

Dorenbeck U, Butz B, Schlaier J, Bretschneider T, Schuierer G, Feuerbach S. 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. 2003;13(4):330-8.

Kim YJ, Chang KH, Song IC, Kim HD, Seong SO, Kim YH et al. Brain abscess and necrotic or cystic brain tumor: discrimination with signal intensity on diffusion-weighted MR imaging. AJR Am J Roentgenol. 1998;171(6):1487-90.

Dev R, Gupta RK, Poptani H, Roy R, Sharma S, Husain M. Role of in vivo proton magnetic resonance spectroscopy in the diagnosis and management of brain abscesses. Neurosurgery. 1998;42(1):37-42.

Noguchi K, Watanabe N, Nagayoshi T, Kanazawa T, Toyoshima S, Shimizu M et al. Role of diffusion-weighted echo-planar MRI in distinguishing between brain abscess and tumor: a preliminary report. Neuroradiology. 1999;41(3):171-4.

Ebisu T, Tanaka C, Umeda M, Kitamura M, Naruse S, Higuchi T et al. Discrimination of brain abscess from necrotic or cystic tumors by diffusion-weighted echo planar imaging. Magn Reson Imaging. 1996;14(9):1113-6.

Hartmann M, Jansen O, Heiland S, Sommer C, Muenkel K, Sartor K. Restricted diffusion within ring enhancement is not pathognomonic for brain abscess. AJNR Am J Neuroradiol. 2001;22(9):1738–42.

Tung GA, Evangelista P, Rogg JM, Duncan JA 3rd. Diffusion-weighted MR imaging of rim-enhancing brain masses: is markedly decreased water diffusion specific for brain abscess? AJR Am J Roentgenol. 2001;177(3):709-12.

Chang SC, Lai PH, Chen WL, Weng HH, Ho JT, Wang JS et al. Diffusion-weighted MRI features of brain abscess and cystic or necrotic brain tumors: comparison with conventional MRI. Clin Imaging 2002;26(4):227-36.

Lai PH, Ho JT, Chen WL, Hsu SS, Wang JS, Pan HB et al. Brain abscess and necrotic brain tumor: discrimination with proton MR spectroscopy and diffusion-weighted imaging. Am J Neuroradiol. 2002; 23(8):1369-1377.

Alam MS, Sajjad Z, Azeemuddin M, Khan ZA, Mubarak F, Akhtar W. Diffusion Weighted MR Imaging of Ring Enhancing Brain Lesions. J Coll Physicians Surg Pak. 2012;22(7):428-31.

Refbacks

There are currently no refbacks.