Pitfalls in the discrimination of cerebral abscess from tumour using diffusion-weighted MRI

Mortimer, Alex; O’Leary, Suzanne; Bradley, Marcus; Renowden, Shelley

doi:10.1016/j.crad.2009.12.012

Cited by 8 publications

(8 citation statements)

References 11 publications

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“…Also, one should be aware of the T2 shine-through effect that is related to T2-dependent components in DWI maps. Notably, this effect can be verified when DWI are compared with ADC maps, since only true restriction of diffusion causes decreased ADC values [ 2 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Differential diagnosis of disseminated brain lesions that are characterised by restricted diffusion includes primarily acute or hyperacute ischaemic infarcts, multiple bacterial abscesses, demyelinating lesions in multiple sclerosis patients, and various forms of primary central nervous lymphomas (PCNSL) [ 1 – 3 ]. In general, cerebral metastases do not display restricted diffusion or the decline in signal on ADC maps [ 4 ]; in contrast, cerebral metastases could display increased diffusion with preserved or increased signal on ADC maps, if they are cystic or necrotic [ 1 , 2 , 5 ]. However, cases of cerebral metastases that were characterised by DWI hyperintensities with corresponding ADC hypointensities have been described [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In general, cerebral metastases do not display restricted diffusion or the decline in signal on ADC maps [ 4 ]; in contrast, cerebral metastases could display increased diffusion with preserved or increased signal on ADC maps, if they are cystic or necrotic [ 1 , 2 , 5 ]. However, cases of cerebral metastases that were characterised by DWI hyperintensities with corresponding ADC hypointensities have been described [ 5 , 6 ]. Because such radiological features suggest disseminated ischemic infarcts, they constitute an important clinical issue.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Metastases of Lung Cancer Mimicking Multiple Ischaemic Lesions – A Case Report and Review of Literature

Zacharzewska-Gondek

Maksymowicz²,

Szymczyk³

et al. 2018

Pol J Radiol

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SummaryBackgroundRestricted diffusion that is found on magnetic resonance diffusion-weighted imaging (DWI) typically indicates acute ischaemic stroke. However, restricted diffusion can also occur in other diseases, like metastatic brain tumours, which we describe in this case report.Case ReportA 57-year-old male, with a diagnosis of small-cell cancer of the right lung (microcellular anaplastic carcinoma), was admitted with focal neurological symptoms. Initial brain MRI revealed multiple, disseminated lesions that were hyperintense on T2-weighted images and did not enhance after contrast administration; notably, some lesions manifested restricted diffusion on DWI images. Based on these findings, disseminated ischaemic lesions were diagnosed. On follow-up MRI that was performed after 2 weeks, we observed enlargement of the lesions; there were multiple, disseminated, sharply outlined, contrast-enhancing, oval foci with persistent restriction of diffusion. We diagnosed the lesions as disseminated brain metastases due to lung cancer. To our knowledge, this is the first description of a patient with brain metastases that were characterised by restricted diffusion and no contrast enhancement.ConclusionsMultiple, disseminated brain lesions, that are characterised by restricted diffusion on DWI, typically indicate acute or hyperacute ischemic infarcts; however, they can also be due to hypercellular metastases, even if no contrast enhancement is observed. This latter possibility should be considered particularly in patients with cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cerebral Metastases of Lung Cancer Mimicking Multiple Ischaemic Lesions – A Case Report and Review of Literature

Zacharzewska-Gondek

Maksymowicz²,

Szymczyk³

et al. 2018

Pol J Radiol

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“…Advent of Diffusion Weighted Imaging in around 1990s has eased to some extent in differentiating these pathologies but is not totally specific again as there has been reports of atypical DWI of both abscess and tumors. 5,6,7,8,9,10 So the purpose of this study was to identify features of ring enhancing brain lesions in conventional and DWI MRI, and evaluate the sensitivity and specificity of different MRI parameters in differentiating the rim enhancing intracranial mass lesions using histopathology as gold standard.…”

Section: Introductionmentioning

confidence: 99%

Role of Diffusion Weighted Imaging in Characterization of Intracranial Rim Enhancing Lesions

Thapa¹,

Suwal²,

Chataut³

et al. 2020

Nep J Radiology

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Introduction: The differentiation of rim enhancing abscess from high grade necrotic lesions is difficult in conventional imaging. Our purpose was to assess the role of diffusion weighted imaging of intracranial rim enhancing lesions to differentiate the etiologies. Methods: Fifty one patients, 32 male and 19 female with mean age of 48.47 years and with rim enhancing intracranial lesions in magnetic resonance imaging, who underwent surgery from January 2012 to December 2012, were studied for different characteristics of the lesions in DWI and pathologically correlated the observed findings. Results: Out of 58 rim enhancing lesions 21 were primary brain tumor, 18 abscess, 14 metastasis and 5 neurocysticercosis. Twenty lesions had restricted diffusion in center, 22 lesions had thin smooth enhancing rim and 23 lesions were with low T2 complete rim. Diffusion restriction at non enhancing center of the lesion and thin smooth enhancing rim have sensitivity and specificity of 88.89% and 90.24% (p <0.0001) for brain abscess and 83.33% and 80.49% (p <0.0001) for other lesions. ADC ratio of center to that of normal white matter showed sensitivity and specificity of 88.9% and 90% respectively (p <0.0001) at cut off point of 1.09. Lesions with thin smooth rim enhancement with diffusion restriction in nonenhancing center are 100% specific for brain abscess. Conclusions: On studying the different MRI characteristics of rim enhancing lesions, combining enhancement characteristic with DWI is more helpful in coming to the proper diagnosis.

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“…[5][6][7][8][9][10][11][12][13] Advanced MRI techniques include perfusionweighted imaging (PWI), diffusion tensor imaging, MR spectroscopy (MRS) and diffusion-weighted imaging (DWI ) is widely used in the diagnosis, prognosis and treatment assessment of diseases. [16][17][18] Recently, scholars have studied HIV-positive patients with conventional DWI 9,11,13 and have made certain achievements. However, multi-b-value DWI applied to studying HIV-positive patients is much less concerned.…”

Section: Introductionmentioning

confidence: 99%

Application of brain multi-b-value diffusion-weighted imaging (DWI) in adolescent orphans from AIDS families

Jiang

Zhong

Zhou

et al. 2016

BJR

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Objective: To evaluate the application value of multib-value diffusion-weighted imaging (DWI) with monoexponential model and stretched-exponential model in the diagnosis of HIV-positive patients. Methods: 50, 150, 200, 400, 600, 800 s mm 22) DWI was performed in 23 adolescent orphans from AIDS families, including 15 HIV-positive subjects and 8 HIV-negative healthy subjects. Apparent diffusion coefficient (ADC) values were fitted by monoexponential model; distribution diffusion coefficient (DDC) values and heterogeneity index (a) values were fitted by stretched-exponential model in bilateral basal ganglia, then non-parametric tests were performed. Results: The signal intensity attenuation in multi-b-value DWI could be well described by both mono-exponential model and stretched-exponential model. In the left basal ganglia, mean a-values in HIV-positive subjects (a 5 0.848 6 0.068) were significantly lower than that in healthy subjects (a 5 0.923 6 0.050, p 5 0.013). There was no statistical difference of a-values between HIV-positive subjects and healthy control subjects in the right basal ganglia. Apart from these, there were also no statistical differences of DDC values or ADC values between two groups in bilateral basal ganglia (all p . , we can see stretched-exponential model DWI can provide more information than mono-exponential model DWI. Advances in knowledge: Multi-b-value DWI was performed in subjects with HIV. DWI measurements could be neuroimaging biomarkers of cerebral injury in the course of HIV infection.

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Pitfalls in the discrimination of cerebral abscess from tumour using diffusion-weighted MRI

Cited by 8 publications

References 11 publications

Cerebral Metastases of Lung Cancer Mimicking Multiple Ischaemic Lesions – A Case Report and Review of Literature

Cerebral Metastases of Lung Cancer Mimicking Multiple Ischaemic Lesions – A Case Report and Review of Literature

Role of Diffusion Weighted Imaging in Characterization of Intracranial Rim Enhancing Lesions

Application of brain multi-b-value diffusion-weighted imaging (DWI) in adolescent orphans from AIDS families

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