Positron emission tomographic findings in a tuberculous brain abscess

Abstract

Several case reports and studies have described the positron emission tomographic (PET) findings of intracranial tuberculomas and bacterial brain abscesses. However, to our knowledge, the PET pattern of a tuberculous brain abscess has not been previously described. We report the case of a diabetic heavy drinker with a left parietal tuberculous abscess. (18)F-fluoro-2-deoxyglucose (FDG)-PET scans showed intense FDG uptake at the abscess periphery, where contrast enhancement was observed on a magnetic resonance image. FDG uptake was reduced within the abscess cavity and in the adjacent cerebral cortex. The possibility of a tuberculous brain abscess should be considered when FDG accumulates at the periphery of a ring-enhancing lesion in a chronically ill or immunocompromised patient.

Pictorial essay: PET/CT in tuberculosis

“…According to Kang et al ., ′the possibility of a tuberculous brain abscess should be considered when FDG accumulates at the periphery of a ring-enhancing lesion in a chronically ill or immunocompromised patient.′[20] FDG-PET shows intense tracer uptake at the periphery of the lesion in a ring-like or ′doughnut′ pattern, with low uptake within the abscess cavity [Figure 2]. …”

Ring-enhancing brain lesions, clinical presentation of focal seizures, and inconclusive anatomical neuroimaging features

“…Such an uptake pattern in brain abscesses has also been documented in another comparative study with 11 C-methionine, and the possible role of PET with both tracers in assessing response to antibiotic therapy was highlighted 6. A high uptake of 18 F-FDG has also been documented in a solitary case of tuberculous brain abscess on 18 F-FDG-PET/CT 7.…”

Recent Trends in Soft-Tissue Infection Imaging

“…One article looked at the imaging characteristics of PET in a patient with a known tuberculous brain abscess. The possibility of a tuberculous brain abscess should be considered when 18 F-FDG accumulates at the periphery of a ring-enhancing lesion in a chronically ill or immunocompromised patient (36). This paper, however, only looked at a single patient and it has been previously suggested that any type of neoplastic or non-neoplastic lesion could produce this pattern of enhancement in the immunocompromised patients (37).…”