BRAIN ABSCESS ON MAGNETIC RESONANCE IMAGING: DIFFUSION RESTRICTION AS A KEY DIAGNOSTIC FEATURE
Keywords:
Brain abscess; Magnetic resonance imaging; Diffusion-weighted imaging; Apparent diffusion coefficient; Ring-enhancing lesion; NeuroradiologyAbstract
DOI: https://doi.org/10.46296/yc.v10i18.0805
Abstract
Introduction: Brain abscess is a focal parenchymal infection associated with substantial morbidity and mortality when diagnosis and source control are delayed. Among ring-enhancing intracranial lesions, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps provide microstructural information that helps distinguish purulent material from tumoral necrosis. Case report (simulated): A 46-year-old immunocompetent man presented with subacute headache, fever, and progressive right-sided weakness. Brain MRI revealed a left frontal ring-enhancing lesion with marked vasogenic edema and striking central DWI hyperintensity with low ADC, supporting the diagnosis of a pyogenic abscess. Empirical ceftriaxone plus metronidazole was started and stereotactic aspiration was performed, yielding thick pus; culture grew Streptococcus anginosus group. The patient improved clinically, and follow-up MRI showed cavity shrinkage with progressive ADC normalization. Conclusion: Restricted diffusion with low central ADC within a ring-enhancing lesion is a powerful diagnostic clue for brain abscess. Integrating DWI/ADC with clinical data supports timely neurosurgical and antimicrobial management while preventing misdirected oncologic pathways.
Keywords: Brain abscess; Magnetic resonance imaging; Diffusion-weighted imaging; Apparent diffusion coefficient; Ring-enhancing lesion; Neuroradiology.
Downloads
References
Brouwer MC, Tunkel AR, van de Beek D. Brain abscess. N Engl J Med. 2014;371(5):447-456. doi:10.1056/NEJMra1301635.
Bodilsen J, D'Alessandris QG, Humphreys H, et al. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66-89.
Sonneville R, Ruimy R, Benzonana N, et al. An update on bacterial brain abscess in immunocompetent patients. Clin Microbiol Infect. 2017;23(9):614-620. doi:10.1016/j.cmi.2017.05.004.
Kim YJ, Chang KH, Song IC, 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):1487-1490. doi:10.2214/ajr.171.6.9843275.
Tung GA, Evangelista P, Rogg JM, Duncan JA. 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):709-712. doi:10.2214/ajr.177.3.1770709.
Cartes-Zumelzu FW, Stavrou I, Castillo M, et al. Diffusion-weighted imaging in the assessment of brain abscesses therapy. AJNR Am J Neuroradiol. 2004;25(8):1310-1317.
Chang SC, Lai PH, Chen WL, et al. Diffusion-weighted MRI features of brain abscess and cystic or necrotic brain tumors: comparison with conventional MRI. Clin Imaging. 2002;26(4):227-236.
Toh CH, Wei KC, Chang CN, et al. Differentiation of pyogenic brain abscesses from necrotic glioblastomas with susceptibility-weighted imaging. AJNR Am J Neuroradiol. 2012;33(8):1534-1538.
Grand S, Passaro G, Ziegler A, et al. Necrotic tumor versus brain abscess: importance of amino acid proton MR spectroscopy. Radiology. 1999;213(3):785-793. doi:10.1148/radiology.213.3.r99dc10785.
Xu XX, Li B, Yang HF, et al. Can diffusion-weighted imaging be used to differentiate brain abscess from other ring-enhancing brain lesions? A meta-analysis. Clin Radiol. 2014;69(9):909-915. doi:10.1016/j.crad.2014.04.012.
Moradi Z, Mohammadzadeh S, Mohebbi A, et al. Diagnostic performance of DWI and ADC parameter in differentiating brain abscess from malignant ring-enhancing brain lesions: a systematic review and meta-analysis. Eur J Radiol. 2026;195:112531. doi:10.1016/j.ejrad.2025.112531.
Castillo M. Imaging brain abscesses with diffusion-weighted and other sequences. AJNR Am J Neuroradiol. 1999;20(7):1193-1194.
Desprechins B, Stadnik T, Koerts G, et al. Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. AJNR Am J Neuroradiol. 1999;20(7):1252-1257.
Ebisu T, Tanaka C, Umeda M, et al. Discrimination of brain abscess from necrotic or cystic tumors by diffusion-weighted echo planar imaging. Magn Reson Imaging. 1996;14(9):1113-1116.
Reiche W, Schuchardt V, Hagen T, Il'yasov KA, Billmann P, Weber J. Differential diagnosis of intracranial ring enhancing cystic mass lesions—role of diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI). Clin Neurol Neurosurg. 2010;112(3):218-225.
Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82(9):806-813. doi:10.1212/WNL.0000000000000172.
Ruiz-Barrera MA, Santamaría-Rodríguez A, Zorro O. Brain abscess: a narrative review. Neurol Perspect. 2022;2(2):98-111.
Published
How to Cite
License
Copyright (c) 2026 REVISTA CIENTÍFICA MULTIDISCIPLINARIA ARBITRADA YACHASUN - ISSN: 2697-3456
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
