Intracranial Pyogenic Abscess: Imaging Diagnosis Utilizing Recent Advances in Computed Tomography and Magnetic Resonance Imaging

Abstract

Intracranial abscesses are life-threatening medical emergencies with pyogenic debris accumulating in the brain. Delay in the diagnosis can result in significant morbidity and mortality. Computed tomography and magnetic resonance imaging play an important role in the diagnosis of brain abscesses. However, the classic ring-enhancing appearance of an intracranial abscess can be mimicked by several other entities, most notably a necrotic tumor. This paper reviews new advances in CT and MR for imaging patients with suspected brain abscess. The role of computed tomography (CT) perfusion and new magnetic resonance sequences including DWI sequences, ADC map, MR spectroscopy, FLAIR and post-contrast enhanced T1 weighted images will also be discussed.

Cortical Regional Hyperperfusion in Nonconvulsive Status Epilepticus Measured by Dynamic Brain Perfusion CT

“…37 The different morphologies and perfusion patterns of NCSE and brain tumors, however, should not provide any diagnostic problem apart from subjects in whom perfusion changes due to epileptic seizures and neovascularized brain tumors coincide. Hyperperfusion in other pathologies, such as encephalitis 38 and abscesses, 39 has been sporadically reported but did not omit the adjacent white matter.…”

Multiple Brain Abscesses due toStreptococcus anginosus: Prediction of Mortality by an Imaging Severity Index Score

“…Cerebritis is acute inflammation consisting of neutrophils, macrophages, lymphocytes, and plasma cells with or without parenchymal necrosis. Abscess capsule is a vascular tissue lining, collagen, reactive gliosis, firm, and fibrous and contains lipid-laden macrophages, capillary proliferation, and chronic inflammatory cells [ 1 ].…”

“…Brain abscess mortality has decreased over the past few decades due to improved diagnosis and improved antibiotic therapy (cf. Table 1 ) [ 1 – 7 ].…”

Fatal thalamic abscess secondary to dental infection

“…Although less sensitive than diffusion-weighted MRI, cranial CT with contrast has become the mainstay of rapid diagnosis of cerebral abscesses, allowing early detection, characterisation and staging of the lesion 11. The routine CT brain scan range extends from the top of the C1 lamina inferiorly to the top of the calvarium, thereby excluding the alveolar processes.…”