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Il Giornale Italiano di Radiologia Medica 2019 Luglio-Agosto;6(4):384-96

DOI: 10.23736/S2283-8376.19.00201-8

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English, Italian

MR footprint of brain abscess: morphological and non morphological aspects of microbiologic imaging

Antonia RAMAGLIA 1 , Massimo BENENATI 1, Giammaria MARZIALI 1, Giovanna PEZZULLO 2, Simona GAUDINO 1, Cesare COLOSIMO 1

1 Unit of Radiology, Department of Imaging Diagnostics, Oncologic Radiotherapy and Hematology, A. Gemelli IRCCS Policlinico Universitario Foundation, Sacred Heart Catholic University, Rome, Italy; 2 Unit of Radiology, Department of Biotechnological and Functional Sciences, Federico II University, Naples, Italy


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Differentiation among pyogenic, tubercular, fungal and parasitic brain abscess (BA) on MR imaging remains in some cases a challenge. Aim of this study is to provide MRI key diagnostic points for each type of BA, pointing out their different behaviors in term of “morphological” and “non morphological” MR findings (structural, metabolic and hemodynamic features). For each kind of BA we highlight key diagnostic conventional MR findings and added value of each non morphological technique and their combination. Bacteria BA. Morphological key points: necrotic core surrounded by a T1 hyperintense rim and ring enhancement usually stronger in the lateral portion. Diffusion is restricted (low ADC values) in the core, SWI shows the “dual rim sign” and amino acids (MRS) are sensitive markers. Tuberculoma. Usually multiple and often associated with tubercular basal meningitis. The core has variable T2 signal and ADC values (related to caseous or colliquative necrosis) and characteristic content at MRS are lipids. Fungal BA. More characteristic morphological findings: irregular T2 hypointense lesion, with papillary intracavitary projections, without contrast enhancement and with ADC values lower than those of the core. Hemorrhagic strokes in basal ganglia, thalami or brainstem are typical findings. Cerebral toxoplasmosis. Multiple lesions in different stages of evolution, often in periventricular white matter. Typical combined features are the concentric target sign (T2w), eccentric target sign (CE) and no restricted diffusion (high ADC values). The combined use of morphological and advanced MR techniques is a useful tool for diagnosis of nature and etiological diagnosis of BA.


KEY WORDS: Brain abscess; Magnetic resonance imaging; Causality; Magnetic resonance spectroscopy

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