Brain Abscess

Andrew E. Auber1, Clifford Belden1

1 Brooke Army Medical Center, San Antonio, Texas
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A4.1
DOI:  10.1002/0471142719.mia0401s00
Online Posting Date:  May, 2001
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Magnetic Resonance Imaging (MRI) in cerebral abscess, as with most other forms of intracranial inflammatory or infectious diseases, is a powerful though largely nonspecific diagnostic tool. This unit presents a variant of a previously published standard imaging protocol, to include gadolinium‐enhanced sequences for imaging of these patients. Several optional sequences, including diffusion (dMRI), perfusion (pMRI), and spectroscopic (MRS) sequences are outlined that can be employed should patient tolerance allow and if specific clinical situations require further clarification. The parameters given in this unit are derived from experience at 1.5 T and may need to be altered slightly depending on the field strength available and the specific equipment manufacturer.

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Table of Contents

  • Basic Protocol 1: Imaging of Cerebral Abscess
  • Alternate Protocol 1: Special Situations
  • Alternate Protocol 2: Imaging of Cerebral Abscess by Magnetic Resonance Diffusion, Perfusion, and Spectroscopy
  • Commentary
  • Figures
  • Tables
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Basic Protocol 1: Imaging of Cerebral Abscess

  • Intravenous MRI contrast agent: gadolinium chelate (e.g., Magnevist,Omniscan, or Prohance)
  • Normal sterile saline (0.9% NaCl)

Alternate Protocol 1: Special Situations

  Additional Materials
  • Enhanced gradient equipped MRI scanner
  • Specialized post‐processing software, especially for pMRI image processing (a separate workstation is preferred for off‐line processing of data sets, enabling continuous patient scanning to proceed)
  • Power injector for dynamic contrast administration (i.e., while scanning)
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Literature Cited

Literature Cited
   Burtscher, I.M. and Holtas, S. 1999. In vivo proton MR spectroscopy of untreated and treated brain abscesses. Am. J.Neuroradiol. 20:1049‐1053.
   Castillo, M. 1998. Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals, 2nd ed. Lippincott New York.
   Desprechins, B., Stadnik, T., Koerts, G., Shabana, W., Breucq, C., and Osteaux, M. 1999. Use of diffusion‐weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. Am. J. Neuroradiol. 20:1252‐1257.
   Ernst, T.M., Chang, L., Witt, M.D., Aronow, H.A., Cornford, M.E., Walot, I., and Goldberg, M.A. 1998. Cerebral toxoplasmosis and lymphoma in AIDS: Perfusion MR experience in 13 patients. Radiology 208:663‐669.
   Grand, S., Passaro, G., Ziegler, A., Esteve, F., Boujet, C., Hoffmann, D., Rubin, C., Segebarth, C., Decorps, M., Le Bas, J., and Remy, C. 1999. Necrotic tumor versus brain abscess: Importance of amino acids detected at 1H MR spectroscopy—initial results. Radiology 213:785‐793.
   Mathisen, G.E. and Johnson, J.P. 1997. Brain abscess. Clin. Infect. Dis. 25:763‐781.
   Orrison, W.W., Lewine, J.D., Sanders, J.A., and Hartshorne, M.F. 1995. Functional Brain Imaging. Mosby, St. Louis.
   Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott‐, Philadelphia.
   Taveras, J.M. and Pile‐Spellman, J. 1996. Inflammatory diseases. In Neuroradiology, 3rd ed. pp. 259‐326. Williams and Wilkins, Baltimore, Maryland.
   Wong, J. and Quint, D.J. 1999. Imaging of central nervous system infections. Semin. Roentgenol. 34:123‐143.
Key References
   Orrison et al., 1995. See above
  Contains lucid explanations for the physics and basic scan parameters of standard and advanced magnetic resonance imaging studies.
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