Article
Cerebral abscesses and necrotic cerebral tumors: differential diagnosis by perfusion-weighted magnetic resonance imaging
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Published: | May 30, 2008 |
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Objective: Evaluate the usefulness of Perfusion-weighted imaging (PWI) in the differential diagnosis of cerebral lesions presenting with “ring-enhancement” including abscesses, high-grade gliomas, and metastases.
Methods: Nine cerebral abscesses (5 from pyogenes, 4 from Toxoplasma Gondii), 10 glioblastomas, and 5 cerebral metastases in 19 patients underwent gadolinium-anhanced MRI, DWI including calculation of average value of apparent diffusion coefficient (DWI-ADC) of the lesions core, and PWI. At PWI, the medium value of the maximum relative cerebral blood volume (rCBV) was calculated in the gadolinium-enhancing peripheral solid areas and compared with that of the controlaterale normal-appearing white matter, as ratio = rCBV (lesion)/rCBV (controlaterale normal-appearing white matter).
Results: DWI-ADC achieved the differential diagnosis in all cases, except for the 4 abscesses from Toxoplasma Gondii. At PWI, the medium ratio of the rCBV of the capsular portion was 0.72±0.08 (range:0.6-0.82) in the piogenic abscesses, 0.84±0.07 (range:0.75-0.91) in the abscesses from Toxoplasma Gondii, 4.45±1.5 (range: 2.9-8)in the high-grade gliomas, and 3.58±0.68 (range: 3.28-4.27) in the metastases.
Conclusions: PWI seems to be useful in the differential diagnosis of cerebral lesions presenting with “ring-enhancement”. High rCBV values in the peripheral areas should indicate the possibility of a necrotic tumor, while low values tend to indicate an abscess.