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Distinction Between Cerebral Abscesses and High-Grade Neoplasms by Dynamic Susceptibility Contrast Perfusion MRI

¹ All authors: Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710.

View larger version (125K): [in a new window]   Fig. 1A. —Depiction of perfusion MRI technique for evaluation of cerebral abscesses in 44-year-old man with two confluent rim-enhancing lesions. At biopsy, lesions were shown to be due to Nocardia organisms. Ratio of relative cerebral blood volume (rCBV) in abscess capsule to rCBV in white matter was 0.78. Contrast-enhanced axial T1-weighted image shows two contiguous rim-enhancing masses in right frontal lobe (which appear as single rim-enhancing lesion) that were lesions selected for rCBV analysis in this patient. Another lesion is noted in left temporal lobe.

View larger version (129K): [in a new window]   Fig. 1B. —Depiction of perfusion MRI technique for evaluation of cerebral abscesses in 44-year-old man with two confluent rim-enhancing lesions. At biopsy, lesions were shown to be due to Nocardia organisms. Ratio of relative cerebral blood volume (rCBV) in abscess capsule to rCBV in white matter was 0.78. This rCBV map obtained at same level as A and derived from dynamic susceptibility imaging sequence shows that regions on rCBV map in right frontal lobe that correspond to right frontal lobe contrast-enhancing lesions in A have low rCBV relative to normal gray matter and appear relatively equivalent to normal white matter.

View larger version (104K): [in a new window]   Fig. 1C. —Depiction of perfusion MRI technique for evaluation of cerebral abscesses in 44-year-old man with two confluent rim-enhancing lesions. At biopsy, lesions were shown to be due to Nocardia organisms. Ratio of relative cerebral blood volume (rCBV) in abscess capsule to rCBV in white matter was 0.78. Enlarged image obtained from axial T1-weighted image seen in A shows 28 pixels placed on rims of contrast-enhancing lesions that were used for analysis on rCBV map. Note thin enhancing rim extending through enhancing mass that serves as interface of two adjacent lesions.

View larger version (62K): [in a new window]   Fig. 1D. —Depiction of perfusion MRI technique for evaluation of cerebral abscesses in 44-year-old man with two confluent rim-enhancing lesions. At biopsy, lesions were shown to be due to Nocardia organisms. Ratio of relative cerebral blood volume (rCBV) in abscess capsule to rCBV in white matter was 0.78. Unsmoothed version of image shown in C that focuses on right frontal lobe mass shows regions of interest (ROIs), each of which was placed within 1 pixel in rim-enhancing portion of lesion.

View larger version (46K): [in a new window]   Fig. 1E. —Depiction of perfusion MRI technique for evaluation of cerebral abscesses in 44-year-old man with two confluent rim-enhancing lesions. At biopsy, lesions were shown to be due to Nocardia organisms. Ratio of relative cerebral blood volume (rCBV) in abscess capsule to rCBV in white matter was 0.78. Magnified unsmoothed version of image shown in B that focuses on right frontal lobe mass shows placement of ROIs within pixels conforming to pixels in enhancing capsule seen in D.

View larger version (117K): [in a new window]   Fig. 2A. —Rim-enhancing lesion and relative cerebral blood volume (rCBV) map in 43-year-old man with glioblastoma multiforme. Ratio of rCBV in area of rim enhancement to rCBV in white matter was 1.30. Contrast-enhanced axial T1-weighted image shows rim-enhancing mass in left thalamus.

View larger version (125K): [in a new window]   Fig. 2B. —Rim-enhancing lesion and relative cerebral blood volume (rCBV) map in 43-year-old man with glioblastoma multiforme. Ratio of rCBV in area of rim enhancement to rCBV in white matter was 1.30. Color-coded rCBV map obtained at same level as A shows that mass has regions of red signal at periphery indicating areas of high rCBV.

View larger version (64K): [in a new window]   Fig. 2C. —Rim-enhancing lesion and relative cerebral blood volume (rCBV) map in 43-year-old man with glioblastoma multiforme. Ratio of rCBV in area of rim enhancement to rCBV in white matter was 1.30. Magnified unsmoothed version of image shown in B that focuses on left thalamic mass shows regions of interest each placed within 1 pixel in regions corresponding to rim-enhancing portion of lesion.

View larger version (7K): [in a new window]   Fig. 3. —Plot of mean relative cerebral blood volume (rCBV) values (with corresponding error bars) in rim-enhancing tumors (left) and cerebral abscesses (right) and rCBV ratios depicted on y-axis. Note that higher mean rCBV values were seen in tumors and no overlap exists between two populations.

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