Cerebral abscesses imaging: A practical approach

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Paola Feraco https://orcid.org/0000-0002-3707-018X
Davide Donner
Cesare Gagliardo https://orcid.org/0000-0003-4088-2020
Irene Leonardi
Silvia Piccinini
Anna Del Poggio
Rossana Franciosi
Benedetto Petralia
Luc van den Hauwe


brain abscess, magnetic resonance imaging (MRI), diffusion weighted imaging (DWI), magnetic resonance spectroscopy (MRS)


Brain abscesses (BAs) are focal infections of the central nervous system (CNS) that start as a localised area of weakening of the brain parenchyma (cerebritis) and develops into a collection of pus surrounded by a capsule. Pyogenic (bacterial) BAs represent the majority of all BAs; in some cases, the diagnostic and therapeutic management can be challenging. Imaging has a primary role in differentiating BAs from other lesions. Conventional magnetic resonance imaging (cMRI) is essential for the identification of the lesion, its localisation and its morphological features. However, cMRI does not allow to reliably differentiate BAs from other intracranial mass lesions such as necrotic tumours. Advanced sequences, such as diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI) and proton MR spectroscopy (1H-MRS) are very useful in the differential diagnosis from other brain lesions, such as non-pyogenic abscesses or necrotic tumours, and provide essential information on structural, vascular and meta-bolic characteristics allowing greater neuroradiological confidence. The aim of this pictorial review is to provide a practical approach showing the added value of more advanced MRI techniques in their diagnostic management.

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