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      In Vivo Proton MR Spectroscopy Evaluation of Pyogenic Brain Abscesses: A Report of 194 Cases

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          Abstract

          BACKGROUND AND PURPOSE:

          The combination of nonspecific clinical findings and similarities in morphologic appearances on imaging often makes it difficult to distinguish abscesses from other brain lesions. We present a retrospective analysis of in vivo 1H-MR spectroscopy data for characterization of the etiology of the brain abscess based on the established criteria and demonstrate the sensitivity and specificity of metabolite markers assigned to specific bacterial groups defined by the microbial culture in 194 patients.

          MATERIALS AND METHODS:

          Conventional MR imaging and in vivo 1H-MR spectroscopy data were evaluated from patients with pyogenic brain abscesses, with ages ranging from 3 to 60 years. Imaging and 1H-MR spectroscopy were performed on a 1.5T scanner. After MR imaging was performed and analyzed, pus aspirates were obtained in all patients. The causative organisms were confirmed by pus cultures.

          RESULTS:

          Resonance of AAs with or without other metabolites on in vivo 1H-MR spectroscopy was observed in 80% of abscesses, with a sensitivity and specificity of 0.72 and 0.30, respectively. Most obligate anaerobes and some facultative anaerobes showed the presence of Lac/Lip, AAs, and Ac with or without Suc. Mostly obligate aerobes or facultative anaerobes showed the presence of Lac and AAs, with or without lipids.

          CONCLUSIONS:

          The presence of AAs on in vivo 1H-MR spectroscopy is a sensitive marker of pyogenic abscess, but its absence does not rule out a pyogenic etiology. The presence of Ac with or without Suc favors an anaerobic bacterial origin of the abscess; however, this may also be seen in some of the abscesses secondary to facultative anaerobes.

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          Author and article information

          Journal
          AJNR Am J Neuroradiol
          AJNR Am J Neuroradiol
          ajnr
          ajnr
          AJNR
          AJNR: American Journal of Neuroradiology
          American Society of Neuroradiology
          0195-6108
          1936-959X
          February 2010
          : 31
          : 2
          : 360-366
          Affiliations
          [1] aFrom the Departments of Radiodiagnosis (D.P., A.B., R.K.G.)
          [2] bBiostatistics (C.M.P.)
          [3] cMicrobiology (K.N.P.), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
          [4] dDepartment of Neurosurgery (M.H.), Chhatrapati Shahuji Maharaj University, Lucknow, UP, India.
          Author notes
          Please address correspondence to Rakesh K. Gupta, MD, Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Rd, Lucknow, UP, India, 226014; e-mail: rgupta@ 123456sgpgi.ac.in or rakeshree1@ 123456gmail.com

          Indicates Editor's Choices selection

          Article
          PMC7964137 PMC7964137 7964137 09-00599
          10.3174/ajnr.A1835
          7964137
          19797788
          1d2ca048-3def-4a8f-aeff-bb1714894972
          Copyright © American Society of Neuroradiology

          Indicates open access to non-subscribers at www.ajnr.org

          History
          : 3 June 2009
          : 10 July 2009
          Categories
          Brain
          Editor's Choice

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