Cerebral Abscess

Findings:

Multiple MR images demonstrate an irregular peripherally enhancing lesion in the right frontal lobe with surrounding edema. The lesion demonstrates a faint T1 hyperintense rim with central marked restricted diffusion. The T2 weighted images also demonstrate a rim of relative hypointensity.

Differential Diagnosis:

Abscess, high grade glioma, metastasis.

Discussion:

-early cerebritis (3-5d), late cerebritis (2 wks), early capsule (>2 wks), late capsule (wks-mos)

-only 50% have fever or WBC count, 90% have headache, most have high ESR

-less than 2.5 cm may be treated with Abx alone, greater need drainage

-internal DWI hyperintensity characteristic, some help in dist GBM/mets from abscess, not absolute

-DWI may be helpful in f/u, development of hyper DWI may indicate recurrence

-T2 hypointense rim with late cerebritis and early capsule, also not absolute

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