Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging

Djamil Fertikh, Jaroslaw Krejza, Alain A. Cunqueiro, Shabbar Danish, Riyadh Alokaili, Elias R. Melhem

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Object. The authors' aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms. Methods. Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis. The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T 2 hypointensity rim. The mean (± standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 ± 0.91 compared with 1.12 ± 0.53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 ± 0.04 (mean ± standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87%) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 ± 0.03 (SEM). Using ADC ratios and T2 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3%). Conclusions. The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.

Original languageEnglish (US)
Pages (from-to)76-81
Number of pages6
JournalJournal of Neurosurgery
Volume106
Issue number1
DOIs
StatePublished - Jan 2007
Externally publishedYes

Fingerprint

Brain Abscess
Diffusion Magnetic Resonance Imaging
Abscess
Neoplasms
Glioblastoma
ROC Curve
Reference Values
Neoplasm Metastasis

Keywords

  • Apparent diffusion coefficient
  • Brain abscess
  • Brain neoplasm
  • Diffusion-weighted imaging
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging. / Fertikh, Djamil; Krejza, Jaroslaw; Cunqueiro, Alain A.; Danish, Shabbar; Alokaili, Riyadh; Melhem, Elias R.

In: Journal of Neurosurgery, Vol. 106, No. 1, 01.2007, p. 76-81.

Research output: Contribution to journalArticle

Fertikh, Djamil ; Krejza, Jaroslaw ; Cunqueiro, Alain A. ; Danish, Shabbar ; Alokaili, Riyadh ; Melhem, Elias R. / Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging. In: Journal of Neurosurgery. 2007 ; Vol. 106, No. 1. pp. 76-81.
@article{9a25cfc5d6f0441eaada084503f34a0a,
title = "Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging",
abstract = "Object. The authors' aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms. Methods. Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis. The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T 2 hypointensity rim. The mean (± standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 ± 0.91 compared with 1.12 ± 0.53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 ± 0.04 (mean ± standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87{\%}) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 ± 0.03 (SEM). Using ADC ratios and T2 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3{\%}). Conclusions. The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.",
keywords = "Apparent diffusion coefficient, Brain abscess, Brain neoplasm, Diffusion-weighted imaging, Magnetic resonance imaging",
author = "Djamil Fertikh and Jaroslaw Krejza and Cunqueiro, {Alain A.} and Shabbar Danish and Riyadh Alokaili and Melhem, {Elias R.}",
year = "2007",
month = "1",
doi = "10.3171/jns.2007.106.1.76",
language = "English (US)",
volume = "106",
pages = "76--81",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "1",

}

TY - JOUR

T1 - Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging

AU - Fertikh, Djamil

AU - Krejza, Jaroslaw

AU - Cunqueiro, Alain A.

AU - Danish, Shabbar

AU - Alokaili, Riyadh

AU - Melhem, Elias R.

PY - 2007/1

Y1 - 2007/1

N2 - Object. The authors' aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms. Methods. Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis. The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T 2 hypointensity rim. The mean (± standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 ± 0.91 compared with 1.12 ± 0.53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 ± 0.04 (mean ± standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87%) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 ± 0.03 (SEM). Using ADC ratios and T2 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3%). Conclusions. The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.

AB - Object. The authors' aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms. Methods. Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis. The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T 2 hypointensity rim. The mean (± standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 ± 0.91 compared with 1.12 ± 0.53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 ± 0.04 (mean ± standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87%) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 ± 0.03 (SEM). Using ADC ratios and T2 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3%). Conclusions. The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.

KW - Apparent diffusion coefficient

KW - Brain abscess

KW - Brain neoplasm

KW - Diffusion-weighted imaging

KW - Magnetic resonance imaging

UR - http://www.scopus.com/inward/record.url?scp=33846310460&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33846310460&partnerID=8YFLogxK

U2 - 10.3171/jns.2007.106.1.76

DO - 10.3171/jns.2007.106.1.76

M3 - Article

C2 - 17236491

AN - SCOPUS:33846310460

VL - 106

SP - 76

EP - 81

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 1

ER -