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Diffusion-weighted magnetic resonance imaging for detection of postoperative intracranial pyogenic abscesses in neurosurgery

  • Original Article - Infection
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Abstract

Background

Diffusion-weighted magnetic resonance imaging (MRI-DWI) is the modality of choice for detecting intracranial abscesses; however, it is unclear whether prior brain surgery has an influence on its diagnostic value. Thus, we assessed the robustness of MRI-DWI and determination of an ADC cutoff value for detecting intracranial abscesses in patients who underwent brain surgery.

Methods

We retrospectively evaluated 19 patients prior to surgery for postoperative supratentorial parenchymal abscesses by means of MRI-DWI. Forty randomly selected patients with routine postoperative MRI-DWI were used for comparative analyses. Clinical and serum biomarkers (C-reactive protein, interleukin-6, white blood cell count) as well as from results of early postoperative imaging findings (computed tomography and/or MRI scan) were recorded. Additionally, ADC values, T1±gadolinium, and T2/fluid-attenuated inversion recovery sequences were investigated.

Results

After initial surgery, early postoperative control imaging showed evidence of hemorrhage and/or hemostatic agents within the resection cavity in 10/19 patients of the abscess group and in 16/40 patients of the control group. No postoperative ischemia was detected. Neither hemostatic agents nor blood affected the mean ADC values in both the reference group (blood 2.96 ± 0.22 × 10−3 mm2/s vs. no blood 2.95 ± 0.26 × 10−3 mm2/s, p = 0.076) and in the abscess group (blood 0.87 ± 0.07 × 10−3 mm2/s vs. no blood 0.76 ± 0.06 × 10−3 mm2/s, p = 0.128). The mean ADC value within the resection cavity was significantly lower in the abscess group (1.5 T 0.88 ± 0.41 vs. 2.88 ± 0.20 × 10−3 mm2/s, p < .01; 3.0 T 0.75 ± 0.24 vs. 3.02 ± 0.26 × 10−3 mm2/s, p < 0.01). The optimal ADC cut-off for the differentiation of an abscess from normal postoperative findings was found at 1.87 × 10−3 mm2/s (area-under-the-curve 1.0, sensitivity = 100%, specificity = 100%). Moreover, no differences between the abscess patients and the control group were seen with respect to the analyzed serum biomarkers.

Conclusion

MRI-DWI provides a robust tool to discriminate postoperative abscess formation from normal postoperative changes.

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Abbreviations

ADC:

Apparent diffusion coefficient

CT:

Computed tomography

CRP:

C-reactive protein

CSF:

Cerebrospinal fluid

DWI:

Diffusion-weighted imaging

IL-6:

Interleukin-6

MRI:

Magnetic resonance imaging

WBCC:

White blood cell count

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Author information

Author notes

  1. Christoph Schwartz

    Present address: Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria

  2. Alexander Romagna

    Present address: Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto, Canada

  3. Hendrik Janssen

    Present address: Department of Neuroradiology, Klinikum Ingolstadt, Ingolstadt, Germany

  4. Christoph Schwartz, Markus Lenski, Robert Forbrig and Niklas Thon contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany

    Christoph Schwartz, Markus Lenski, Alexander Romagna, Christian Schichor, Joerg-Christian Tonn & Niklas Thon

  2. Department of Neurosurgery, Christian-Doppler-Klinik, Paracelsus Medical University Salzburg, Salzburg, Austria

    Alexander Romagna

  3. Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany

    Hartmut Brueckmann, Hendrik Janssen, Thomas Liebig & Robert Forbrig

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Correspondence to Niklas Thon.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (ethics committee of the Ludwig-Maximilians-University Munich, Germany) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Schwartz, C., Lenski, M., Romagna, A. et al. Diffusion-weighted magnetic resonance imaging for detection of postoperative intracranial pyogenic abscesses in neurosurgery. Acta Neurochir 161, 985–993 (2019). https://doi.org/10.1007/s00701-019-03875-8

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