Fact-sheet: Abcess of brain


Updated on 08/14/2020 at 10:09 AM

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Definition

Pyogenic abscess: organized intraparenchymal cerebral collection that may be of locoregional origin (ENT extension), secondary to sepsis, trauma, surgery, or of indeterminate origin.
Granulomatous abscess: tuberculoma, sarcoidosis, fungal (coccidioidomycosis, rhinocerebral mucormycosis, aspergillosis, cryptococcosis)...

CT

Without injection: - Hypodensity - Mass effect - Sometimes a slightly dense peripheral rim - Intralesional gas. After injection: - Peripheral rim enhancement with perilesional edema - Homogeneous enhancement if small lesion

MRI

- Organized collection with variable central T2 hyperintensity
- The peripheral capsule is spontaneously hyperintense on T1 and hypointense on T2
- Perilesional edema hypointense on T1 and hyperintense on T2
- Diffusion hyperintensity with decreased ADC in the case of pyogenic abscesses

Differential diagnosis

  • Primary/secondary neoplasm (diffusion sequences are of interest)
  • Infarction
  • Resolving hematoma
  • Post-radiation sequela
  • Demyelination