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- Title
Diffusion-weighted magnetic resonance imaging for detection of postoperative intracranial pyogenic abscesses in neurosurgery.
- Authors
Schwartz, Christoph; Lenski, Markus; Romagna, Alexander; Schichor, Christian; Tonn, Joerg-Christian; Brueckmann, Hartmut; Janssen, Hendrik; Liebig, Thomas; Forbrig, Robert; Thon, Niklas
- 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.
- Subjects
DIFFUSION magnetic resonance imaging; BRAIN abscess; BRAIN surgery; LEUKOCYTE count; NEUROSURGERY
- Publication
Acta Neurochirurgica, 2019, Vol 161, Issue 5, p985
- ISSN
0001-6268
- Publication type
Article
- DOI
10.1007/s00701-019-03875-8