Brain abscess differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Differential Diagnosis

• Some studies suggest that indium scans can help differentiate abscess from CA, and thallium SPECT scans can distinguish CNS toxo from lymphoma.
• A CT scan with contrast will show a ring-enhancing mass that surrounds an area of hypodensity (necrosis or edema).
• The big differential is metastatic tumor: abscesses are often located in watershed regions, and tumors often enhance diffusely with contrast.
• Despite these differences, the true Dx is sometimes not made until biopsy.
• MRI is generally thought to be the imaging modality of choice and can more accurately stage the abscess and gauge the response to therapy.

• T1 images are similar to CT, with a central hypodense signal and surrounding ring-enhancement.
• T2 images reveal a central hyperintense area surrounded by a well-defined hypointense capsule with surrounding edema.