Brain abscess differential diagnosis

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

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Overview

Brain abscess must be differentiated from metastatic tumors, necrotic tumors, and lymphomas.

Differential Diagnosis

Brain abscess must be differentiated from:

• Metastatic tumors
• Necrotic tumors
• Lymphomas

Despite these differences, the true diagnosis is sometimes not made until biopsy.

Metastatic Tumor

• • The big differential is metastatic tumor: abscesses are often located in watershed regions, and tumors often enhance diffusely with contrast.

Necrotic Tumor

• Diagnosis of brain abscesses and necrotic tumors is often impossible without conventional MR imaging.
  • Several studies demonstrate the utility of Diffusion-weighted imaging (DWI) to differentiate between necrotic or cystic lesions and brain abscesses.
  • DWI has a sensitivity and specificity of over 90% for distinguishing abscess (low ADC) from necrotic tumors (high ADC).

Lymphoma

• Some studies suggest that indium scans can help differentiate abscess from CA, and thallium SPECT scans can distinguish CNS toxoplasmosis from lymphoma.