Pyogenic Abscess MRI

A young male, admitted for recent onset seizures. 

On admission MRI

Description of findings:
A well defined focal lesion in left parietal sub cortical white matter, size ~45x35mm.
Lesion has thin T2 hypointense wall, intensely enhancing on post contrast T1 with a multi locularity, enhancement pattern is peripheral type due to enhancement along its wall, non enhancing necrotic core which is hyper intense T2 and shows restricted diffusion on Diffusion weighted images.
Marked perilesional T2 hyperintense vasogenic odema. Left lateral ventricle is compressed.
No significant mass effect.

Imagingwise Possible DDs: Abscess > Glioma.

Restricted diffusion goes in favor of an Abscess over Glioma.

Histopathology Report : Xanthogranulomatous inflammation, macrophages, granulation tissue with fibroblasts surrounding necrotic core  S/o Pyogenic abscess.

Related post :

Abscess MR Spectroscopy

Multiple ring enhancing lesions in brain

A 12 y o boy came with history of nocturnal seizures.
No neurological signs.

MRI BRAIN WITH MR SPECTROSCOPY

Findings:

Multiple round to ovoid cystic signal intensity focal lesions in supra tentorium.

Content of cyst is very clear, iso intense to Csf on all pulse sequences.

No obvious eccentric nodule.

Most of the lesions show peri lesional vasogenic odema.

No significant mass effect. Effacement of hemispheric cortical sulci.

Enhancement is seen on post contrast T1w images along the thin T2w isointense wall with uniform thickness, most of the lesion show multi locularity. Size of cysts varies from 7mm to 2.5cm.

Single voxel MR Spectroscopy at short TE of  35ms and TR of 1500ms.

From right to left.

At 1.3 ppm - sharp short doublets of lactate.

At 2.01ppm - peak of NAA.

At 3.03ppm - no peak of Creatinine.

At 3.2ppm - no peak of Choline.

NAA/ Creatinine ratio is NA, Choline/ Creatinine ratio is NA.

Imaging wise possible DDs:

Abscess - Tubercular*, Pyogenic.

Hydatid cyst.

Cysticercoids unlikely as cyst size is too large with multi locularity. None of the lesion show eccentric scolex.

Hydatid cyst is possible though less likely as there is enhancement along its wall and perilesional odema, known in complicated or ruptured cysts and indicate ongoing inflammation. Usg abdomen for liver normal.

So Abscess, in that tubercular abscess is most likely.