MRI in Brain Abscess Follow-up

Imaging Modality Choice

The European Society of Clinical Microbiology and Infectious Diseases recommends brain MRI, including diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC) sequences, and T1-weighted imaging with and without gadolinium, for radiological follow-up of brain abscess, due to its superior sensitivity (92%) and specificity (91%) compared to CT, in patients with brain abscess 1
MRI with DWI/ADC and T1-weighted imaging with and without gadolinium has a sensitivity of 92% (95% CI 88-95), specificity of 91% (95% CI 86-94), positive predictive value of 88%, and negative predictive value of 90%, based on a meta-analysis of 28 studies involving 2,128 patients/lesions 1
The optimal MRI protocol for follow-up includes DWI sequences, ADC sequences, and T1-weighted imaging with and without gadolinium, which allows differentiation of brain abscess from other intracranial mass lesions 1
CT may only be used when MRI is not available, due to its lower sensitivity and specificity compared to brain MRI 1

MRI may have reduced sensitivity in patients treated with antibiotics for several weeks, toxoplasmosis abscesses, and post-neurosurgical brain abscesses, requiring clinical correlation and potentially more frequent imaging 1
The European Society of Clinical Microbiology and Infectious Diseases issued a strong recommendation for brain MRI, including DWI/ADC and T1-weighted imaging with and without gadolinium, for patients with brain abscess 1