title: Fungal versus bacterial brain abscesses: is diffusion-weighted MR imaging a useful tool in the differential diagnosis?
abstract: BACKGROUND
  The aim of this study was to investigate the appearance of fungal brain abscesses on diffusion-weighted (DW) images, and to evaluate whether the imaging characteristics and apparent diffusion coefficient (ADC) values associated with fungal abscesses were distinct from those of bacterial abscesses.
  
  
  METHODS
  We retrospectively reviewed the MR images from nine patients with fungal brain infections, and 17 patients with pyogenic brain abscesses. All patients underwent conventional MR sequences and DW imaging on 1.5-T clinical MR scanners. ADC values of 20 fungal and 20 bacterial brain abscesses were calculated and compared using a random factor analysis of variance.
  
  
  RESULTS
  Multiple lesions were present in 6 of 9 patients (67%) with fungal abscesses and in 5 of 17 patients (29%) with bacterial abscesses. On DW images, all but one bacterial brain abscess showed a homogeneous high signal, whereas the appearance of fungal abscesses on DW images was more variable: in five of nine patients with fungal abscesses, the lesions were homogeneously hyperintense, while in the remaining four patients, the lesions were of mixed signal intensity. Mean ADC values were 0.74 x 10(-3) mm(2)/s in the fungal group and 0.486 x 10(-3) mm(2)/s in the bacterial group (P< or =0.05).
  
  
  CONCLUSIONS
  Our results indicate that there is a trend towards higher ADC values in fungal lesions. Additional findings that support fungal rather than bacterial cerebral infection are multiplicity, signal heterogeneity on T2-weighted and DW imaging, and involvement of deep grey-matter nuclei.
authors.affiliation: Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Mueller-Mang
authors.forename: Mauricio
authors.initials: M
authors.lastname: Castillo
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Mang
authors.forename: Fabiola
authors.initials: F
authors.lastname: Cartes-Zumelzu
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Majda M
authors.initials: MM
authors.lastname: Thurnher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000175:diagnosis*; D001922:Brain Abscess / Q000175:diagnosis* / Q000382:microbiology*; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies