title: The difference in diffusion-weighted imaging with apparent diffusion coefficient between spontaneous and postoperative intracranial infection.
abstract: BACKGROUND
  Although the roles of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) have been accepted as the initial or confirmatory diagnostic tool for spontaneous intracranial infections, the usefulness of these has rarely been investigated in intracranial infections after a craniotomy procedure. Through an analysis of the clinico-radiological characteristics of spontaneous and postoperative intracranial infections, the authors revealed the specific factors that affect the accuracy of DWI and ADC in diagnosing intracranial infections.
  
  
  METHODS
  The authors retrospectively analyzed 67 intracranial infections confirmed using preoperative MR imaging, including the DWI, ADC and gadolium-enhanced (Gd) images, and by peroperative pus drainage.
  
  
  RESULTS
  In 67 enrolled patients, no or uncertain diffusion restriction on DWI and ADC was found in 9 cases (13%). All the cases showed typical peripheral enhancement on Gd images. Among nine cases without diffusion restriction, postoperative infection was seen in five cases (62.5% [5/8 postoperative infection group] vs. 6.8% [4/59 spontaneous infection group], p = 0.001). On multivariate analysis, postoperative infection was the predictive factor for false-negative restriction on DWI and ADC (hazard ratio: 41.2, 95% confidential index: 2.39-710.25, p = 0.01).
  
  
  CONCLUSIONS
  Despite the excellent availability of DWI and ADC for diagnosing spontaneous intracranial infections, negative restriction results of those images are not sufficient to exclude postoperative intracranial infection.
authors: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School , Hwasun-gun, Jeollanamdo , Republic of Korea.
authors: Yeong-Jin
authors: YJ
authors: Kim
authors: Kyung-Sub
authors: KS
authors: Moon
authors: Seul Kee
authors: SK
authors: Kim
authors: Seong-Ji
authors: SJ
authors: Kang
authors: Kyung-Hwa
authors: KH
authors: Lee
authors: Woo-Yool
authors: WY
authors: Jang
authors: Tae-Young
authors: TY
authors: Jung
authors: In-Young
authors: IY
authors: Kim
authors: Shin
authors: S
authors: Jung
mesh_terms: D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000175:diagnosis* / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging / Q000592:standards*; D005260:Female; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000209:etiology
chemical_list: D005682:Gadolinium
keywords: apparent diffusion coefficient; brain abscess; diagnosis; diffusion-weighted image; postoperative infection