Differentiation of brain tumors from brain infections and abscesses
Brain abscesses caused by aerobic bacteria can mimic GBM tumors in MRI image appearance and single voxel proton MR spectroscopy, leading to misdiagnosis. Based on the hypothesis that metabolite levels of choline would be decreased in the ring-enhancing portion of abscesses compared to GBM, one study using MR spectroscopic imaging found that metabolite ratios and maximum choline/choline-n, choline/creatine, and choline/ N-acetylaspartate ratios of the contrast-enhancing rim could be useful differentiating aerobic abscesses from GBM. In MRI procedures, the apparent diffusion coefficient (APC) may be useful in differentiating GBM from brain fungal abscess. Combining diffusion tensor imaging (DTI) and dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) provides better results in differentiating lesions from brain infections than each technique used alone [54-56].