Fungal brain abscess – Typical MRI features

ObjectiveTo evaluate the diagnostic value of magnetic resonance imaging (MRI) in brain abscess induced by fungal infection of the central nervous system.MethodsWe analyzed an immune-compromised patient with various neurological symptoms. Imaging studies included T2, T1, post-contrast T1 and diffusion weighted imaging (DWI). The patient had typical imaging features of fungal brain abscess which was later confirmed by histo-pathology.ResultsThe fungal abscess showed irregular walls with intracavitary projections. The abscess showed peripheral ring enhancement with non enhancement of the intra-cavitatory projections. The periphery of the abscess showed susceptibility artifact, thus indicating towards its fungal composition. In the fungal abscesses, the wall and projections showed low ADC; however, the cavity itself showed high ADC.ConclusionMRI-DWI and contrast enhanced MRI changes can improve the early diagnosis of brain abscess & distinguish the fungal brain abscess from pyogenic & tubercular abscesses.