Current Possibilities of In Vivo Proton (1H) Magnetic Resonance Spectroscopy in the Diagnosis of Brain Abscess

Authors: Z. Večeřa 1;  P. Hanzlíková 2;  T. Krejčí 1;  R. Lipina 1,3;  M. Kanta 4
Authors‘ workplace: Neurochirurgická klinika LF OU a FN Ostrava 1;  MR pracoviště, Sagena s. r. o., Frýdek Místek 2;  Lékařská fakulta OU v Ostravě 3;  Neurochirurgická klinika LF UK a FN Hradec Králové 4
Published in: Cesk Slov Neurol N 2016; 79/112(3): 294-298
Category: Review Article


Brain abscess remains a serious inflammatory brain disease with significant morbidity and mortality. Neuroimaging is an essential part of diagnostic process, postcontrast T1-weighted imaging and diffusion-weighted imaging in particular. The examination should also include in vivo proton (1H) spectroscopy. Its role in differentiating similarly appearing intracranial cystic lesions was confirmed. Spectroscopy is increasingly being used in experimental and clinical applications – noninvasive identification of bacterial type, evaluation of chronological change of the brain abscess, assessment of therapy and postoperative changes. This paper summarizes current findings of in vivo proton MR spectroscopy in the diagnosis of cerebral abscess.

Key words:
brain abscess – diffusion weighted imaging – MR spectroscopy – diffusion tensor imaging

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


1. Alvis-Miranda H, Castel­lar-Leones SM, Elzain MA, et al. Brain absces­s: cur­rent management. J NeurosciRural Pract 2013;4(Suppl 1):67– 81. doi: 10.4103/0976-3147.116472.

2. Starčuk Z, Krupa P, Starčuk Z jr, et al. 1H in vivoMR spektroskopie v klinické neurologii. Neurol Prax 2005;6(3):113– 39.

3. Oz G, Alger JR, Barker PB, et al. Clinical Proton MR Spec­troscopy in Central Nervous System Disorders. Radiology 2014;270(3):658– 79. doi: 10.1148/radiol.13130531.

4. Demaerel P, Van Hecke P, Van Oostende S, et al. Bacterial metabolism shown by magnetic resonance spectroscopy. Lancet 1994;344(8931):1234– 5.

5. Hsu SH, Chou MC, Ko CW, et al. Proton MR spectroscopy in patients with pyogenic brain absces­s: MR spectroscopic imag­ing versus single-voxel spectroscopy Eur J Radiol 2013;82(8):1299– 307. doi: 10.1016/j.ejrad.2013.01.032.

6. Otto D, Hen­n­ing J, Ernst T. Human brain tumors: as­ses­s­-ment with in vivo proton MR spectroscopy. Radiology 1993;186(3):745– 52.

7. Schumacher DJ, Nelson TR, Van Son­nenberg E,et al. Quantification of amino acids in human body fluids by 1 H magnetic resonance spectroscopy: a specific test for the identification of absces­s. Invest Radiol 1992;27(12):999– 1004.

8. Harada M, Tanouchi M, Miyoshi H, et al. Brain ab­scess observed by localized proton magnetic resonance spectroscopy. Magn Reson Imag­ing 1994;12(8):1269– 74.

9. Garg M, Gupta RK, Husain N, et al. Brain absces­ses: etiologic categorization with in vivo proton MR spectroscopy. Radiology 2004;230(2):519– 27.

10. Lai PH, Li KT, Hsu SS, et al. Pyogenic brain ab­sces­s: findings from in vivo 1.5-T and 11.7-T in vitro proton MR spectroscopy. AJNR Am J Neuroradiol 2005;26(2):279– 88.

11. Bajpai A, Prasad KN, Mishra P, et al. Multimodal ap­proach for dia­gnosis of bacterial etiology in brain absces­s. Magn Reson Imag­ing 2014;32(5):491– 6. doi: 10.1016/j.mri.2014.02.015.

12. Wil­lett HP. Energy metabolism. In: Joklik WK, Wil­lett HP, Amos DB, eds. Zins­ser Microbio­logy, 19th ed. Stamford, CT: Appleton Lange 1988:25– 43.

13. Tsui EY, Chan JH, Cheung YK, et al. Evaluation of cerebral absces­ses by dif­fusion-weighted MR imag­ing and MR spectroscopy. Comput Med Imag­ing Graph 2002;26(5):347– 51.

14. Him­melreich U, Accurso R, Malik R, et al. Identification of Staphylococcus aureus brain absces­ses: rat and human studies with 1H MR spectroscopy. Radiology 2005;236(1):261– 70.

15. Jurtshuk P. Bacterial metabolism. In: Baron S, ed. Medical Microbio­logy, 2nd ed. Galveston, TX: University of Texas 1996:65– 84.

16. Britt RH, Engmann DR, Yeager AS. Neuropathological and computerized tomographic findings in experimental brain absces­s. J Neurosurg 1981;55(4):590– 603.

17. Santy K, Nan P, Chantana Y, et al. The dia­gnosis of brain tuberculoma by (1)H-magnetic resonance spectroscopy. Eur J Pediatr 2011;170(3):379– 87. doi: 10.1007/s00431-011-1408-7.

18. Rus­sell DG. Who puts the tubercle in tuberculosis? Nat Rev Microbio­l 2007;5(1):39– 47.

19. Karakousis PC, Bishai WR, Dorman SE. Mycobacterium tuberculosis cell envelope lipids and the host im­mune response. Cell Microbio­l 2004;6(2):105– 16.

20. Chang KH, Song IC, Kim SH, et al. In vivo single voxel proton MR spectroscopy in intracranial cystic mas­ses. AJNR Am J Neuroradiol 1998;19(3):401– 5.

21. Grand S, Pas­saro G, Ziegler A, et al. Necrotic tumor versus brain absces­s: importance of amino acids detected at 1H MR spectroscopy: initial results. Radiology 1999;213(3):785– 93.

22. Poptani H, Gupta RK, Jain VK, et al. Cystic intracranial mass lesions: pos­sible role of in vivo MR spectroscopy in its dif­ferential dia­gnosis. Magn Reson Imag­ing 1995;13(7):1019– 29.

23. Peng J, Ouyang Y, Fang WD, et al. Dif­ferentiation of intracranial tuberculomas and high grade gliomas us­ing proton MR spectroscopy and dif­fusion MR imaging. Eur J Radiol 2012; 81(12):4057– 63. doi: 10.1016/j.ejrad.2012.06.005.

24. Kaminogo M, Ishimaru H, Morikawa M, et al. Proton MR spectroscopy and dif­fusion-weighted MR imag­ing for the dia­gnosis of intracranial tuberculomas. Report of two cases. Neurol Res 2002;24(6):537– 43.

25. Mishra AM Gupta RK, Jaggi RS, et al. Role of dif­fusion-weighted imag­ing and in vivo proton magnetic resonance spectroscopy in the dif­ferential dia­gnosis of ring-enhanc­ing intracranial cystic mass lesions. J Comput As­sist Tomog 2004;28(4):540– 7.

26. Reddy JS, Mishra AM, Behari S, et al. The role of dif­fusion-weighted imag­ing in the dif­ferential dia­gnosis of intracranial cystic mass lesions: a report of 147 lesions. Surg Neurol 2006;66(3):246– 50.

27. Dusak A, Hakyemez B, Kocaeli H, et al. Magnetic Resonance Spectroscopy Findings of Pyogenic, Tuberculous and Cryptococcus Intracranial Absces­ses. Neurochem Res 2012;37(2):233– 7. doi: 10.1007/s11064-011-0622-z.

28. Park SH, Chang KH, Song IC, et al. Dif­fusion weighted MRI in cystic or necrotic intracranial lesions. Neuroradiology 2000;42(10):716– 21.

29. Fuchs J, Siekmeyer M, Kiess W, et al. Tuberculous cerebel­lar abscess in a child--role of 1H-magnetic resonance spectroscopy. Klin Padiatr 2012;224(5):318– 9.

30. Chang L, Mil­ler BL, McBride D, et al. Brain lesions in patients with AIDS: H1 MR spectroscopy. Radiology 1995;197(2):525– 31.

31. Barket et al. Clinical MR spectroscopy –  techniques and applications. MRS in infectious, inflam­matory, and demyelinat­ing lesions, Cambridge University Press 2010: 110– 24.

32. Mamidi A, DeSimone JA, Pomerantz RJ. Central nervous system infections in individuals with HIV-1 infection. J Neurovirol 2002;8(3):158– 67.

33. Pomper MG, Constantinides CD, Barker PB, et al. Quantitative MR spectroscopic imag­ing of brain lesions in patients with AIDS: cor­relation with 11C-methyl-thymidine PET and thal­lium-201 SPECT. Acad Radiol 2002;9(4):398– 409.

34. Kingsley PB, Shah TC, Woldenberg R. Identification of dif­fuse and focal brain lesions by clinical magnetic resonance spectroscopy. NMR Biomed 2006;19(4):435– 62.

35. Simone IL, Federico F, Tortorel­la C, et al. Localized 1H-MR spectroscopy for metabolic characterisation of dif­fuse and focal brain lesions in patients infected with HIV. J Neurol Neurosurg Psychiatry 1998;64(4):516– 23.

36. Holtas S, Geijer B, Stromblad L, et al. A ring-enhanc­ing metastasis with central high signal on dif­fusion--weighted imag­ing and low apparent dif­fusion coef­ficient. Neuroradiology 2000;42(11):824– 7.

37. Reiche W, Schuchardt V, Hagen T, et al. Dif­ferential dia­gnosis of intracranial r­ing enhanc­ing cystic mass lesions – role of dif­fusion-weighted imag­ing (DWI) and dif­fusion-tensor imag­ing (DTI). Clin Neurol Neurosurg 2010;112(3):218– 25. doi: 10.1016/j.clineuro.2009.11.016.

38. Lai PH, Ho JT, Chen WL, et al. Brain abscess and necrotic brain tumors: discrimination with proton MR spectroscopy and dif­fusion-weighted imaging. Am J Neuroradiol 2002;23(8):1369– 77.

39. Her­rnberger B. Dif­fusion tensor magnetic resonance imaging. Nervenheilkunde 2004;23:50– 9.

40. Gupta RK, Hasan KM, Mishra AM, et al. High fractional anisotropy in brain absces­ses versus other cystic intracranial lesions. Am J Neuroradiol 2005;26(5):1107– 14.

41. Nath K, Agarwal M, Ramola M, et al. Role of dif­fusion tensor imag­ing matrics and in vivo proton magnetic resonance spectroscopy in the dif­ferential dia­gnsosis of cystic intracranial mass lesions. Magn Reson Imag­ing 2009;27(2):198– 206. doi: 10.1016/j.mri.2008.06.006.

42. Dev R, Gupta RK, Poptani H, et al. Role of in vivo proton magnetic resonance spectroscopy in the dia­gnosis and management of brain absces­ses. Neurosurgery 1998;42(4):37– 43.

43. Pal D, Bhattacharyya A, Husain M, et al. In vivo proton MR spectroscopy evaluation of pyogenic brain absces­ses: a report of 194 cases. AJNR Am J Neuroradiol 2010;31(2):360– 6. doi: 10.3174/ajnr.A1835.

44. Akutsu H, Matsumura A, Isobe T, et al. Chronological change of brain abscess in 1H magnetic resonance spectroscopy. Neuroradiology 2002;44(7):574– 8.

45. Burtscher IM, Holtas S. In vivo proton MR spectroscopy of untreated and treated brain absces­ses. AJNR Am J Neuroradiol 1999;20(6):1049– 53.

46. Rémy C, Grand S, Lai ES, et al. 1H MRS of human brain abscess in vivo and in vitro. Magn Reson Med 1995;34(4):508– 14.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2016 Issue 3

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account