Assessment of therapeutic response in patients with brain abscess using diffusion tensor imaging

Nath, Kavindra; Ramola, Mahesh; Husain, Mazhar; Kumar, Manoj; Prasad, Kashi; Gupta, Rakesh

doi:10.1016/j.surneu.2009.04.003

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Volume 73, Issue 1 , Pages 63-68, January 2010

Assessment of therapeutic response in patients with brain abscess using diffusion tensor imaging

Kavindra Nath, PhD
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP 226014, India
Mahesh Ramola, MS
- Department of Neurosurgery, Chhatrapati SahuJi Maharaj Medical University, Lucknow, UP 266003, India
Mazhar Husain, MCh
- Department of Neurosurgery, Chhatrapati SahuJi Maharaj Medical University, Lucknow, UP 266003, India
Manoj Kumar, MSc
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP 226014, India
Kashi Prasad, MD
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP 226014, India
Rakesh Gupta, MD
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP 226014, India
- Corresponding author. Tel.: +91 522 2668700x2599 (O), 2600 (R); fax: +91 522 2668017.

Received 8 July 2008; accepted 8 April 2009. published online 10 August 2009.

Abstract

Background

Accurate assessment of therapeutic response in patients with brain abscess (BA) is essential to direct appropriate therapy. This study was performed with an aim to see the treatment-induced changes in diffusion tensor imaging (DTI) indices (ie, fractional anisotropy [FA] and mean diffusivity [MD]) in follow-up patients with BA after treatment.

Methods

Twenty patients with BA were prospectively studied in this study. Diffusion tensor imaging in first follow-up was done in all after 1 week and in 6 at 4 weeks of the initial study.

Results

The mean FA and MD values in first, second, and third studies were 0.28 ± 0.03 and (0.81 ± 0.07) × 10⁻³ mm²/s, 0.18 ± 0.09 and (1.08 ± 0.09) × 10⁻³ mm²/s, and 0.13 ± 0.04 and (0.99 ± 0.13) × 10⁻³ mm²/s, respectively. The FA value was significantly (P < .01) decreased along with no significant change in MD value (P = .08) for 3 study periods. The mean volume (in milliliter) of the abscesses was 2.14 ± 1.04, 1.34 ± 0.45, and 0.77 ± 0.14 in first, second, and third studies, respectively.

Conclusions

We conclude that the reduction in FA value reflects the down-regulation of the neuroinflammatory molecules in response to treatment in patient with BA and may be used to assess therapeutic response in these patients in future.

Abbreviations: ADC, Apparent diffusion coefficient, ANOVA, analysis of variance, CAM, cell adhesion molecule, CNS, central nervous system, DTI, diffusion tensor imaging, DWI, diffusion-weighted imaging, ETL, echo train length, FA, fractional anisotropy, FOV, field of view, FSE, fast spin echo, Gd-DTPA-BMA, gadolinium–diethylenetriamine pentaacetic acid-bismethylamide, ICAM-1, intercellular adhesion molecule-1, MD, mean diffusivity, MRI, magnetic resonance imaging, NEX, number of excitations, NIH, National Institutes of Health, PMRS, proton magnetic resonance spectroscopy, ROI, region of interest, SE, spin echo, SNR, signal-to-noise ratio, TE, echo time, TR, repetition time