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Contribution of in vivo1H spectroscopy to the diagnosis of deep-seated brain abscess
  1. JEAN SABATIER,
  2. MICHEL TREMOULET
  1. Department of Neurosurgery
  2. Department of Neuroradiology, University Hospital Purpan
  3. IMRCP Laboratory, Paul Sabatier University, Toulouse, France
  1. Dr Jean Sabatier, Service de Neurochirurgie, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse Cedex, France. Telephone 0033 5 61 77 22 67; fax 0033 5 61 77 90 37; email JFS{at}CICT.FR
  1. JEAN-PHILIPPE RANJEVA,
  2. CLAUDE MANELFE,
  3. ISABELLE BERRY
  1. Department of Neurosurgery
  2. Department of Neuroradiology, University Hospital Purpan
  3. IMRCP Laboratory, Paul Sabatier University, Toulouse, France
  1. Dr Jean Sabatier, Service de Neurochirurgie, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse Cedex, France. Telephone 0033 5 61 77 22 67; fax 0033 5 61 77 90 37; email JFS{at}CICT.FR
  1. VERONIQUE GILARD,
  2. MYRIAM MALET-MARTINO
  1. Department of Neurosurgery
  2. Department of Neuroradiology, University Hospital Purpan
  3. IMRCP Laboratory, Paul Sabatier University, Toulouse, France
  1. Dr Jean Sabatier, Service de Neurochirurgie, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse Cedex, France. Telephone 0033 5 61 77 22 67; fax 0033 5 61 77 90 37; email JFS{at}CICT.FR

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Brain abscesses are associated with high mortality and morbidity even in the antibiotic era and with complex imaging techniques, mainly because of delayed diagnosis. Several reasons can be identified: (1) the incidence of abscesses is low, about 1.1/100 000 person-year1; (2) clinical features may be non-specific without evidence of infection and with neurological signs similar to tumours, which are 50 times more frequent; (3) neuroradiological imaging may be confusing specially in the early stages.

The only way to improve the outcome of this pathology is to consider an abscess when faced with a space occupying lesion and to perform a stereotactic biopsy even in elderly or severely deteriorated patients.

Recently, in vivo 1H MR spectroscopy (MRS) was reported to give metabolic information on brain abscesses very different from that of brain tumours, permitting a non-invasive differential diagnosis between these two diseases.2

(A) T2 weighted MRI in the axial plane. (B) In vivo1H MRS spectrum from abscess (echo time=135 ms). (C) In vitro 400 MHz 1H MRS spectrum from aspirated pus (aa = aminoacids Ac=acetate, Ala=alanine, Gly=glycine, Lac=lactate, Succ=succinate, Tau=taurine).

We report a case in which the diagnosis of an abscess was made on the basis of in vivo 1H MRS resulting in complete …

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