Differentiating Necrotic Neoplastic Lesions from Brain Abscess Using Multiparametric Magnetic Resonance Imaging (MRI)

Abstract

Abstract Background: Brain abscesses and necrotic neoplastic lesions are two distinct and often challenging conditions to differentiate due to overlapping clinical and imaging features. Accurate identification is critical for guiding appropriate treatment strategies, as these conditions require fundamentally different management approaches. Traditional MRI may not always provide sufficient contrast to differentiate these lesions, necessitating the exploration of more advanced imaging techniques. Multiparametric MRI (mpMRI) has shown promise in offering deeper insights into lesion characterization, utilizing multiple sequences such as diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy (MRS). Objective: This study aims to assess the diagnostic utility of multiparametric MRI (mpMRI) in differentiating brain abscesses from necrotic neoplastic lesions, focusing on the contribution of DWI, PWI, and MRS in the differential diagnosis. The study investigates how these imaging modalities enhance diagnostic accuracy and clinical decision-making. Methods: This retrospective study included 150 patients, aged 18 to 80, from NIMS University & Hospital, who presented with clinical symptoms suggestive of intracranial pathology. Each patient underwent MRI scans, including DWI, PWI, and MRS, between 2024 and 2025. The final diagnosis was confirmed based on histopathology. MRI findings were analyzed by two independent radiologists to assess lesion morphology, diffusion characteristics, perfusion, and metabolic changes. Statistical analysis was performed to evaluate the sensitivity, specificity, and diagnostic accuracy of each imaging modality.