Original Articles

MRI-DWI improves the early diagnosis of brain abscess induced by Candida albicans in preterm infants

Jian Mao, Juan Li, Dan Chen, Jing Zhang, Ya-Nan Du, Ying-Jie Wang, Xin Li, Rui Wang, Li-Ying Chen, Xiao-Ming Wang


Objective: To investigate the diagnostic value of magnetic resonance imaging (MRI) in brain abscess induced by invasive fungal infection (IFI) of the central nervous system.
Methods: The clinical data of eight preterm infants with IFI of the central nervous system were retrospectively analyzed. All these eight children received three sequential brain MRI modes T1WI, T2WI and DWI during hospitalization and after discharge.
Results: All these eight preterm infants were infected with Candida albicans, seven of which were manifested by brain abscess and four were accompanied by meningitis. MRI of seven infants with brain abscess indicated extensive invasion including involvement of subcortical white matter, deep periventricular white matter and semiovale center white matter. MRI examination was conducted within 11 d following infection on four cases and showed diffuse or multiple miliary nodules, hyper-intense signal on DWI, while insignificant signal changes on T1WI and T2WI. DWI signal nearly disappeared three weeks later. T1WI/T2WI signal changed most significantly 2-4 weeks following infection, with nodules ring-shaped, hyper-intense signal around T1WI and hypo-intense signal in the center. Signal on T2WI was just on the opposite. Severe cases presented fusion of different degrees. Significant enhanced effect was observed on T1WI. Four weeks later, the lesion gradually became fewer and smaller on T1WI, transferred into dot or line-like hyper-intense signal and presented obviously hypo-intense signal on T2WI. Dynamic MRI of two cases showed delayed myelination and corpus callosum thinning.
Conclusion: MRI-DWI and dynamic MRI changes can improve the early diagnosis of brain abscess induced by Candida albicans in preterm infants.

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