Biological correlates of diffusivity in brain abscess

Restricted diffusion in brain abscess is assumed to be due to a combination of inflammatory cells, necrotic debris, viscosity, and macromolecules present in the pus. We performed diffusion-weighted imaging (DWI) on 41 patients with proven brain abscesses (36 pyogenic and five tuberculous), and correlated the apparent diffusion coefficient (ADC) from the abscess cavity with viable cell density, viscosity, and extracellular-protein content quantified from the pus. On the basis of the correlation between cell density and ADC in animal tumor models and human tumors in the literature, we assumed that the restricted ADC represents the cellular portion in the abscess cavity. We calculated restricted and unrestricted lesion volumes, and modeled cell density over the restricted area with viable cell density per mm(3) obtained from the pus. The mean restricted ADC in the cavity (0.65 +/- 0.01 x 10(-3) MM2/S) correlated inversely with restricted cell density in both the pyogenic (r = -0.90, P = < 0.05) and tuberculous (0.60 +/- 0.04 x 10(-3) mm(2)/S, r = -0.94, P = < 0.05) abscesses. We conclude that viable cell density is the main biological parameter responsible for restricted diffusion in brain abscess, and it is not influenced by the etiological agents responsible for its causation.