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60 year-old with diabetes and renal disease presents with progressive aphasia
CT noncontrast
CT postcontrast
FLAIR
T1 noncontrast (Gad not given due to renal disease)
GRE
DWI
ADC
MR spectroscopy single voxel: control right brain
Findings:
Multiple ring-enhancing partially hemorrhagic mass lesions with restricted diffusion and high lactate (1.3 PPM)
DDX:
Metastases Abscess Subacute embolic infarcts
Diagnosis:
Left temporal biopsy revealed gram positive cocci in clusters consistent with abscess. Culture grew Strep milleri.
Discussion:
Restricted diffusion and elevated lactate with low NAA and choline favor brain abscess over metastases
Submitted by Kathleen Tozer, MD, UW Neuroradiology Fellow