Afridi et al. 17 Differentiation of Brain Abscesses from Necrotic High- grade Gliomas Using Advanced MR Imaging Techniques: A Mini Review Mini-Review Open Access https://doi.org/10.17756/jnpn.2019-030 Muhammad Omar Afridi 1,2 , Shadi Asadollahi 1 , Kavindra Nath 1* and Sanjeev Chawla 1* 1 Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA 2 Rowan School of Osteopathic Medicine at Rowan University, Voorhees, NJ, USA * Correspondence to: Sanjeev Chawla, PhD Research Assistant Professor Department of Radiology Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA E-mail: Sanjeev.Chawla@pennmedicine.upenn.edu Kavindra Nath, PhD Research Assistant Professor Department of Radiology Perelman School of Medicine University of Pennsylvania, Philadelphia, PA, USA Tel: 215-746-7387 E-mail: Kavindra.Nath@pennmedicine.upenn.edu Received: October 08, 2019 Accepted: November 22, 2019 Published: November 25, 2019 Citation: Afridi MO, Asadollahi S, Nath K, Chawla S. 2019. Differentiation of Brain Abscesses from Necrotic High-grade Gliomas Using Advanced MR Imaging Techniques: A Mini Review. J Neuroimaging Psychiatry Neurol 4(2): 17-22. Copyright: © 2019 Afridi et al. is is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY) (http://creativecommons. org/licenses/by/4.0/) which permits commercial use, including reproduction, adaptation, and distribution of the article provided the original author and source are credited. Published by United Scientific Group Abstract e accurate discrimination between brain abscesses and cystic high-grade gliomas (HGGs) is of great importance for planning adequate treatment and for estimating outcome and future prognosis. MR imaging plays an essential role in the discrimination of these two entities. However, differential diagnosis often becomes difficult as conventional neuroimaging features of brain abscess are nonspecific and may simulate those of cystic rim-enhancing mass lesions of varying etiologies including HGGs. It is well documented that cellular and vascular microenvironment of cystic cavity and enhancing rim of abscess is considerably different from that of necrotic HGG. By exploiting these unique characteristics, several studies have shown the potential of physiologic MR imaging techniques in facilitating better characterization of both of these intracranial cystic lesions. e purpose of this mini review is to summarize the basic principles and clinical role of commonly used advanced MR imaging techniques such as diffusion, perfusion MR imaging and MR spectroscopy in differentiation of brain abscesses from necrotic HGGs. Briefly, we will also discuss the potential role of emerging imaging techniques such as chemical exchange saturation transfer (CEST) in characterizing brain abscesses. We will also describe the existing challenges and limitations of using these techniques in routine clinical settings and will finally discuss possible solutions to avoiding pitfalls in data acquisition, and analysis for future studies. Keywords Brain abscesses, Necrotic high-grade gliomas, Advanced MR imaging techniques, Diffusion tensor imaging, Dynamic susceptibility contrast-perfusion weighted imaging, Proton MR spectroscopy, ree-dimensional-echo planar spectroscopic imaging Introduction Differentiation of patients with brain abscesses from those with necrotic or cystic high-grade gliomas (HGGs) can present a significant diagnostic challenge. An accurate and timely differential diagnosis is essential as the treatment and prognosis between these two disease conditions are quite different [1]. Brain abscesses are potentially curable and can be treated successfully by means of standard therapeutic interventions or simply by multiple needle aspirations resulting in significantly improved clinical outcomes [2]. However, the morbidity and mortality rates associated with brain abscesses still remain significantly elevated, especially if appropriate treatment is delayed [3]. On the other hand, J ournal of Neuroimaging in Psychiatry & Neurology