Role of Imaging with Microbiological Evaluation in Early Detection of Brain Abscess

Abstract

Background: Brain abscess in a severe life-threatening focal infection of central nervous system presents a significant and disproportionately high burden in developing country including Bangladesh. Both neuroimaging and microbiological testing are critical for the early detection and effective management of a brain abscess. The aim of the study for the diagnostic value of neuroimaging and microbiological testing in early detection of brain abscess. Methods: This retrospective cross sectional study was carried out on 52 patients from January, 2022 to December 2022 in Department of radiology & Imaging, Neurology, Neurosurgery, and Microbiology at Sir Salimullah Medical College Mitford hospital, Dhaka. Patients were admitted into Neurosurgery Department Neurology and Neurosurgery was selected for neuroimaging and laboratory assessment of blood. Sensitivity, specificity, PPV, NPV was calculated for all ways of each data analysis and the overall composite. Interobserver agreement was assessed with Cohen’s kappa. Correlations between imaging features (e.g., abscess capsule thickness, diffusion) and pathogen types were evaluated using Chi-square or Fisher’s exact tests. The statistical analysis of the data was done using SPSS 26.0. Results: This study demonstrated higher sensitivity (88%) and specificity (80%) MRI than CT (72% and 66%, respectively) for detecting brain abscesses, while microbiology showed high specificity (90%) but lower sensitivity (69%). An integrated approach combining MRI, CT, and microbiology achieved the highest diagnostic accuracy (sensitivity 96%, specificity 92%). Interobserver agreement for key MRI features was excellent (K>.75). Conclusion: Compared to traditional and single modality assessment, the integration of imaging and microbiological testing results in improved therapeutic decisions, faster diagnosis times, and higher diagnostic accuracy.

Sir Salimullah Med Coll J 2025; 33: 26-31