{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:36:43Z","timestamp":1769726203208,"version":"3.49.0"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"16","license":[{"start":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T00:00:00Z","timestamp":1760918400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,10,20]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Diffusion-weighted imaging (DWI) is a valuable tool in distinguishing brain abscesses from neoplastic lesions, with restricted diffusion often interpreted as indicative of infection. However, some metastatic brain lesions can mimic abscesses both radiologically and clinically, presenting a diagnostic challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 58-year-old woman presented with confusion and was found to have multiple ring-enhancing brain lesions with uniform restricted diffusion on DWI. Initial imaging raised concern for pyogenic abscesses, and empiric antibiotics were initiated. However, systemic imaging revealed a left upper lobe lung mass, and stereotactic biopsy confirmed metastatic adenocarcinoma. The authors performed a systematic review and identified 28 studies describing metastatic lesions with restricted diffusion, most involving solitary lesions with partial restriction. Only a few described multiple lesions with partial restricted diffusion. Lung adenocarcinoma was the most common primary source.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case illustrates that metastatic disease can mimic abscesses on DWI, particularly when lesions are ring enhancing and diffusion restricting. In the absence of clear infectious signs, a broader differential should be considered. Clinical context, systemic imaging, and early biopsy may help clarify the diagnosis and guide appropriate management.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25528\">https:\/\/thejns.org\/doi\/10.3171\/CASE25528<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25528","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:23:12Z","timestamp":1760955792000},"source":"Crossref","is-referenced-by-count":0,"title":["Brain metastasis mimicking brain abscess: illustrative case and systematic review"],"prefix":"10.3171","volume":"10","author":[{"given":"Anoop S.","family":"Chinthala","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3346-1631","authenticated-orcid":true,"given":"Barnabas","family":"Obeng-Gyasi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7547-9400","authenticated-orcid":true,"given":"Kenneth L.","family":"Virgin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Macy","family":"Deckert","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordon","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Top Magn Reson Imaging","first-page":"e0311","article-title":"Multiple ring-enhancing brain lesions: fulminant diffuse cerebral toxoplasmosis or cerebral metastases?","volume":"33","author":"De Keersmaecker","year":"2024","unstructured":"De Keersmaecker SVan Cauter SBekelaar K.Multiple ring-enhancing brain lesions: fulminant diffuse cerebral toxoplasmosis or cerebral metastases? Top Magn Reson Imaging. 2024;33(2):e0311."},{"issue":"6","key":"bib2","series-title":"AJR Am J Roentgenol","first-page":"1487","article-title":"Brain abscess and necrotic or cystic brain tumor: discrimination with signal intensity on diffusion-weighted MR imaging","volume":"171","author":"Kim","year":"1998","unstructured":"Kim YJChang KHSong ICBrain abscess and necrotic or cystic brain tumor: discrimination with signal intensity on diffusion-weighted MR imaging. AJR Am J Roentgenol. 1998;171(6):1487-1490."},{"issue":"7","key":"bib3","series-title":"AJNR Am J Neuroradiol","first-page":"1252","article-title":"Use of diffusion-weighted MR imaging in the differential diagnosis between intracerebral necrotic tumors and cerebral abscesses","volume":"20","author":"Desprechins","year":"1999","unstructured":"Desprechins BStadnik TKoerts GShabana WBreucq COsteaux M.Use of diffusion-weighted MR imaging in the differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. AJNR Am J Neuroradiol. 1999;20(7):1252-1257."},{"issue":"9","key":"bib4","series-title":"Clin Radiol","first-page":"909","article-title":"Can diffusion-weighted imaging be used to differentiate brain abscess from other ring-enhancing brain lesions? A meta-analysis","volume":"69","author":"Xu","year":"2014","unstructured":"Xu XXLi BYang HFCan diffusion-weighted imaging be used to differentiate brain abscess from other ring-enhancing brain lesions? A meta-analysis. Clin Radiol. 2014;69(9):909-915."},{"issue":"9","key":"bib5","series-title":"AJNR Am J Neuroradiol","first-page":"1738","article-title":"Restricted diffusion within ring enhancement is not pathognomonic for brain abscess","volume":"22","author":"Hartmann","year":"2001","unstructured":"Hartmann MJansen OHeiland SSommer CM\u00fcnkel KSartor K.Restricted diffusion within ring enhancement is not pathognomonic for brain abscess. 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