Unveiling Hidden Abscesses: The Clinical Utility of Diffusion-Weighted Whole-Body Imaging with Background Suppression (DWIBS) in Metastatic Abscess Screening

TL;DR

DWIBS imaging helps detect hidden abscesses in patients with MRSA, offering a safer and more cost-effective alternative to CT.

Contribution

DWIBS is shown to be a non-invasive, radiation-free tool for identifying metastatic abscesses missed by CT.

Findings

DWIBS identified a prostatic abscess, urethritis, and subcutaneous cysts missed by CT.

DWIBS is more cost-effective and avoids radiation compared to PET-CT.

DWIBS can detect inflammatory foci that are often overlooked by conventional imaging.

Abstract

A 74-year-old man with type 2 diabetes presented with fever, urinary retention, and urinary difficulties. Initial abdominal Computed Tomography (CT) suggested acute pyelonephritis, but a low-density area in the prostate was overlooked. Following the confirmation of methicillin-resistant Staphylococcus aureus (MRSA) in blood and urine cultures, comprehensive screening for metastatic abscesses was necessitated. Diffusion-weighted whole-body imaging with background suppression (DWIBS) was utilized and clearly identified a prostatic abscess (PA), nephritis, urethritis, and subcutaneous cysts. These findings also raised suspicion of pyogenic vertebral osteomyelitis. Crucially, the PA, urethritis, subcutaneous cysts, and potentially the vertebral osteomyelitis were either overlooked or not detected by initial CT imaging. DWIBS allows for simultaneous whole-body screening and serves as a useful adjunctive tool for identifying minute abscesses, which may assist in detecting inflammatory foci that are sometimes overlooked by conventional imaging. Unlike CT, DWIBS avoids radiation and contrast agents, and is significantly more cost-effective than positron emission tomography-CT (PET-CT). DWIBS can thus serve as a useful, non-invasive tool for the early detection and exclusion of abscesses in other organs when metastatic abscess formation is suspected or cultures are positive for microorganisms causing metastatic abscesses.

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