Precision Treatment of Cryptogenic Brain Abscesses: Metagenomic Next-generation Sequencing and Imaging for Recurrence Control.

Objective: To investigate the precision diagnosis and treatment strategies for cryptogenic brain abscesses, integrating multimodal imaging (320-slice computed tomography + 3.0 T magnetic resonance imaging) and metagenomic next-generation sequencing (mNGS) technology to optimize treatment regimens and control recurrence risk.

Methods: A retrospective analysis was performed on 88 patients with cryptogenic brain abscesses admitted to the Department of Neurosurgery, the First Affiliated Hospital of Jinan University from January 2014 to August 2023. The patients were defined as having no clear infection source, acute onset, and negative or delayed-positive bacterial cultures. They were divided into a medication group (16 cases), a surgical puncture group (15 cases), and a surgical resection group (57 cases) according to treatment modalities. Fisher's exact test, Kruskal-Wallis test, and multivariate logistic regression were used to analyze the factors related to efficacy and recurrence.

Results: The cure rate in the surgical resection group (98.2%, 56/57) was significantly higher than that in the surgical puncture group (86.7%, 13/15) and the medication group (68.8%, 11/16) (P < 0.001). The recurrence rates were 0% in the surgical resection group, 13.3% (2/15) in the puncture group, and 43.8% (7/16) in the medication group (P < 0.001). Multivariate regression analysis showed that an abscess diameter ≤2.5 cm (95%CI: 1.12-9.43, P < 0.05) and mixed infections was an independent risk factor for recurrence. The pathogen detection rate was increased to 84.1% (74/88) by mNGS, which was significantly higher than that of traditional culture (44.3%, 39/88, P < 0.001).

Conclusions: Combined multimodal imaging and mNGS serve as the core modalities for early diagnosis of cryptogenic brain abscesses. Surgical resection significantly improves cure rates and reduces recurrence risk, particularly suitable for patients with abscesses larger than 2.5 cm in diameter or mixed infections.