To analyze and evaluate ‘ring-enhancing’ appearance as a sign in the differential diagnosis of neurological lesions in the brain. To distinguish between neoplastic and non-neoplastic peripheral enhancing or ring like lesions on contrast enhanced CT or MRI Clinical and pathological correlation of ring lesions with patients mode of presentation, etiological factors, outcome and mode of management.

Forty patients diagnosed with ring enhancing lesions on CT and MRI studies, admitted to Care Hospitals, Hyderabad,India were included in this retrospective study. Neuroimaging studies were done with multi detector computed tomography (MDCT) or 1.5 T magnetic resonance imaging (MRI) with contrast as was indicated. Ancillary investigations like X-ray chest, USG of abdomen,and CT scan of chest, abdomen was done whenever the clinical situation demanded .

Ring Enhancing Lesions: May be single or multiple ,unilocularor multilocular Causes: Bacterial- Tuberculoma ,Pyogenic abscess Fungal- Histoplasmosis, Aspergilosis, Nocardiosis, Mucormycosis Parasitic- Neurcysticersosis,toxoplasmosis,Amebic abscess ,Echinococcosis Neoplastic- Primary brain tumors, Metastasis Primary CNS Lymphoma in AIDS Demyelination - Multiple sclerosis ,Tumefactive demyelination Others - Subacute infarct,Resolving hematoma, Cavernous hemangioma ,Radiation necrosis. Aneurysm wit central hthrombus, post operative ,ADEM, Sarcoidosis Pattern of contrast enhancement: Fig.1,2. Benign: Round and convex Smooth ,uniform Thin(<20mm) Malignant: Undulating Irregular,variable Thick(>20mm Tuberculoma :Fig.3,4. Intracranial tuberculoma can occur with or without tuberculous meningitis. Multiple...

This work provides a comprehensive overview of spectrum of the classic patterns of ring enhancing lesion in the brain. Ring-enhancing lesions of the brain remain a diagnostic challenge .An attempt has been made to establish the etiological diagnoses of ring-enhancing lesions of the brain using neuroimaging (CT and MRI) and by clinical findings with histopathological corelation. Our study establishes the role of TB as the leading cause of ring-enhancing lesions in the Indian setup as compared to tumors in the Western world. It might serve...

Garg RK, Desai P, Kar M, Kar AM. Multiple ring enhancing brain lesions on computed tomography: an Indian perspective. J Neurol Sci 2008;266:92-6. Schwartz KM, Erickson BJ, Lucchinetti C. Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology. Neuroradiology 2006;48:143-9. Young RJ, Sills AK, Brem S, Knopp EA. Neuroimaging of Metastatic Brain Disease. Neurosurgery 2005;57:S4-10-S4-23 James G. Smirniotopoulos, Frances M. Murphy ,MPHElizabeth J. Rushing ,John H. Rees, Jason W.Schroeder LT,MC, USNR:Patterns of Contrast Enhancement in the Brain and Meninges:RadioGraphics 2007;...

Belman Murali MD, Sr.Consultant Radiologist, Dept. of Radiology,Care Hospitals,hyderabad, India. [email protected] Srpathi Pandit Vidyasagar DMRD, DNB, Sr.Consultant Radiologist, Dept. of Radiology,Care Hospitals,hyderabad, India. [email protected] Ameya Jagadish Baxi DMRD, DNB,Consultant Radiologist,Dept. of Radiology,Care Hospitals,hyderabad, India. [email protected]