Learning objectives
To enlist the various differentials of ring-enhancing lesions in the brain.
To discuss the various imaging characteristics of ring-enhancing lesions in brain and utilization of MRI advances in prompt diagnosis in case-based approach.
Background
The lesions with ring pattern of enhancement after contrast administration are most commonly seen in the broad spectrum of brain pathologies.
These ring enhancing pattern can be solitary or multiple and is seen in the spectrum of diseases ranging from demyelination to neoplastic etiologies.
Henceforth it is mandatory to differentiate these pathologies on MRI.
The MR advances such as MR perfusion and MR spectroscopy helps in accurate characterization in many pathologies which help in further medical or surgical management.
Findings and procedure details
- A total of 300 patients who presented clinically with varied clinical presentation who underwent magnetic resonance imaging of the brain with MR perfusion and MR spectroscopy analysis wherever necessary were evaluated.
- The following cases with clinical and laboratory parameters correlation were included.
- The following pathologies were observed:
-Demyelination: Tumefactive demyelination,
multiple sclerosis.
-Infections: Neurocysticercosis,
tuberculoma,
pyogenic abscess,
toxoplasmosis.
-Vascular: Infarcts,
aneurysms.
-Neoplastic: GBM,
Lymphoma,
pilocytic astrocytoma,
metastasis.
-Inflammatory: ADEM,
Sarcoidosis,
radiation necrosis.
A pattern approach to ring-enhancing lesions using advanced MRI techniques:...
Conclusion
MRI with its recent advances plays a major role in the evaluation of the wide spectrum of ring-enhancing lesions in the brain which pose a diagnostic challenge.
References
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.
Maarouf M,
Kuchta J,
Miletic H,
Ebel H,
Hesselmann V,
Hilker R,
et al.
Acute demyelination: diagnostic difficulties and the need for brain biopsy.
Acta Neurochir (Wien)2003; 145:961-9.
Garg RK,
Desai P,
Kar M,
Kar AM.
Multiple ring enhancing brain lesions on computedtomography: an Indian perspective.
J Neurol Sci 2008;266:92-6.
Osborn AG.
Diagnostic neuroradiology.
St.
Louis: Mosby,1994:639-649,
660-664.