Type:
Educational Exhibit
Keywords:
Neuroradiology brain, CNS, MR, MR-Diffusion/Perfusion, MR-Spectroscopy, Surgery, Biopsy, Infection, Neoplasia, Inflammation
Authors:
S. T. Prabhakar1, B. N. Reddy2, B. B. Das1, P. KUMAR3, A. Muralidhar4, S. Viswamitra1; 1Bangalore/IN, 2Bangalore, ka/IN, 3Mumbai/IN, 4Bangalore /IN
DOI:
10.26044/ecr2019/C-0932
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:
1.
In any case of ring-enhancing lesions first look into DWI images.
- DWI - No restriction -> TDL,
radiation necrosis,
glioma,
metastasis.
- DWI - Restriction -> Abscess,
lymphoma,
Glioma.
2.
After DWI,
look into MR perfusion - CBV images for relative CBV.
- In cases of no restriction -> If rCBV is high ->Metastasis/Glioma,
If rCBV is low -> TDL (further look into MRS),
Radiation necrosis,
- In cases of diffusion restriction -> If rCBV is high -> Glioma,
If rCBV is low -> Abscess/Lymphoma (Lymphoma usually unsusually show necrosis)(further look into MRS).
3.
Peritumoral MRS/CBV: Positive in glioma and metastasis.
The case-based approach of each pathology - Refer to figures 1-16.