Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology

• Published in: Neuroradiology 2006-03, Vol.48 (3), p.143-149
• Main Authors: SCHWARTZ, K. M, ERICKSON, B. J, LUCCHINETTI, C
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Brain - pathology; Brain damage; Brain Diseases - pathology; Contrast Media; Diagnosis, Differential; Electrodiagnosis. Electric activity recording; Gadolinium DTPA; Humans; Investigative techniques, diagnostic techniques (general aspects); Luminescence; Magnetic Resonance Imaging; Medical imaging; Medical sciences; Miscellaneous. Technology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system; Neurology; Pathology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Reproducibility of Results; Retrospective Studies; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-005-0024-5

Ring-enhancing lesions seen on MR images can occur with a variety of etiologies. Some ring-enhancing lesions have hypointense rims peripherally on T2-weighted MR images. In this study, we examined whether T2 hypointense rims were associated with specific pathologies. A search for ring-enhancing lesions on MR images obtained from 1996 to 2004 was performed, and revealed 221 patients with MRI findings of ring enhancement. The pattern of T2 hypointensity (arc or rim) corresponding with ring enhancement was recorded. In addition, we analyzed other imaging characteristics, including signal on diffusion-weighted images, central homogeneity on T2 and multiplicity of lesions. We then reviewed clinical data on the patients to ascertain the diagnosis for each examination. The most common associated pathologies in our study were gliomas (40%), metastases (30%), abscesses (8%) and multiple sclerosis (MS; 6%). Hypointense borders on T2-weighted images were present in 67% of lesions in the form of a rim in 40% and an arc in 60%. Abscesses had the highest percentage of hypointense rims. Metastases and gliomas more commonly had arcs, and MS lesions were divided between rims and arcs. Abscesses and MS lesions were more commonly homogeneous centrally, compared to gliomas and metastases. Additionally, abscesses were more often bright on diffusion imaging than the other pathologies. As expected, abscesses and MS lesions were usually multiple, whereas metastases were typically multiple in approximately 50% of the patients; gliomas were generally solitary. Trends in T2 hypointensity may aid in distinguishing among etiologies of ring-enhancing lesions, although there is overlap between the MR appearance of these various pathologies.