Cerebral ring enhancing lesions
Updates to Article Attributes
Body
was changed:
The differential for peripheral or ring enhancing cerebral lesions includes:
- cerebral abscess
- tuberculoma
- neurocysticercosis
- metastasis
- glioblastoma multiforme
- subacute infarct / haemorrhage / contusion
- demyelination (incomplete ring)
- tumefactive demyelinating lesion (incomplete ring)
- radiation necrosis
- postoperative change
- lymphoma - in immunocompromised patient
A helpful mnemonic is MAGIC DR
Radiographic features
No single feature is pathognomonic, although a cystic lesion that markedly restricts centrally (the fluid component) on DWI should be considered an abscess until proven otherwise.
Many features of the lesion as well as clinical presentation and patient demographics need to be taken together to help narrow the differential. Helpful rules of thumb include:
- enhancing wall characteristics
- thick and nodular favours neoplasm
- thin and regular favours abscess
- incomplete ring often opened toward the cortex favours demyelination
- intermediate to low T2 signal capsule favours abscess
- restricted diffusion of enhancing wall favours GBM or demyelination
- surrounding oedema
- extensive oedema relative to lesion size favours abscess
- increased perfusion favours neoplasm (metastases or primary cerebral malignancy)
- central fluid / content
- restricted diffusion favours abscess
- number of lesions
- similar sized rounded lesions at grey white matter junction favours metastases or abscesses
- irregular mass with adjacent secondary lesions embedded in the same region of 'oedema' favours GBM
- small (<1-2cm) lesions with thin walls especially if other calcific foci are present suggest neurocysticercosis.
Related video
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- +<li><a title="tuberculoma" href="/articles/cns-tuberculosis-1">tuberculoma</a></li>
- +<li><a href="/articles/neurocysticercosis">neurocysticercosis</a></li>
-<a href="/articles/demyelination">demyelination</a> (<a href="/articles/open_ring_sign">incomplete ring</a>)</li>- +<a href="/articles/demyelination">demyelination</a> (<a href="/articles/open-ring-sign">incomplete ring</a>)</li>
-<a href="/articles/tumefactive_demyelinating_lesion">tumefactive demyelinating lesion</a> (incomplete ring)</li>- +<a href="/articles/tumefactive-demyelinating-lesion">tumefactive demyelinating lesion</a> (incomplete ring)</li>
-<li>low T2 signal favours abscess</li>- +<li>intermediate to low T2 signal capsule favours abscess</li>
References changed:
- 3. Garg RK, Sinha MK. Multiple ring-enhancing lesions of the brain. J Postgrad Med. 2010;56 (4): 307-16. <a href="http://dx.doi.org/10.4103/0022-3859.70939">doi:10.4103/0022-3859.70939</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/20935408">Pubmed citation</a><span class="auto"></span>
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