zerebrale Läsionen mit ringförmiger Kontrastmittelanreicherung
Cerebral ring
enhancing lesions • Cerebral abscess - Ganzer Fall bei Radiopaedia
Cerebral ring
enhancing lesions • Ring enhancing cerebral metastasis - Ganzer Fall bei Radiopaedia
Cerebral ring
enhancing lesions • Glioblastoma NOS (cystic) - Ganzer Fall bei Radiopaedia
Cerebral ring
enhancing lesions • Subacute hemorrhagic stroke - enhancing - Ganzer Fall bei Radiopaedia
Cerebral ring
enhancing lesions • Cerebral radiation necrosis - Ganzer Fall bei Radiopaedia
Open ring
sign • Acute disseminated encephalomyelitis - Ganzer Fall bei Radiopaedia
Brain abscess
• Cerebral abscess - Ganzer Fall bei Radiopaedia
Glioblastoma,
IDH-wildtype • Glioblastoma NOS - Ganzer Fall bei Radiopaedia
Cerebral ring
enhancing lesions (mnemonic) • Diffuse axonal injury and rim enhancing contusions - Ganzer Fall bei Radiopaedia
Tuberculosis
(intracranial manifestations) • Cerebellar tuberculoma - Ganzer Fall bei Radiopaedia
Intracranial
tuberculous granuloma • Cerebral tuberculoma - Ganzer Fall bei Radiopaedia
Intracranial
tuberculous abscess • Tuberculous brain abscess - Ganzer Fall bei Radiopaedia
The differential for peripheral or ring enhancing cerebral lesions includes:
- cerebral abscess
- tuberculoma
- neurocysticercosis
- metastasis
- glioblastoma
- subacute infarct/hemorrhage/contusion
- demyelination (incomplete ring)
- tumefactive demyelinating lesion (incomplete ring)
- radiation necrosis
- postoperative change
- lymphoma - in an immunocompromised patient
- leukemia
- thrombosed aneurysm
- necrotizing leukoencephalopathy after methotrexate
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 favors neoplasm
- thin and regular favors abscess
- incomplete ring often opened toward the cortex favors demyelination
- intermediate to low T2 signal capsule favors abscess
- restricted diffusion of enhancing wall favors GBM or demyelination
- surrounding edema
- extensive edema relative to lesion size favors abscess
- increased perfusion favors neoplasm (metastases or primary cerebral malignancy)
- central fluid content
- restricted diffusion favors abscess
- an absence of diffusion restriction favor a tumor with a central necrotic component (classically metastases)
- number of lesions
- similar sized rounded lesions at grey-white matter junction favors metastases or abscesses
- irregular mass with adjacent secondary lesions embedded in the same region of 'edema' favors GBM
- small (<1-2 cm) lesions with thin walls, especially if other calcific foci are present, suggest neurocysticercosis.
See also
Related video
Siehe auch:
- Hirnmetastase
- Glioblastoma multiforme
- Lymphom
- Neurozystizerkose
- Hirnabszess
- Ischämischer Schlaganfall
- Abszess
- Metastase
- Demyelinisierende Erkrankung
- zerebrale Radionekrose
- haematoma
- inkomplettes Ringenhancement
- infarct
- contusion
- haemorrhage
- Strahlennekrose
- MAGIC DR
- Tuberkulom des ZNS
und weiter:
Assoziationen und Differentialdiagnosen zu zerebrale Läsionen mit ringförmiger Kontrastmittelanreicherung:
