Diffusion-weighted MRI in cystic or necrotic intracranial lesions

Our purpose was to investigate the signal intensities of cystic or necrotic intracranial lesions on diffusion-weighted MRI (DWI) and measure their apparent diffusion coefficients (ADC). We examined 39 cystic or necrotic intracranial lesions in 33 consecutive patients: five malignant gliomas, seven metastases, two other necrotic tumours, a haemangioblastoma, three epidermoids, an arachnoid cyst, seven pyogenic abscesses, 12 cases of cysticercosis and one of radiation necrosis. DWI was performed on a 1.5 T unit using a single-shot echo-planar spin-echo pulse sequence with b 1,000 s/mm2. The signal intensity of the cystic or necrotic portion on DWI was classified by visual assessment as markedly low (as low as cerebrospinal fluid), slightly lower than, isointense with, and slightly or markedly higher than normal brain parenchyma. ADC were calculated in 31 lesions using a linear estimation method with measurements from b of 0 and 1,000 s/ mm2. The cystic or necrotic portions of all neoplasms (other than two metastases) gave slightly or markedly low signal, with ADC of more than 2.60 x 10(-3) mm2/s. Two metastases in two patients showed marked high signal, with ADC of 0.50 x 10(-3) mm2/s and 1.23 x 10(-3) mm2/s, respectively. Epidermoids showed slight or marked high signal, with ADC of less than 1.03 x 10(-3) mm2/s. The arachnoid cyst gave markedly low signal, with ADC of 3.00 x 10(-3) mm2/s. All abscesses showed marked high signal, with ADC below 0.95 x 10(-3) mm2/s. The cases of cysticercosis showed variable signal intensity; markedly low in five, slightly low in three and markedly high in four.