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A ring-enhancing metastasis with central high signal on diffusion-weighted imaging and low apparent diffusion
S Holtås1, B Geijer, L G Strömblad
1Department of Radiology, University Hospital, 22185 Lund, Sweden. stig.holtas@drad.lu.se
Neuroradiology
|January 11, 2001
Summary
Diffusion-weighted imaging (DWI) can mimic abscesses in ring-enhancing brain tumors. Apparent diffusion coefficient (ADC) values in early tumor necrosis may resemble those of abscesses, requiring careful interpretation.
Area of Science:
- Radiology
- Neuroimaging
- Oncology
Background:
- Diffusion-weighted imaging (DWI) is used to differentiate brain abscesses from cystic or necrotic tumors.
- Limited experience exists regarding the sensitivity and specificity of DWI in these differential diagnoses.
Observation:
- A case of a 1.5 cm ring-enhancing adenocarcinoma metastasis presented with a DWI pattern resembling an abscess.
- The tumor showed central T1 isointensity, T2 hyperintensity, a low-signal capsule, high DWI signal, and a low apparent diffusion coefficient (ADC) of 0.55 x 10(-3) mm2/s.
Findings:
- The observed DWI pattern was initially misinterpreted as an early-stage abscess.
- The pattern likely represented early tumor necrosis with intracellular edema, rather than liquefaction.
Implications:
- DWI findings in early-stage abscesses and early tumor necrosis can be similar.
- Radiologists must exercise caution when interpreting DWI in such cases to avoid misdiagnosis.