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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
Abstract:
Diffusion-weighted imaging (DWI) has been reported to be useful in the differential diagnosis between abscesses and cystic or necrotic tumours. However, experience is still limited and the true sensitivity and specificity remain to be determined. Our purpose is to describe a ring-enhancing metastasis of adenocarcinoma with a DWI pattern similar to that reported for abscesses. The tumour had a diameter of 1.5 cm and give signal from its centre similar to that of normal brain on T1-weighted images, whereas it was increased on T2-weighted images, and surrounded by a low signal ring, suggesting a capsule. The signal was high on DWI and the apparent diffusion coefficient (ADC) was low (0.55 x 10(-3) mm2/s). The findings were misinterpreted as representing an abscess in the early capsule-formation stage, but the signal pattern probably represented early tumour necrosis with intracellular oedema, but without liquefaction. Findings on DWI during the early capsule formation stage in abscesses and early tumour necrosis are probably similar and must be interpreted with caution.
Insights
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.
