Capillary telangiectasias of the pons. Does diffusion-weighted MR increase diagnostic accuracy?
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Updated: Jun 22, 2026
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Published on: April 7, 2015
Thomas Finkenzeller1, Franz A Fellner, Johannes Trenkler
1Institute of Diagnostic Radiology, University of Regensburg, Germany. thomas.finkenzeller@kliniken-nordoberpfalz.ag
Background And Purpose:
Capillary telangiectasias are benign lesions of the brainstem which are sometimes difficult to distinguish from other lesions in standard MRI. The purpose of this study was to evaluate if diffusion-weighted imaging (DWI) could help to improve diagnostic accuracy.
Methods:
148 MR examinations of patients with pontine lesions were evaluated retrospectively and revealed capillary telangiectasia (n=18), presumed microvascular disease (n=20), encephalitis disseminata (n=21), pontine myelinolysis (n=16), tumor (n=20), acute infarction (n=20), subacute infarction (n=13) and chronic infarction (n=20). All patients were examined using identical measurement parameters for DWI, Fluid attenuated inversion recovery, T2-weighted turbo spin-echo, and T1-weighted spin-echo before and after application of contrast agent in transverse orientation.
Results:
All capillary telangiectasias showed low signal intensity in DWI and significant contrast enhancement after application of gadolinium. Hypointense signal on DWI was very rare for the remaining lesions: only 1 pontine myelinolysis, 1 tumor, 4 subacute infarctions, and 19 chronic infarctions also revealed low signal intensity on DWI. The combination of high signal intensity on T1-weighted post-contrast images and low signal intensity on DWI was found for all capillary telangiectasias, but only for 1/20 tumor and for 4/13 subacute infarctions. These lesions could be differentiated by their clinical course and/or MRI follow-up examinations. The results of the visual assessment were confirmed by quantitative evaluation.
Conclusion:
DWI seems to be a useful adjunct for the diagnosis of capillary telangiectasias which will facilitate the differential diagnosis concerning tumorous, inflammatory and ischemic lesions.
Insights
Diffusion-weighted imaging (DWI) aids in diagnosing brainstem capillary telangiectasias. This technique helps differentiate these benign lesions from tumors, inflammation, and ischemic conditions on MRI scans.
Area of Science:
- Neuroradiology
- Medical Imaging
- Neuroscience
Background:
- Capillary telangiectasias are benign brainstem lesions.
- Distinguishing them from other lesions on standard MRI can be challenging.
Purpose of the Study:
- To evaluate the utility of diffusion-weighted imaging (DWI) in improving diagnostic accuracy for capillary telangiectasias.
- To assess DWI's role in differentiating capillary telangiectasias from other pontine lesions.
Main Methods:
- Retrospective analysis of 148 MR examinations of patients with pontine lesions.
- Inclusion of various pathologies: capillary telangiectasia, microvascular disease, encephalitis, pontine myelinolysis, tumors, and infarctions (acute, subacute, chronic).
- Standard MRI sequences including DWI, FLAIR, T2-weighted, and T1-weighted pre- and post-contrast were utilized.
Main Results:
- Capillary telangiectasias consistently showed low signal intensity on DWI and significant contrast enhancement.
- Hypointense signal on DWI was rare in other lesions, with few exceptions noted.
- A combination of high T1 post-contrast signal and low DWI signal was characteristic of capillary telangiectasias, aiding differentiation from tumors and subacute infarctions.
Conclusions:
- Diffusion-weighted imaging (DWI) is a valuable tool for diagnosing capillary telangiectasias.
- DWI facilitates the differential diagnosis of capillary telangiectasias from neoplastic, inflammatory, and ischemic lesions.
- The findings support the integration of DWI into MRI protocols for pontine lesions.
