Lesions of the brain stem: assessment by magnetic resonance imaging

Ninety-six magnetic resonance imaging (MRI) studies demonstrating solitary brain stem lesions were reviewed in order to establish distinguishing features between tumours and other lesions. Histological confirmation of the radiological diagnoses was obtained in 33% of patients. The morphology of the lesion rather than its signal characteristics was the most useful feature in differential diagnosis, except after haemorrhage. However, areas of abnormal T2 recovery time were significantly more extensive than areas of abnormal T1 recovery time in tumours at presentation. In other lesions and in tumours following radiotherapy induced regression, the extent of abnormal T1 and T2 signal was the same. Possible reasons for this observation are discussed. The accuracy of computed tomography (CT) and MRI were similar for lesions causing brain stem expansion but for small lesions MRI was more sensitive and provided better topographical information.