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Updated: Jan 17, 2026

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Diffusion-Weighted Imaging of Intracranial Ring-Enhancing Lesions.

Adrien M Dupanloup1, Craig S Brown2, Karen M Vernau1

  • 1Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA.

Veterinary Radiology & Ultrasound : the Official Journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association
|September 17, 2025
PubMed
Summary

Apparent diffusion coefficient (ADC) values can help differentiate infectious brain lesions. Lower ADC values indicate bacterial abscesses, aiding diagnosis in ring-enhancing lesions on MRI, but this is not seen in all infections.

Keywords:
abscessapparent diffusion coefficient (ADC)diffusion‐weighted imaging (DWI)magnetic resonance imaging (MRI)ring

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Area of Science:

  • Veterinary Radiology
  • Neuroimaging
  • Infectious Disease Imaging

Background:

  • Ring-enhancing lesions on MRI present diagnostic challenges due to diverse etiologies like infection, neoplasia, and inflammation.
  • Standard MRI sequences often struggle to differentiate these lesions effectively.
  • Diffusion-weighted imaging (DWI) offers additional information for lesion characterization.

Purpose of the Study:

  • To compare apparent diffusion coefficient (ADC) values of intracranial ring-enhancing lesions of infectious etiology with those of other causes.
  • To evaluate the utility of ADC values in differentiating infectious from non-infectious ring-enhancing lesions.
  • To determine if restricted diffusion on DWI is a reliable marker for specific types of infectious brain lesions.

Main Methods:

  • Retrospective review of MRI studies with DWI and post-gadolinium T1-weighted imaging in animals with ring-enhancing lesions and definitive diagnoses.
  • Generation of ADC maps and selection of regions of interest (ROIs) for lesional and contralateral brain tissue.
  • Calculation of normalized ADC values (rADC = ADClesion/ADCbrain) for quantitative analysis.

Main Results:

  • Intraparenchymal bacterial abscesses showed significantly lower median rADC (0.54) compared to gliomas (1.7) and non-infectious inflammatory lesions (1.7).
  • Hemorrhagic lesions had similar rADC values (0.54) to bacterial abscesses, posing a potential diagnostic overlap.
  • Extraparenchymal bacterial empyema (rADC 2.8) and fungal abscesses (rADC 1.2) did not consistently exhibit restricted diffusion.
  • An rADC cutoff of 0.65 demonstrated high specificity (98%) and sensitivity (78%) for intraparenchymal bacterial abscesses when excluding hemorrhagic lesions.

Conclusions:

  • Apparent restricted diffusion on DWI is a valuable indicator for identifying intraparenchymal bacterial abscesses among ring-enhancing lesions.
  • However, extraparenchymal bacterial empyema and fungal abscesses may not display restricted diffusion, limiting the universal applicability of this finding.
  • ADC values, particularly rADC, aid in differentiating infectious from neoplastic or inflammatory ring-enhancing lesions, with specific considerations for hemorrhagic and non-bacterial infectious etiologies.