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Ependymal enhancement on MRI: imaging patterns and diagnostic algorithms - a pictorial essay

João Gonçalves1,2, Alexandra Rodrigues3,4, Ricardo Pires5

  • 1Neuroradiology Department, Unidade Local de Saúde São José, Lisbon, Portugal. joao.gonc94@gmail.com.

Neuroradiology
|December 17, 2025
PubMed
Abstract

Insights

Ependymal enhancement on MRI presents diagnostic challenges. This study offers two algorithms, based on immune status, to differentiate causes like infections, inflammation, and tumors.

Area of Science:

  • Neuroradiology
  • Neuroimaging
  • Diagnostic Imaging

Background:

  • Ependymal enhancement on MRI is an uncommon finding.
  • It presents a diagnostic challenge due to diverse etiologies.

Purpose of the Study:

  • To present an algorithmic approach for the differential diagnosis of ependymal enhancement.
  • To categorize causes into infectious, inflammatory, and neoplastic groups.

Main Methods:

  • Categorization of ependymal enhancement into three main etiologic groups.
  • Development of two diagnostic algorithms tailored to patient immune status (immunosuppressed vs. immunocompetent).
  • Highlighting key demographic, clinical, and imaging findings for diagnosis.

Main Results:

  • Algorithms differentiate causes based on enhancement patterns (linear, band-like, nodular) and presence of intra-axial masses.
  • For immunosuppressed patients, focus is on enhancement patterns and masses, suggesting toxoplasmosis or lymphoma.
  • For immunocompetent patients, diagnosis relies on clinical history and lesion characteristics to distinguish infectious, inflammatory, and neoplastic etiologies.

Conclusions:

  • Diagnostic algorithms aid neuroradiologists in structuring differential diagnoses.
  • These algorithms can improve clinical decision-making for ependymal enhancement.
Keywords:
EnhancementEpendymalImmunocompetenceImmunosuppressionInfectionInflammationMRIPatternsTumor

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