The value of unenhanced scans in differentiating lesions producing ring enhancement

Ring enhancement with contrast material is a nonspecific computed tomographic finding seen in a variety of lesions, including benign and malignant neoplasms, inflammation, infarction, and hematoma. This lack of specificity is especially troublesome in the differentiation of self-limiting disorders (infarction and hematoma) from progressive processes (tumor or abscess) potentially requiring surgical treatment. To determine whether more specific diagnoses were possible, 115 cases with ring lesions were retrospectively evaluated for the usefulness of precontrast scan features. The presence or absence of a complete ring proved useful. A complete ring on unenhanced scans effectively excluded self-limiting processes; it was seen in none of 18 infarcts or 11 hematomas. A complete ring on unenhanced scans occurred in 37 of 65 neoplasms, and was more common in metastatic disease (2:1) than in gliomas. A complete ring on unenhanced computed tomography was also seen in four of 15 pyogenic abscesses.