Patterns of Contrast Enhancement in the Brain and Meninges

Smirniotopoulos, James G.; Murphy, Frances M.; Rushing, E J; Rees, John H.; Schroeder, Jason W.

doi:10.1148/rg.272065155

Cited by 412 publications

(353 citation statements)

References 50 publications

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“…Further investigation in animal models is needed to elucidate the exact nature of this enhancement, which might be related to neovascularization. 32 Of note, in the previous application of MR imaging-guided focused sonography for neuropathic pain syndromes, 10 enhancement was seen at 24 hours and had resolved by 48 hours. Patients were not imaged beyond 48 hours.…”

Section: Discussionmentioning

confidence: 98%

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

Wintermark

Druzgal

Huss³

et al. 2013

American Journal of Neuroradiology

125

115

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BACKGROUND AND PURPOSE: MR imaging-guided focused sonography surgery is a new stereotactic technique that uses high-intensity focused sonography to heat and ablate tissue. The goal of this study was to describe MR imaging findings pre-and post-ventralis intermedius nucleus lesioning by MR imaging-guided focused sonography as a treatment for essential tremor and to determine whether there was an association between these imaging features and the clinical response to MR imaging-guided focused sonography.

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Section: Discussionmentioning

confidence: 98%

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

Wintermark

Druzgal

Huss³

et al. 2013

American Journal of Neuroradiology

125

115

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“…Lesions are therefore most commonly found in a subcortical location. Another means of infection is the transdural spread of an underlying paranasal sinus or mastoid infection [8].…”

Section: Discussionmentioning

confidence: 99%

CT and MRI Findings in Cerebral Aspergilloma

Gärtner

Forstenpointner²,

Ertl‐Wagner

et al. 2017

Fortschr Röntgenstr

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ZUSAMMENFASSUNG Ziel Zerebrale Aspergillose betrifft meist immunsupprimiertePatienten und weist aufgrund der oftmals unspezifischen Klinik ein hohes Morbiditäts-und Mortalitätsrisiko auf. Eine frühe Diagnosestellung ermöglicht die effektivere Einleitung der Therapiemaßnahmen und die Verbesserung des Outcome.Material und Methoden Die CT-und MRT-Aufnahmen von neun Patienten aus zwei Zentren wurden ausgewertet. Die Diagnose der zerebralen Aspergillose wurde mittels Biopsie und histopathologischer Begutachtung verifiziert. Die MRT wurde an 1,5T-und 3T-Geräten durchgeführt, die Untersuchungsprotokolle enthielten jeweils DWI, T2-und T1-gewichtete Bilder mit und ohne Kontrastmittel.Ergebnisse In der CT wiesen die Aspergillome kein typisches Erscheinungsbild auf. In der MRT waren die Aspergillome zu 100 % randständig diffusionsgestört (9/9). Mehrere hypointense Schichten in der Aspergilluswand, insbesondere an der Innenseite, waren typisch in den Aufnahmen mit T2-Wichtung (100 %, 9/9). Die Aspergillome waren sowohl T1-hypointens (66 %, 6/9), sowie in 33 % anteilig T1-hyperintens (3/9). In 78 % (7/9) der Fälle fand sich ein randständiges Enhancement nach Gadoliniumapplikation.Schlussfolgerung Aspergillome weisen typischerweise eine kräftige, ringförmige Diffusionsrestriktion auf (9/9). Typische Befunde in Aufnahmen der T2-gewichteten Bilder sind zwiebelschalenartig angeordnete hypointense Schichten, die innere Zone der Aspergilluswand ist aufgrund paramagnetischer Effekte besonders signalarm (9/9). Der Großteil der Aspergillome weist nach Kontrastmittelapplikation ein ringförmiges Enhancement auf (7/9). ABSTR AC TPurpose Invasive aspergillosis usually affects immunocompromised patients. It carries a high risk of morbidity and mortality and usually has a nonspecific clinical presentation. Early diagnosis is essential in order to start effective treatment and improve clinical outcome. Materials and MethodsIn a retrospective search of the PACS databases from two medical centers, we identified 9 patients with histologically proven cerebral aspergilloma. We systematically analyzed CT and MRI imaging findings to identify typical imaging appearances of cerebral aspergilloma.Results CT did not show a typical appearance of the aspergillomas. In 100 % (9/9) there was a rim-attenuated diffusion restriction on MRI imaging. Multiple hypointense layers in the aspergillus wall, especially on the internal side, were detected in 100 % on T2-weighted imaging (9/9). Aspergillomas were T1-hypointense in 66 % of cases (6/9) and partly T1-hyperintense in 33 % (3/9). In 78 % (7/9) of cases, a rim-attenuated diffusion restriction was detected after contrast agent application.Conclusion Nine cases were identified. Whereas CT features were less typical, we observed the following imaging features on MRI: A strong, rim-attenuated diffusion restriction (9/9); onion layer-like hypointense zones, in particular in the innermost part of the abscess wall on T2-weighted images (9/9). Enhancement of the lesion border was present in the majority of the cas...

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“…In both human and veterinary medicine, the pattern of contrast enhancement has been used to evaluate tumor type,4, 5 predict seizure risk in cases of intracranial neoplasia,31 and differentiate neoplastic from non‐neoplastic lesions, such as postoperative scar tissue, irradiation injury, inflammation or cerebrovascular lesions 3, 32, 33. However, contrast enhancement patterns do not consistently reflect the histologic features of an intracranial lesion, with no association between MR images and histologic findings in approximately 25% of cases in 1 veterinary study 34…”

Section: Discussionmentioning

confidence: 99%

“…Gadolinium‐based contrast media act as paramagnetic substances, shortening the T1‐relaxation time of adjacent protons with resultant hyperintensity at regions of contrast media accumulation on subsequent imaging 2. Contrast accumulation may occur in pathological tissues because of disruption of the blood–brain barrier, vasodilatation or neovascularization 2, 3…”

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confidence: 99%

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Exclusion of a Brain Lesion: Is Intravenous Contrast Administration Required after Normal Precontrast Magnetic Resonance Imaging?

Ives

Rousset

Heliczer

et al. 2014

Veterinary Internal Medicne

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BackgroundNo evidence‐based guidelines are available for the administration of gadolinium‐based contrast media to veterinary patients.ObjectiveTo investigate whether administration of intravenous (IV) contrast media alters the likelihood of identifying a brain lesion in dogs and cats.AnimalsFour hundred and eighty‐seven client‐owned animals referred for investigation of intracranial disease.MethodsTwo reviewers retrospectively analyzed precontrast transverse and sagittal T1‐weighted (T1W), T2‐weighted, and fluid‐attenuated inversion recovery low‐field MRI sequences from each patient for the presence of a clinically relevant brain lesion. All sequences subsequently were reviewed in the same manner with additional access to postcontrast T1W images.ResultsOf the 487 precontrast MRI studies, 312 were judged to be normal by 1 or both reviewers. Of these 312 studies, a previously undetected lesion was identified in only 6 cases (1.9%) based on changes observed on postcontrast sequences. Final diagnoses included meningoencephalitis of unknown origin (n = 1), feline infectious peritonitis (n = 1), and neoplasia (n = 2). All 4 of these cases had persistent neurological deficits suggestive of an underlying brain lesion. Contrast enhancement observed in the 2 other cases was considered falsely positive based on the results of further investigations.Conclusions and Clinical ImportanceIn patients with normal neurological examination and normal precontrast MRI, the subsequent administration of IV gadolinium‐based contrast media is highly unlikely to disclose a previously unidentified lesion, calling into question the routine administration of contrast media to these patients. However, administration still should be considered in animals with persistent neurological deficits suggestive of an underlying inflammatory or neoplastic brain lesion.

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Patterns of Contrast Enhancement in the Brain and Meninges

Cited by 412 publications

References 50 publications

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

Imaging Findings in MR Imaging-Guided Focused Ultrasound Treatment for Patients with Essential Tremor

CT and MRI Findings in Cerebral Aspergilloma

Exclusion of a Brain Lesion: Is Intravenous Contrast Administration Required after Normal Precontrast Magnetic Resonance Imaging?

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