Restricted Diffusion in a Ring-Enhancing Mucoid Metastasis With Histological Confirmation

Abstract

We present a case of restricted diffusion in a ring-enhancing cerebellar metastasis in a 58-year-old man. Diffusion imaging showed restriction with low apparent diffusion coefficient values within the cavity. Diagnosis of abscess was suggested based on radiological findings. A suspicious lung nodule was found in the systemic evaluation, and histological examination of the brain lesion confirmed metastatic adenocarcinoma with mucoid content confirmed by further specific pathological tests. We discuss the reason of diffusion findings and the importance of the correct interpretation of this technique in a clinical situation. Our case confirms previous hypothesis about restricted diffusion related to mucoid content in metastasis.

Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes—a 10-year single-center study

“…Pyogenic abscesses show a hyperintense signal in diffusion-weighted MRI (DWI) and low signal in apparent diffusion coefficient (ADC) (Fig. 1), whereas tumor cystic or necrotic regions show low signal in DWI and high signal in ADC with a few exceptions, such as mucus-containing metastasis [1]. Abscessed tumor may show a mix pattern (Fig.…”

Role of Diffusion Weighted Imaging in Characterization of Intracranial Rim Enhancing Lesions

“…Advent of Diffusion Weighted Imaging in around 1990s has eased to some extent in differentiating these pathologies but is not totally specific again as there has been reports of atypical DWI of both abscess and tumors. 5,6,7,8,9,10 So the purpose of this study was to identify features of ring enhancing brain lesions in conventional and DWI MRI, and evaluate the sensitivity and specificity of different MRI parameters in differentiating the rim enhancing intracranial mass lesions using histopathology as gold standard.…”