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The Role of Diffusion Weighted Imaging and Mr Spectroscopy in Ring Enhancing Brain Lesions Seen on Magnetic Resonance Imaging

Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Ring-enhancing lesions (RELs) pose a signicant diagnostic challenge due to their varied etiologies, including infections, neoplasms, and demyelinating disorders. In regions like India, tuberculoma and neurocysticercosis (NCC) are commonly encountered. While MRI provides detailed anatomy, it often lacks specicity. Advanced techniques like DWI and MRS enhance diagnostic accuracy by revealing diffusion and metabolic characteristics. The present study aimed to evaluate and compare the diagnostic performance of MRI, DWI, and MRS in characterizing intracranial RELs. This prospective observational study included 50 patients with Materials And Methods: RELs identied on MRI, conducted over 18 months at a tertiary care centre. All patients underwent MRI with DWI and singlevoxel MRS. Final diagnosis was based on histopathology or clinical follow-up. Imaging ndings were analyzed using standard statistical methods. Tuberculomas (36%) were the most common lesions, followed by metastases (22%), Results: NCC (18%), abscesses (10%), and primary tumors (10%). MRS identied lipid/lactate peaks in 94.4% of tuberculomas, succinate/acetate in 88.9% of NCC, and elevated amino acids in 80% of abscesses. Metastases showed high choline/creatine ratios in 90.9%. DWI detected diffusion restriction in 80% of abscesses and tumors. MRI+MRS showed the highest diagnostic accuracy (96%) compared to MRI alone (84–88%) or MRI+DWI (90–92%). Signicant associations were observed between lesion type and age (p = 0.039), lesion number (p = 0.016), and diffusion restriction (p = 0.005). MRI with DWI and MRS Conclusion: signicantly improves non-invasive diagnostic accuracy for RELs, aiding early and accurate differentiation between infectious and neoplastic causes.
DOI: 10.36106/gjra/3406443
Authors: Pramod Sakhi, Pranshul Gupta, Deepal Nema
Language: English
Field: Medicine
Open Access status: diamond
OpenAlex ID: W4414657337
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