AFIP Archives - From the Archives of the AFIP
Patterns of Contrast Enhancement in the Brain and Meninges
Published Online:Mar 1 2007https://doi.org/10.1148/rg.272065155
Abstract
Contrast material enhancement for cross-sectional imaging has been used since the mid 1970s for computed tomography and the mid 1980s for magnetic resonance imaging. Knowledge of the patterns and mechanisms of contrast enhancement facilitate radiologic differential diagnosis. Brain and spinal cord enhancement is related to both intravascular and extravascular contrast material. Extraaxial enhancing lesions include primary neoplasms (meningioma), granulomatous disease (sarcoid), and metastases (which often manifest as mass lesions). Linear pachymeningeal (dura-arachnoid) enhancement occurs after surgery and with spontaneous intracranial hypotension. Leptomeningeal (pia-arachnoid) enhancement is present in meningitis and meningoencephalitis. Superficial gyral enhancement is seen after reperfusion in cerebral ischemia, during the healing phase of cerebral infarction, and with encephalitis. Nodular subcortical lesions are typical for hematogenous dissemination and may be neoplastic (metastases) or infectious (septic emboli). Deeper lesions may form rings or affect the ventricular margins. Ring enhancement that is smooth and thin is typical of an organizing abscess, whereas thick irregular rings suggest a necrotic neoplasm. Some low-grade neoplasms are “fluid-secreting,” and they may form heterogeneously enhancing lesions with an incomplete ring sign as well as the classic “cyst-with-nodule” morphology. Demyelinating lesions, including both classic multiple sclerosis and tumefactive demyelination, may also create an open ring or incomplete ring sign. Thick and irregular periventricular enhancement is typical for primary central nervous system lymphoma. Thin enhancement of the ventricular margin occurs with infectious ependymitis. Understanding the classic patterns of lesion enhancement—and the radiologic-pathologic mechanisms that produce them—can improve image assessment and differential diagnosis.
References
- 1
Sage MR - 2
Provenzale JM - 3
Wilms G - 4
Meltzer CC - 5
Burke JW - 6
Mittl RL - 7
Phillips ME - 8
Paldino M - 9
Buetow MP - 10
Sheporaitis LA - 11
Elster AD - 12
New PF - 13
Aoki S - 14
Gupta S - 15
Tien RD - 16
Nakau H - 17
Nagele T - 18
Spellerberg B - 19
Schaefer PW - 20
Provenzale JM - 21
Silverstein AM - 22
Burke JW - 23
Davis JM - 24
Zimmerman RD - 25
Kinkel WR - 26
Ketonen L - 27
Muller JP - 28
Enzmann DR - 29
Elster AD - 30
Crain MR - 31
Inoue Y - 32
Runge VM - 33
Norton GA - 34
Stark AM - 35
Pedersen H - 36
Schwartz KM - 37
Brant-Zawadzki M - 38
Britt RH - 39
Britt RH - 40
Haimes AB - 41
Daumas-Duport C - 42
Rees JH - 43
Rong Y - 44
Machein MR - 45
Takano S - 46
Fulham MJ - 47
Takeuchi H - 48
Ho VB - 49
Beni-Adani L - 50
Cotton F - 51
Cha S - 52
Masdeu JC - 53
Masdeu JC - 54
Bot JC - 55
Reinarz SJ - 56
Ciricillo SF - 57
Tomlinson FH - 58
Koeller KK
