Radiological features of neuropathologies
| Radiological characteristics of neurological pathologies | |||||||
|---|---|---|---|---|---|---|---|
| Pathology | Ultra-sound | CT | MRI-T1 | MRI-T2/FLIR | DWI | MRS | Other sequences |
| Oedema | Diffuse echogenicity | Hypodense. Reduced grey-white matte differentiation; sulcal pattern flattened | Hypointense | Hyperintense | Hyperintense. Cytotoxic: Decreased ADC (restricted diffusion) Vasogenic: Increased ADC (increased diffusion) | ||
| Mitochondrial cytopathy | Focal hypo-densities | Hypointense | Hyperintense | Vasogenic pattern in MELAS | Lactate doublet peak in mitochondrial disorders; NAA/Cr reduced | Perfusion-imaging: increased perfusion indices | |
| Infarction | Decreased echogenicity | Hypodense | Hypointense | Hyperintense in chronic lesions (lags DWI changes) | Hyperintense with decreased ADC (cytotoxic pattern) in recent lesions. Normal/increased ADC in older lesions | Lactate increased, NAA/Cr reduced, | Perfusionimaging: increased MTT, reduced CBF (reduced perfusion) |
| Haemorrhage | Increased echogenicity | Hyperdense | Hypointense, then hyperintense after a few days. Hypointense in chronic lesions | Hypointense early. Hyperintense cavity in later lesions | |||
| Abscess | Hypodense. Contrastenhancing | Hypointense | Hyperintense. Surrounding oedema hyperintensity typical | Hyper-intense/low ADC (restricted diffusion) | Perfusion-imaging: Decreased perfusion indices |
||
| Demyelination | Hypo-dense/normal | Hypointense. Contrastenhancement in acute lesions | Hyperintense. Focal lesions with surrounding oedema (hypointense rim) in tumefactive lesions | Variable ADC. | Increased choline/Cr; myo-inositol and lactate peak. Decreased NAA/Cr | ||
| Tumour (glioma) | – | Hypodense. Perilesional oedema and contrastenhancement in high-grade lesion | Hypointense. Contrastenhancement in high-grade lesion | Hyperintense. High-grade lesions have oedema | Hypointense/high ADC (more restricted diffusion in high-grade) | Increased choline/Cr ratio; decreased NAA/Cr | Perfusion imaging: increased perfusion indices in high-grade lesion |
| Fat/lipoma | Increased echogenicity | Hypodense | Hyperintense, No contrast enhancement | Hyperintense | |||
| Calcification | Increased echogenicity | Hyperdensities | Variable (subtle) | Hypointense (subtle) | |||
Differential of ring-enhancing lesions.
Infective: toxoplasmosis, cystericosis; TB, miliary bacterial abscesses.
Haemorrhage.
Lymphoma, high-grade glioma.
Demyelination.
Tumour.
Also see: Quick yet systematic approach to MR imaging of brain lesions
Source: Forsyth R, Newton R, eds. Paediatric Neurology (Oxford Specialist Handbooks in Paediatrics). 3 ed. ed. Oxford, UK: Oxford University Press; 2017. https://oxfordmedicine.com/view/10.1093/med/9780198784449.001.0001/med-9780198784449.
Discussion