Radiological features of neuropathologies [ICNApedia]

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====== 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.                                                                                                                          
{{tag>neurolists}}

Also see: [[systematic_approach_to_mr_images]]

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.