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Insights into Imaging
Fig. 15 | Insights into Imaging

Fig. 15

From: Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions

Fig. 15

Bickerstaff brainstem encephalitis. Conventional MRI Findings: (a) Axial T2W, (b, c) sagittal and coronal FLAIR and (d) axial post-contrast T1W sequences, show a diffuse high signal lesion in the pons with no enhancement post-contrast. Multiparametric MRI: e, f DWI shows high ADC throughout the lesion (> 1000 × 10−6 mm2 s−1). g, h MRS shows normal mI/Cr, normal Cho/Cr (arrow) and normal NAA/Cr ratios and minimally increased glutamine and glutamate peaks (2.3 and 2.4 ppm). PWI (not shown) had low rCBV compared to normal-appearing white matter. The lack of enhancement, low rCBV, high ADC and normal choline exclude glioma. These multiparametric MRI features in conjunction with an acute presentation favour an inflammatory lesion. Two-month follow-up imaging: (i) axial T2W, (j) FLAIR and (k) ADC sequences show lesion regression and normalisation of diffusion. In this case, CSF analysis revealed antiganglioside antibodies consistent with a diagnosis of Bickerstaff brainstem encephalitis

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