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Insights into Imaging
Fig. 16 | Insights into Imaging

Fig. 16

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

Fig. 16

Tumefactive demyelination. Conventional MRI: a, b T2W and post-contrast T1W sequences reveals a large heterogeneous space occupying mass lesion and diffuse pattern of enhancement. Multiparametric MRI: c, d DWI and ADC images show high ADC centrally (> 1000 × 10−6 mm2 s−1) and a thin rim of low ADC reflecting advancing edge of demyelination (arrow). e MRS shows a high Cho/Cr ratio (6.4), near normal NAA/Cr ratio, high glutamate and glutamine (arrow), low mI/Cr ratio and the presence of lipid and lactate at 0.9 ppm and 1.3 ppm respectively. f The metabolic profile from the adjacent perilesional area also shows a similarly abnormal spectral pattern. PWI (not shown) demonstrated a low rCBV except in the anterior-superior component. The striking presence of glutamine and glutamate on MRS, the enhancement pattern and generally low perfusion favour an inflammatory lesion, as opposed to high-grade glioma or lymphoma. The patient made a recovery on methylprednisolone. One-month follow-up imaging: (g) Axial T2W, (h) post-contrast T1W and (i) ADC map shows significant improvement in mass effect, midline shift and overall volume of the lesion

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