ROLE OF MRI IN THE EVALUATION OF RING ENHANCING LESIONS IN BRAIN IN CORRELATION WITH MR SPECTROSCOPY

ROLE OF MRI IN THE EVALUATION OF RING ENHANCING LESIONS IN BRAIN IN CORRELATION WITH MR SPECTROSCOPY Dr Devendra Khatana (3rd Yr Resident) Dr Sangeeta Saxena (Prof. & HOD) Dr Dharamraj Meena Dr Harshvardhan Dept. Of Radiodiagnosis Govt.Medical College Kota

INTRODUCTIONAIMS- OBJECTIVESMATERIALS & METHODSOBSERVATION & RESULTS CASE DISCUSSION CONCLUSION REFERENCES

D/D for peripheral orring enhancing Brain lesions:MetastasisAbscessGlioblastoma multiforme(GBM)TuberculomaNeurocysticercosis(NCC)Subacute infarct /haemorrhage /contusionDemyelination(incomplete ring)Tumefactive demyelinating lesion(incomplete ring)Postoperative changeLymphoma- in HIV pt

INTRODUCTION

IMAGING MODILITIES

Magnetic resonance spectroscopy (MRS) provides information about the possible extent and nature of changes on a routine MRI scan by analyzing the presence and/or ratio of tissue metabolites such as NAA, creatine, choline, and lactate etc.

AIMS- OBJECTIVES

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SOURCE OF DATA: Patients from Goverment Medical College And Associated Group of Hospitals,Kota.

METHOD OF COLLECTION OF DATA: All patients CT Diagnosed cerebral ring enhancing lesions in a period of 1 years was subjected for the study. 50 Patients of CT ring enhancing lesions evaluated for MRI & MRS.EQUIPMENT 1.5 TESLA PHILIPS ACHIEVA MRI MACHINE

MATERIAL & METHODS

INCLUSION CRITERIA All patients with ring enhancing lesions of brain detected on contrast MR studies All patients with incidentally diagnosed ring enhancing lesion by CT. All age groups irrespective of sex

EXCLUSION CRITERIA

Patient having H/O claustrophobia. Patient having metallic implants insertion, cardiac pacemakers and metallic foreign body in situ

OBSERVATIONS AND RESULTS

PATHOLOGY WISE DISTRIBUTATION OF VARIOUS RING ENHANCING LESIONS

SEX WISE DISTRIBUTION OF VARIOUS RING ENHANCING LESIONS

C/F PRESENTED BY A PATIENT WITH VARIOUS RING ENHANCING LESIONS

NO. OF LESIONS CASE WISE

SIZE OF LESIONS

DW IN RING ENHANCING LESIONS

AGE WISE DISTRIBUTION OF RING ENHANCING LESIONS

VARIOUS METABOLITE PEAK IN VARIOUS RING ENHANCING LESIONS

CASE-1 PRIMARY NEOPLASTIC LESION(OLIGO DENDRO GLIOMA)

CASE-2 TUBERCULOMA

CASE-3 BRAIN METASTASIS(K/C/O Primary Lung Carcinoma)

CASE-4NCC(Neurocysticercosis)

Multiple ring enhancing lesions showing choline peak and scolex on CISS 3D suggestive of NCC granuloma .

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CASE-5BRAIN ABSCESS

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CASE-6 TUMEFACTIVE DEMYLINATING DISEASE

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CONCLUSION

MRI is the most sensitive modality in the characterization of intracranial ring enhancing lesions

Irregular type of ring enhancement is the most common feature noted in most of the lesions .

3. Most common lesion seen is Tuberculoma (44%) followed by primary brain Tumours (22%),NCC(12%) Abscess (10%), Metastasis ( 10%), and Tumefactive demyelination (2%).

4. 21-30 years is the most common age group involve 28%

5. Male are more prevalance sex 62%

CONCLUSION.

6. Seizures is the most common presenting complaint (84%). 7. Multiple lesion was noted in 66 % of patients whereas the rest 34% presented with single lesions. 8. Choline peak seen in most of lesions(56%) followed by lipid peak9. Pattern of signal intensity on T2 and FLAIR, DWI and MRS help to differentiate between benign and malignant lesions.

10. MRS helps in characterization of various ring enhancing lesions. However no lesion can be diagnosed based on the findings of MRS as the sole criteria.

Schwartz KM, Erickson BJ, Lucchinetti C Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology Neuroradiology. 2006 Mar;48(3):143-9 Vasudev MK, Jayakumar PN, Srikanth SG, Nagarajan K, Mohanty AQuantitative magnetic resonance techniques in the evaluation of intracranial tuberculomasActaRadiol. 2007 Mar;48(2):200-6. Batra A, TripathiRP.Diffusion-weighted magnetic resonance imaging andmagnetic resonance spectroscopy in the evaluation of focal cerebral tubercular lesions. ActaRadiol. 2004 Oct;45(6):679-88 Gupta RK, Husain M, Vatsal DK, Kumar R, Chawla S, Husain N. Comparative evaluation of magnetization transfer MR imaging and in-vivo 80 proton MR spectroscopy in brain tuberculomas. MagnReson Imaging. 2002 Jun;20(5):375-81 Daoud E, Mezghani S, Fourati H, Ketata H, Guermazi Y, Ayadi K, Dabbeche C, Mnif J, Ben Mahfoudh K, Mnif Z MR imaging features of tuberculosis of the sellar region J Radiol. 2011 Jul-Aug;92(7-8):714-21.

REFRENCES

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