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.
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
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.
Lymphoma, high-grade glioma.

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.

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