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Imaging Tutorial: Differential Diagnosis of Bright Lesions on Diffusion-weighted MR Images¹

¹ From the Departments of Radiology (T.W.S., R.R.L., M.J.O.), Neurosurgery (C.C., K.L.V.R.), and Neurology (A.M.), Academisch Ziekenhuis AZ Vrije Universiteit, Laarbeeklaan 101, 1090 Brussels, Belgium; and the Department of Radiology, Universitaire Ziekenhuizen, Leuven, Belgium (P.D.). Presented as a scientific exhibit at the 2001 RSNA scientific assembly. Received January 16, 2002, revision requested April 4, revision received and accepted August 18. Address correspondence to T.W.S. (e-mail: cradrew@az.vub.ac.be).

High sensitivity (94%) and specificity (100%) have been reported in the diagnosis of acute cerebral infarction with diffusion-weighted magnetic resonance (MR) imaging. However, high signal intensity on diffusion-weighted MR images and low apparent diffusion coefficient values (similar to the findings in acute cerebral infarction) were reported in such diverse conditions as hemorrhage, abscess, lymphoma, and even Creutzfeldt-Jakob disease. The differential diagnosis of these conditions (eg, acute ischemic infarction and acute cerebral hemorrhage) is critical for the determination of appropriate treatment. The authors present a systematic review of bright lesions on diffusion-weighted MR images and their differential diagnosis, with emphasis on the practical and clinical approaches of differential diagnosis.

© RSNA, 2002

Index Terms: Brain, abscess, 13.256 • Brain, diseases, 13.836, 13.871 • Brain, ischemia, 13.781, 13.782 • Brain, MR, 13.12144 • Brain neoplasms, diagnosis, 13.12144 • Brain neoplasms, primary, 13.36 • Brain neoplasms, secondary, 13.38 • Encephalitis, 13.253 • Magnetic resonance (MR), diffusion study, 13.12144

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