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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).

View larger version (144K): [in a new window]   Figure 1a.  Acute infarction within the 1st hour after stroke. (a) Fast T2-weighted spin-echo (SE) image. (b, c) DW (trace) multishot echo-planar image (b) and corresponding ADC map (c). (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine. (f) Time-of-flight (TOF) MR angiogram. Comments: Acute thrombosis of the right middle cerebral artery. On T2-weighted SE image, only scattered white matter hyperintensities are seen. Small occipital hyperintensity is seen on DW image, with moderate decrease in the ADC value (0.48 x 10-3 mm2/sec). There is an important perfusion deficit ("penumbra" [2]) in the middle cerebral artery territory.

View larger version (122K): [in a new window]   Figure 1b.  Acute infarction within the 1st hour after stroke. (a) Fast T2-weighted spin-echo (SE) image. (b, c) DW (trace) multishot echo-planar image (b) and corresponding ADC map (c). (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine. (f) Time-of-flight (TOF) MR angiogram. Comments: Acute thrombosis of the right middle cerebral artery. On T2-weighted SE image, only scattered white matter hyperintensities are seen. Small occipital hyperintensity is seen on DW image, with moderate decrease in the ADC value (0.48 x 10-3 mm2/sec). There is an important perfusion deficit ("penumbra" [2]) in the middle cerebral artery territory.

View larger version (124K): [in a new window]   Figure 1c.  Acute infarction within the 1st hour after stroke. (a) Fast T2-weighted spin-echo (SE) image. (b, c) DW (trace) multishot echo-planar image (b) and corresponding ADC map (c). (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine. (f) Time-of-flight (TOF) MR angiogram. Comments: Acute thrombosis of the right middle cerebral artery. On T2-weighted SE image, only scattered white matter hyperintensities are seen. Small occipital hyperintensity is seen on DW image, with moderate decrease in the ADC value (0.48 x 10-3 mm2/sec). There is an important perfusion deficit ("penumbra" [2]) in the middle cerebral artery territory.

View larger version (93K): [in a new window]   Figure 1d.  Acute infarction within the 1st hour after stroke. (a) Fast T2-weighted spin-echo (SE) image. (b, c) DW (trace) multishot echo-planar image (b) and corresponding ADC map (c). (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine. (f) Time-of-flight (TOF) MR angiogram. Comments: Acute thrombosis of the right middle cerebral artery. On T2-weighted SE image, only scattered white matter hyperintensities are seen. Small occipital hyperintensity is seen on DW image, with moderate decrease in the ADC value (0.48 x 10-3 mm2/sec). There is an important perfusion deficit ("penumbra" [2]) in the middle cerebral artery territory.

View larger version (85K): [in a new window]   Figure 1e.  Acute infarction within the 1st hour after stroke. (a) Fast T2-weighted spin-echo (SE) image. (b, c) DW (trace) multishot echo-planar image (b) and corresponding ADC map (c). (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine. (f) Time-of-flight (TOF) MR angiogram. Comments: Acute thrombosis of the right middle cerebral artery. On T2-weighted SE image, only scattered white matter hyperintensities are seen. Small occipital hyperintensity is seen on DW image, with moderate decrease in the ADC value (0.48 x 10-3 mm2/sec). There is an important perfusion deficit ("penumbra" [2]) in the middle cerebral artery territory.

View larger version (133K): [in a new window]   Figure 1f.  Acute infarction within the 1st hour after stroke. (a) Fast T2-weighted spin-echo (SE) image. (b, c) DW (trace) multishot echo-planar image (b) and corresponding ADC map (c). (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine. (f) Time-of-flight (TOF) MR angiogram. Comments: Acute thrombosis of the right middle cerebral artery. On T2-weighted SE image, only scattered white matter hyperintensities are seen. Small occipital hyperintensity is seen on DW image, with moderate decrease in the ADC value (0.48 x 10-3 mm2/sec). There is an important perfusion deficit ("penumbra" [2]) in the middle cerebral artery territory.

View larger version (147K): [in a new window]   Figure 2a.  Acute infarction within the first 6 hours after stroke. (a) Fast T2-weighted SE image. (b, c) DW (trace) multishot echo-planar image and corresponding ADC map. (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine (f) TOF MR angiogram. Comment: Acute thrombosis of the left carotid artery. On T2-weighted SE image, only a faint increase in signal intensity in the insular cortex is seen. There is typical hyperintensity on DW image, with a decreased ADC value. There is an important perfusion deficit and only a limited penumbra (2).

View larger version (122K): [in a new window]   Figure 2b.  Acute infarction within the first 6 hours after stroke. (a) Fast T2-weighted SE image. (b, c) DW (trace) multishot echo-planar image and corresponding ADC map. (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine (f) TOF MR angiogram. Comment: Acute thrombosis of the left carotid artery. On T2-weighted SE image, only a faint increase in signal intensity in the insular cortex is seen. There is typical hyperintensity on DW image, with a decreased ADC value. There is an important perfusion deficit and only a limited penumbra (2).

View larger version (147K): [in a new window]   Figure 2c.  Acute infarction within the first 6 hours after stroke. (a) Fast T2-weighted SE image. (b, c) DW (trace) multishot echo-planar image and corresponding ADC map. (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine (f) TOF MR angiogram. Comment: Acute thrombosis of the left carotid artery. On T2-weighted SE image, only a faint increase in signal intensity in the insular cortex is seen. There is typical hyperintensity on DW image, with a decreased ADC value. There is an important perfusion deficit and only a limited penumbra (2).

View larger version (78K): [in a new window]   Figure 2d.  Acute infarction within the first 6 hours after stroke. (a) Fast T2-weighted SE image. (b, c) DW (trace) multishot echo-planar image and corresponding ADC map. (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine (f) TOF MR angiogram. Comment: Acute thrombosis of the left carotid artery. On T2-weighted SE image, only a faint increase in signal intensity in the insular cortex is seen. There is typical hyperintensity on DW image, with a decreased ADC value. There is an important perfusion deficit and only a limited penumbra (2).

View larger version (73K): [in a new window]   Figure 2e.  Acute infarction within the first 6 hours after stroke. (a) Fast T2-weighted SE image. (b, c) DW (trace) multishot echo-planar image and corresponding ADC map. (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine (f) TOF MR angiogram. Comment: Acute thrombosis of the left carotid artery. On T2-weighted SE image, only a faint increase in signal intensity in the insular cortex is seen. There is typical hyperintensity on DW image, with a decreased ADC value. There is an important perfusion deficit and only a limited penumbra (2).

View larger version (126K): [in a new window]   Figure 2f.  Acute infarction within the first 6 hours after stroke. (a) Fast T2-weighted SE image. (b, c) DW (trace) multishot echo-planar image and corresponding ADC map. (d, e) Perfusion-weighted multishot echo-planar imaging; (d) relative cerebral blood volume and (e) time-to-peak maps calculated from the time-intensity curve after injection of 40 mL of gadopentetate dimeglumine (f) TOF MR angiogram. Comment: Acute thrombosis of the left carotid artery. On T2-weighted SE image, only a faint increase in signal intensity in the insular cortex is seen. There is typical hyperintensity on DW image, with a decreased ADC value. There is an important perfusion deficit and only a limited penumbra (2).

View larger version (163K): [in a new window]   Figure 3a.  Venous infarction. (a) T2-weighted SE image and (b, c) DW echo-planar image (b) and corresponding ADC map (c).

View larger version (110K): [in a new window]   Figure 3b.  Venous infarction. (a) T2-weighted SE image and (b, c) DW echo-planar image (b) and corresponding ADC map (c).

View larger version (77K): [in a new window]   Figure 3c.  Venous infarction. (a) T2-weighted SE image and (b, c) DW echo-planar image (b) and corresponding ADC map (c).

View larger version (153K): [in a new window]   Figure 4a.  Early stage of cerebral abscess. (a) T2-weighted SE image, (b) contrast-enhanced T1-weighted SE image, and (c, d) DW echo-planar image (c) and corresponding ADC map (d). The signal intensity on the DW image and ADC map looks like that of an acute stroke. However, on the T2-weighted and enhanced T1-weighted images a fine capsule is readily recognized.

View larger version (143K): [in a new window]   Figure 4b.  Early stage of cerebral abscess. (a) T2-weighted SE image, (b) contrast-enhanced T1-weighted SE image, and (c, d) DW echo-planar image (c) and corresponding ADC map (d). The signal intensity on the DW image and ADC map looks like that of an acute stroke. However, on the T2-weighted and enhanced T1-weighted images a fine capsule is readily recognized.

View larger version (146K): [in a new window]   Figure 4c.  Early stage of cerebral abscess. (a) T2-weighted SE image, (b) contrast-enhanced T1-weighted SE image, and (c, d) DW echo-planar image (c) and corresponding ADC map (d). The signal intensity on the DW image and ADC map looks like that of an acute stroke. However, on the T2-weighted and enhanced T1-weighted images a fine capsule is readily recognized.

View larger version (99K): [in a new window]   Figure 4d.  Early stage of cerebral abscess. (a) T2-weighted SE image, (b) contrast-enhanced T1-weighted SE image, and (c, d) DW echo-planar image (c) and corresponding ADC map (d). The signal intensity on the DW image and ADC map looks like that of an acute stroke. However, on the T2-weighted and enhanced T1-weighted images a fine capsule is readily recognized.

View larger version (168K): [in a new window]   Figure 5a.  Acute venous infarction (superior sagittal sinus thrombosis) with high signal intensity on DW images and low ADC values. (a) Transverse T2-weighted fast SE image (5500/128 [repetition time/echo time]; 6-mm section thickness; three signals averaged; echo train length, 23; and 230 x 512 matrix). (b) Transverse T1-weighted SE image (550/14), 6-mm section thickness, three signals averaged, one echo, and 192 x 256). (c, d) Transverse DW image (x = sensitizing direction) (c) multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness) and corresponding ADC map (d). (e) Maximum-intensity projection of TOF venogram. These findings may be consistent with prominent cytotoxic edema. The differential diagnosis of hyperacute arterial stroke and venous stroke remains difficult on T2- or T1-weighed SE and DW images.

View larger version (96K): [in a new window]   Figure 5b.  Acute venous infarction (superior sagittal sinus thrombosis) with high signal intensity on DW images and low ADC values. (a) Transverse T2-weighted fast SE image (5500/128 [repetition time/echo time]; 6-mm section thickness; three signals averaged; echo train length, 23; and 230 x 512 matrix). (b) Transverse T1-weighted SE image (550/14), 6-mm section thickness, three signals averaged, one echo, and 192 x 256). (c, d) Transverse DW image (x = sensitizing direction) (c) multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness) and corresponding ADC map (d). (e) Maximum-intensity projection of TOF venogram. These findings may be consistent with prominent cytotoxic edema. The differential diagnosis of hyperacute arterial stroke and venous stroke remains difficult on T2- or T1-weighed SE and DW images.

View larger version (114K): [in a new window]   Figure 5c.  Acute venous infarction (superior sagittal sinus thrombosis) with high signal intensity on DW images and low ADC values. (a) Transverse T2-weighted fast SE image (5500/128 [repetition time/echo time]; 6-mm section thickness; three signals averaged; echo train length, 23; and 230 x 512 matrix). (b) Transverse T1-weighted SE image (550/14), 6-mm section thickness, three signals averaged, one echo, and 192 x 256). (c, d) Transverse DW image (x = sensitizing direction) (c) multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness) and corresponding ADC map (d). (e) Maximum-intensity projection of TOF venogram. These findings may be consistent with prominent cytotoxic edema. The differential diagnosis of hyperacute arterial stroke and venous stroke remains difficult on T2- or T1-weighed SE and DW images.

View larger version (76K): [in a new window]   Figure 5d.  Acute venous infarction (superior sagittal sinus thrombosis) with high signal intensity on DW images and low ADC values. (a) Transverse T2-weighted fast SE image (5500/128 [repetition time/echo time]; 6-mm section thickness; three signals averaged; echo train length, 23; and 230 x 512 matrix). (b) Transverse T1-weighted SE image (550/14), 6-mm section thickness, three signals averaged, one echo, and 192 x 256). (c, d) Transverse DW image (x = sensitizing direction) (c) multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness) and corresponding ADC map (d). (e) Maximum-intensity projection of TOF venogram. These findings may be consistent with prominent cytotoxic edema. The differential diagnosis of hyperacute arterial stroke and venous stroke remains difficult on T2- or T1-weighed SE and DW images.

View larger version (117K): [in a new window]   Figure 5e.  Acute venous infarction (superior sagittal sinus thrombosis) with high signal intensity on DW images and low ADC values. (a) Transverse T2-weighted fast SE image (5500/128 [repetition time/echo time]; 6-mm section thickness; three signals averaged; echo train length, 23; and 230 x 512 matrix). (b) Transverse T1-weighted SE image (550/14), 6-mm section thickness, three signals averaged, one echo, and 192 x 256). (c, d) Transverse DW image (x = sensitizing direction) (c) multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness) and corresponding ADC map (d). (e) Maximum-intensity projection of TOF venogram. These findings may be consistent with prominent cytotoxic edema. The differential diagnosis of hyperacute arterial stroke and venous stroke remains difficult on T2- or T1-weighed SE and DW images.

View larger version (156K): [in a new window]   Figure 6a.  Acute venous infarction with low signal on DW images and increased ADC values (left lateral sinus thrombosis). (a, b) Transverse T2-weighted (a) and T1-weighted (b) SE images. (c, d) Transverse DW (trace) multishot echo-planar image (c) and corresponding ADC map (d). (e) Maximum-intensity projection of phase-contrast venography (20 cm/sec). These findings may be consistent with prominent vasogenic edema.

View larger version (145K): [in a new window]   Figure 6b.  Acute venous infarction with low signal on DW images and increased ADC values (left lateral sinus thrombosis). (a, b) Transverse T2-weighted (a) and T1-weighted (b) SE images. (c, d) Transverse DW (trace) multishot echo-planar image (c) and corresponding ADC map (d). (e) Maximum-intensity projection of phase-contrast venography (20 cm/sec). These findings may be consistent with prominent vasogenic edema.

View larger version (127K): [in a new window]   Figure 6c.  Acute venous infarction with low signal on DW images and increased ADC values (left lateral sinus thrombosis). (a, b) Transverse T2-weighted (a) and T1-weighted (b) SE images. (c, d) Transverse DW (trace) multishot echo-planar image (c) and corresponding ADC map (d). (e) Maximum-intensity projection of phase-contrast venography (20 cm/sec). These findings may be consistent with prominent vasogenic edema.

View larger version (146K): [in a new window]   Figure 6d.  Acute venous infarction with low signal on DW images and increased ADC values (left lateral sinus thrombosis). (a, b) Transverse T2-weighted (a) and T1-weighted (b) SE images. (c, d) Transverse DW (trace) multishot echo-planar image (c) and corresponding ADC map (d). (e) Maximum-intensity projection of phase-contrast venography (20 cm/sec). These findings may be consistent with prominent vasogenic edema.

View larger version (161K): [in a new window]   Figure 7a.  Glioblastoma multiforme. (a) Transverse T2-weighted fast SE image (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512). (b) Transverse T1-weighted nonenhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (c) Transverse T1-weighted contrast-enhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (d-f) (d) Transverse multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness), (e) corresponding DW echo-planar image (sensitizing direction = x), and (f) corresponding ADC map. The high signal intensity of cerebrospinal fluid on the multishot echo-planar image (d) is suppressed on the DW echo-planar image (e). The nonnecrotic components of glioblastoma are slightly hyperintense on the DW echo-planar image (T2 shine-through effect). On DW images (e), the peritumoral vasogenic edema is isointense to the white matter because the effect of increased diffusion (dark) is compensated for by the increased T2 values of edema (bright). The peritumoral edema, cerebrospinal fluid, and necrotic component of the tumor are hyperintense (high diffusion) on the ADC map.

View larger version (123K): [in a new window]   Figure 7b.  Glioblastoma multiforme. (a) Transverse T2-weighted fast SE image (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512). (b) Transverse T1-weighted nonenhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (c) Transverse T1-weighted contrast-enhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (d-f) (d) Transverse multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness), (e) corresponding DW echo-planar image (sensitizing direction = x), and (f) corresponding ADC map. The high signal intensity of cerebrospinal fluid on the multishot echo-planar image (d) is suppressed on the DW echo-planar image (e). The nonnecrotic components of glioblastoma are slightly hyperintense on the DW echo-planar image (T2 shine-through effect). On DW images (e), the peritumoral vasogenic edema is isointense to the white matter because the effect of increased diffusion (dark) is compensated for by the increased T2 values of edema (bright). The peritumoral edema, cerebrospinal fluid, and necrotic component of the tumor are hyperintense (high diffusion) on the ADC map.

View larger version (105K): [in a new window]   Figure 7c.  Glioblastoma multiforme. (a) Transverse T2-weighted fast SE image (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512). (b) Transverse T1-weighted nonenhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (c) Transverse T1-weighted contrast-enhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (d-f) (d) Transverse multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness), (e) corresponding DW echo-planar image (sensitizing direction = x), and (f) corresponding ADC map. The high signal intensity of cerebrospinal fluid on the multishot echo-planar image (d) is suppressed on the DW echo-planar image (e). The nonnecrotic components of glioblastoma are slightly hyperintense on the DW echo-planar image (T2 shine-through effect). On DW images (e), the peritumoral vasogenic edema is isointense to the white matter because the effect of increased diffusion (dark) is compensated for by the increased T2 values of edema (bright). The peritumoral edema, cerebrospinal fluid, and necrotic component of the tumor are hyperintense (high diffusion) on the ADC map.

View larger version (102K): [in a new window]   Figure 7d.  Glioblastoma multiforme. (a) Transverse T2-weighted fast SE image (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512). (b) Transverse T1-weighted nonenhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (c) Transverse T1-weighted contrast-enhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (d-f) (d) Transverse multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness), (e) corresponding DW echo-planar image (sensitizing direction = x), and (f) corresponding ADC map. The high signal intensity of cerebrospinal fluid on the multishot echo-planar image (d) is suppressed on the DW echo-planar image (e). The nonnecrotic components of glioblastoma are slightly hyperintense on the DW echo-planar image (T2 shine-through effect). On DW images (e), the peritumoral vasogenic edema is isointense to the white matter because the effect of increased diffusion (dark) is compensated for by the increased T2 values of edema (bright). The peritumoral edema, cerebrospinal fluid, and necrotic component of the tumor are hyperintense (high diffusion) on the ADC map.

View larger version (112K): [in a new window]   Figure 7e.  Glioblastoma multiforme. (a) Transverse T2-weighted fast SE image (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512). (b) Transverse T1-weighted nonenhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (c) Transverse T1-weighted contrast-enhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (d-f) (d) Transverse multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness), (e) corresponding DW echo-planar image (sensitizing direction = x), and (f) corresponding ADC map. The high signal intensity of cerebrospinal fluid on the multishot echo-planar image (d) is suppressed on the DW echo-planar image (e). The nonnecrotic components of glioblastoma are slightly hyperintense on the DW echo-planar image (T2 shine-through effect). On DW images (e), the peritumoral vasogenic edema is isointense to the white matter because the effect of increased diffusion (dark) is compensated for by the increased T2 values of edema (bright). The peritumoral edema, cerebrospinal fluid, and necrotic component of the tumor are hyperintense (high diffusion) on the ADC map.

View larger version (101K): [in a new window]   Figure 7f.  Glioblastoma multiforme. (a) Transverse T2-weighted fast SE image (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512). (b) Transverse T1-weighted nonenhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (c) Transverse T1-weighted contrast-enhanced SE image (520/14; two signals averaged; 6-mm section thickness; matrix, 179 x 256). (d-f) (d) Transverse multishot echo-planar image (800/123, one signal acquired, 6-mm section thickness), (e) corresponding DW echo-planar image (sensitizing direction = x), and (f) corresponding ADC map. The high signal intensity of cerebrospinal fluid on the multishot echo-planar image (d) is suppressed on the DW echo-planar image (e). The nonnecrotic components of glioblastoma are slightly hyperintense on the DW echo-planar image (T2 shine-through effect). On DW images (e), the peritumoral vasogenic edema is isointense to the white matter because the effect of increased diffusion (dark) is compensated for by the increased T2 values of edema (bright). The peritumoral edema, cerebrospinal fluid, and necrotic component of the tumor are hyperintense (high diffusion) on the ADC map.

View larger version (164K): [in a new window]   Figure 8a.  Multiple metastases. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map.

View larger version (130K): [in a new window]   Figure 8b.  Multiple metastases. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map.

View larger version (129K): [in a new window]   Figure 8c.  Multiple metastases. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map.

View larger version (109K): [in a new window]   Figure 8d.  Multiple metastases. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map.

View larger version (121K): [in a new window]   Figure 8e.  Multiple metastases. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map.

View larger version (149K): [in a new window]   Figure 9a.  Multiple metastases in same patient as in Figure 8, at a different level. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW images (trace) and (e) corresponding ADC map. (f) Magnification of e. The ADC value for region of interest 1 (solid component of metastasis) is 0.76 x 10-3 mm2/sec; for region of interest 2 (contralateral gray and white matter), the ADC value is 0.73 x 10-3 mm2/sec.

View larger version (111K): [in a new window]   Figure 9b.  Multiple metastases in same patient as in Figure 8, at a different level. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW images (trace) and (e) corresponding ADC map. (f) Magnification of e. The ADC value for region of interest 1 (solid component of metastasis) is 0.76 x 10-3 mm2/sec; for region of interest 2 (contralateral gray and white matter), the ADC value is 0.73 x 10-3 mm2/sec.

View larger version (110K): [in a new window]   Figure 9c.  Multiple metastases in same patient as in Figure 8, at a different level. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW images (trace) and (e) corresponding ADC map. (f) Magnification of e. The ADC value for region of interest 1 (solid component of metastasis) is 0.76 x 10-3 mm2/sec; for region of interest 2 (contralateral gray and white matter), the ADC value is 0.73 x 10-3 mm2/sec.

View larger version (86K): [in a new window]   Figure 9d.  Multiple metastases in same patient as in Figure 8, at a different level. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW images (trace) and (e) corresponding ADC map. (f) Magnification of e. The ADC value for region of interest 1 (solid component of metastasis) is 0.76 x 10-3 mm2/sec; for region of interest 2 (contralateral gray and white matter), the ADC value is 0.73 x 10-3 mm2/sec.

View larger version (89K): [in a new window]   Figure 9e.  Multiple metastases in same patient as in Figure 8, at a different level. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW images (trace) and (e) corresponding ADC map. (f) Magnification of e. The ADC value for region of interest 1 (solid component of metastasis) is 0.76 x 10-3 mm2/sec; for region of interest 2 (contralateral gray and white matter), the ADC value is 0.73 x 10-3 mm2/sec.

View larger version (149K): [in a new window]   Figure 9f.  Multiple metastases in same patient as in Figure 8, at a different level. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW images (trace) and (e) corresponding ADC map. (f) Magnification of e. The ADC value for region of interest 1 (solid component of metastasis) is 0.76 x 10-3 mm2/sec; for region of interest 2 (contralateral gray and white matter), the ADC value is 0.73 x 10-3 mm2/sec.

View larger version (150K): [in a new window]   Figure 10a.  Cerebral metastasis. (a) T2-weighted fast SE, (b) contrast-enhanced T1-weighted SE, and (c) DW (sensitizing direction = z) multishot echo-planar (800/123, five signals averaged, 6-mm section thickness images and (d) corresponding ADC map.

View larger version (107K): [in a new window]   Figure 10b.  Cerebral metastasis. (a) T2-weighted fast SE, (b) contrast-enhanced T1-weighted SE, and (c) DW (sensitizing direction = z) multishot echo-planar (800/123, five signals averaged, 6-mm section thickness images and (d) corresponding ADC map.

View larger version (158K): [in a new window]   Figure 10c.  Cerebral metastasis. (a) T2-weighted fast SE, (b) contrast-enhanced T1-weighted SE, and (c) DW (sensitizing direction = z) multishot echo-planar (800/123, five signals averaged, 6-mm section thickness images and (d) corresponding ADC map.

View larger version (110K): [in a new window]   Figure 10d.  Cerebral metastasis. (a) T2-weighted fast SE, (b) contrast-enhanced T1-weighted SE, and (c) DW (sensitizing direction = z) multishot echo-planar (800/123, five signals averaged, 6-mm section thickness images and (d) corresponding ADC map.

View larger version (150K): [in a new window]   Figure 11a.  Cerebral metastasis with increased signal intensity on DW images. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map. Old hemorrhagic content was found at surgery.

View larger version (98K): [in a new window]   Figure 11b.  Cerebral metastasis with increased signal intensity on DW images. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map. Old hemorrhagic content was found at surgery.

View larger version (104K): [in a new window]   Figure 11c.  Cerebral metastasis with increased signal intensity on DW images. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map. Old hemorrhagic content was found at surgery.

View larger version (143K): [in a new window]   Figure 11d.  Cerebral metastasis with increased signal intensity on DW images. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map. Old hemorrhagic content was found at surgery.

View larger version (118K): [in a new window]   Figure 11e.  Cerebral metastasis with increased signal intensity on DW images. (a) Axial T2-weighted fast SE, (b, c) T1-weighted (b) nonenhanced and (c) contrast-enhanced SE, and (d) DW (trace) images and (e) corresponding ADC map. Old hemorrhagic content was found at surgery.

View larger version (177K): [in a new window]   Figure 12a.  Benign meningioma. (a) T2-weighted SE, (b) T1-weighted SE, and (c) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (d) corresponding ADC map. (e, f) Contrast-enhanced T1-weighted SE images acquired in the (e) transverse and (f) coronal planes. This meningioma is hyperintense on the DW echo-planar image and iso- to hypointense on the corresponding ADC map. The ADC values were in the range 0.39-0.46 x 10-3 mm2/sec (0.61-0.63 x 10-3 mm2/sec for the contralateral white and gray matter).

View larger version (154K): [in a new window]   Figure 12b.  Benign meningioma. (a) T2-weighted SE, (b) T1-weighted SE, and (c) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (d) corresponding ADC map. (e, f) Contrast-enhanced T1-weighted SE images acquired in the (e) transverse and (f) coronal planes. This meningioma is hyperintense on the DW echo-planar image and iso- to hypointense on the corresponding ADC map. The ADC values were in the range 0.39-0.46 x 10-3 mm2/sec (0.61-0.63 x 10-3 mm2/sec for the contralateral white and gray matter).

View larger version (168K): [in a new window]   Figure 12c.  Benign meningioma. (a) T2-weighted SE, (b) T1-weighted SE, and (c) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (d) corresponding ADC map. (e, f) Contrast-enhanced T1-weighted SE images acquired in the (e) transverse and (f) coronal planes. This meningioma is hyperintense on the DW echo-planar image and iso- to hypointense on the corresponding ADC map. The ADC values were in the range 0.39-0.46 x 10-3 mm2/sec (0.61-0.63 x 10-3 mm2/sec for the contralateral white and gray matter).

View larger version (139K): [in a new window]   Figure 12d.  Benign meningioma. (a) T2-weighted SE, (b) T1-weighted SE, and (c) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (d) corresponding ADC map. (e, f) Contrast-enhanced T1-weighted SE images acquired in the (e) transverse and (f) coronal planes. This meningioma is hyperintense on the DW echo-planar image and iso- to hypointense on the corresponding ADC map. The ADC values were in the range 0.39-0.46 x 10-3 mm2/sec (0.61-0.63 x 10-3 mm2/sec for the contralateral white and gray matter).

View larger version (152K): [in a new window]   Figure 12e.  Benign meningioma. (a) T2-weighted SE, (b) T1-weighted SE, and (c) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (d) corresponding ADC map. (e, f) Contrast-enhanced T1-weighted SE images acquired in the (e) transverse and (f) coronal planes. This meningioma is hyperintense on the DW echo-planar image and iso- to hypointense on the corresponding ADC map. The ADC values were in the range 0.39-0.46 x 10-3 mm2/sec (0.61-0.63 x 10-3 mm2/sec for the contralateral white and gray matter).

View larger version (138K): [in a new window]   Figure 12f.  Benign meningioma. (a) T2-weighted SE, (b) T1-weighted SE, and (c) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (d) corresponding ADC map. (e, f) Contrast-enhanced T1-weighted SE images acquired in the (e) transverse and (f) coronal planes. This meningioma is hyperintense on the DW echo-planar image and iso- to hypointense on the corresponding ADC map. The ADC values were in the range 0.39-0.46 x 10-3 mm2/sec (0.61-0.63 x 10-3 mm2/sec for the contralateral white and gray matter).

View larger version (67K): [in a new window]   Figure 13a.  Calcified meningioma with cortical infarction. (a) Nonenhanced CT, (b) T2-weighted SE, (c) contrast-enhanced T1-weighted SE, and (d) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (e) corresponding ADC map. This calcified meningioma was an incidental finding. It is hypointense on the DW echo-planar image and on the corresponding ADC map. The ADC values were in the range 0.21-0.75 x 10-3 mm2/sec.

View larger version (156K): [in a new window]   Figure 13b.  Calcified meningioma with cortical infarction. (a) Nonenhanced CT, (b) T2-weighted SE, (c) contrast-enhanced T1-weighted SE, and (d) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (e) corresponding ADC map. This calcified meningioma was an incidental finding. It is hypointense on the DW echo-planar image and on the corresponding ADC map. The ADC values were in the range 0.21-0.75 x 10-3 mm2/sec.

View larger version (107K): [in a new window]   Figure 13c.  Calcified meningioma with cortical infarction. (a) Nonenhanced CT, (b) T2-weighted SE, (c) contrast-enhanced T1-weighted SE, and (d) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (e) corresponding ADC map. This calcified meningioma was an incidental finding. It is hypointense on the DW echo-planar image and on the corresponding ADC map. The ADC values were in the range 0.21-0.75 x 10-3 mm2/sec.

View larger version (153K): [in a new window]   Figure 13d.  Calcified meningioma with cortical infarction. (a) Nonenhanced CT, (b) T2-weighted SE, (c) contrast-enhanced T1-weighted SE, and (d) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (e) corresponding ADC map. This calcified meningioma was an incidental finding. It is hypointense on the DW echo-planar image and on the corresponding ADC map. The ADC values were in the range 0.21-0.75 x 10-3 mm2/sec.

View larger version (112K): [in a new window]   Figure 13e.  Calcified meningioma with cortical infarction. (a) Nonenhanced CT, (b) T2-weighted SE, (c) contrast-enhanced T1-weighted SE, and (d) multishot (800/123, one signal acquired, 6-mm section thickness) DW echo-planar (sensitizing direction = z) images and (e) corresponding ADC map. This calcified meningioma was an incidental finding. It is hypointense on the DW echo-planar image and on the corresponding ADC map. The ADC values were in the range 0.21-0.75 x 10-3 mm2/sec.

View larger version (160K): [in a new window]   Figure 14a.  Cerebral lymphoma. (a) Axial T2-weighted fast SE (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512), (b) axial T1-weighted nonenhanced SE (520/14, two signals averaged, 6-mm section thickness, 179 x 256 matrix), (c) axial T1-weighted contrast-enhanced SE (520/14, two signals averaged, 6-mm section thickness, 179 x 256), and (d) axial DW echo-planar (sensitizing direction = z) (800/123, one signal acquired, 6-mm section thickness) images and (e) corresponding ADC map. The enhancing component shows high signal intensity on the DW echo-planar image (d) and reduced ADC values (e). The peritumoral edema is hyperintense on the ADC map.

View larger version (136K): [in a new window]   Figure 14b.  Cerebral lymphoma. (a) Axial T2-weighted fast SE (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512), (b) axial T1-weighted nonenhanced SE (520/14, two signals averaged, 6-mm section thickness, 179 x 256 matrix), (c) axial T1-weighted contrast-enhanced SE (520/14, two signals averaged, 6-mm section thickness, 179 x 256), and (d) axial DW echo-planar (sensitizing direction = z) (800/123, one signal acquired, 6-mm section thickness) images and (e) corresponding ADC map. The enhancing component shows high signal intensity on the DW echo-planar image (d) and reduced ADC values (e). The peritumoral edema is hyperintense on the ADC map.

View larger version (131K): [in a new window]   Figure 14c.  Cerebral lymphoma. (a) Axial T2-weighted fast SE (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230 x 512), (b) axial T1-weighted nonenhanced SE (520/14, two signals averaged, 6-mm section thickness, 179 x 256 matrix), (c) axial T1-weighted contrast-enhanced SE (520/14, two signals averaged, 6-mm section thickness, 179 x 256), and (d) axial DW echo-planar (sensitizing direction = z) (800/123, one signal acquired, 6-mm section thickness) images and (e) corresponding ADC map. The enhancing component shows high signal intensity on the DW echo-planar image (d) and reduced ADC values (e). The peritumoral edema is hyperintense on the ADC map.

View larger version (129K): [in a new window]   Figure 14d.  Cerebral lymphoma. (a) Axial T2-weighted fast SE (5000/128; two signals averaged; 6-mm section thickness; echo train length, 23; matrix, 230