A ring-enhancing metastasis with central high signal on diffusion-weighted imaging and low apparent diffusion coefficients

Abstract

Diffusion-weighted imaging (DWI) has been reported to be useful in the differential diagnosis between abscesses and cystic or necrotic tumours. However, experience is still limited and the true sensitivity and specificity remain to be determined. Our purpose is to describe a ring-enhancing metastasis of adenocarcinoma with a DWI pattern similar to that reported for abscesses. The tumour had a diameter of 1.5 cm and give signal from its centre similar to that of normal brain on T1-weighted images, whereas it was increased on T2-weighted images, and surrounded by a low signal ring, suggesting a capsule. The signal was high on DWI and the apparent diffusion coefficient (ADC) was low (0.55 × 10^–3 mm²/s). The findings were misinterpreted as representing an abscess in the early capsule-formation stage, but the signal pattern probably represented early tumour necrosis with intracellular oedema, but without liquefaction. Findings on DWI during the early capsule formation stage in abscesses and early tumour necrosis are probably similar and must be interpreted with caution.