Ring-enhancing lesion

Background

Cerebral CT or MRI with lesions having an enhancing ring of contrast around a less dense center can indicate certain neurological infections, injuries, and indolent disorders. See DDx below. Immune status of patients is key in helping to narrow potential causative agents.

Differential Diagnosis

Ring-Enhancing Lesion

Common Mnemonic: DR MAGIC

• Demyelination
• Radionecrosis/hematoma
• Metastasis
• Abscess (consider bacterial, fungal, parasitic)
• Glioma (and other primary neoplasms such as lymphoma)
• Infarction
• Contusion

HIV and ring-enhancing lesion(s)

• Toxoplasmosis v. lymphoma (see comparison of characteristics at Radiopaedia.org.)

Neoplasm

• Primary brain tumor
• Primary CNS lymphoma
• Metastatic disease

Infectious

• Pyogenic brain abscess
• Tuberculoma
• Toxoplasmosis
• Syphilis
• Neurocysticercosis
• Nocardiosis
• Cryptococcosis
• Aspergillosis

Neurologic

• Multiple Sclerosis
• Sarcoidosis
• Vasculitis
• Aneurysm
• Resolving hematoma
• Cerebral infarct
• Post-op changes