- Veterinary View Box
- Posts
- Can you tell the difference between an abscess and ring enhancing glioma?
Can you tell the difference between an abscess and ring enhancing glioma?
VRU 2023
Obi Veterinary Education
April 13, 2025
Andrea Carloni1 Marco Bernardini1,2 Chiara Mattei1, et al.
Background
Ring-enhancing brain lesions in veterinary patients often present a diagnostic challenge due to overlapping imaging features between gliomas and intra-axial abscesses. Accurate differentiation is critical because these conditions require vastly different treatments. This study aimed to identify magnetic resonance imaging (MRI) features that distinguish ring-enhancing gliomas from intra-axial abscesses in dogs and cats, hypothesizing that specific qualitative characteristics and a quantitative threshold for lesion diameter-to-capsule thickness ratio could aid differentiation.
Methods
A multicenter, retrospective study analyzed MRI data from 31 animals (16 gliomas, 15 abscesses) with confirmed diagnoses through histopathology or cytology. Required sequences included pre- and postcontrast T1-weighted (T1W), T2-weighted (T2W), and T2 FLAIR images. Additional data from T2*W GE, diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), and delayed postcontrast T1W sequences were included if available. Statistical analysis identified imaging features associated with each condition.
Results
Key findings for abscesses:
-Homogeneous signal intensity on T1W and T2W sequences.
-Peripheral hypointense halo on T2W and T2*W GE sequences.
-Evenly enhancing capsule.
-Restricted diffusion on DWI.
Key findings for gliomas:
-Heterogeneous signal intensity on T1W and T2W sequences.
-Progressive central enhancement on delayed postcontrast T1W sequences.
-Higher lesion diameter-to-capsule thickness ratio (>12) in T1W postcontrast images.
-Non-significant features: Signal intensity relative to gray matter, intralesional T2 FLAIR attenuation, and perilesional vasogenic edema severity.
Limitations
-Variability in MRI equipment and protocols across institutions.
-Retrospective nature prevented standardization, particularly for advanced imaging sequences like DWI and SWI, which were inconsistently available.
-Small sample size limited the statistical power for less common findings.
Conclusions
While significant overlap exists between gliomas and abscesses in MRI appearance, certain features can aid differentiation. Evenly enhancing capsules, peripheral hypointense halos, and restricted diffusion favor abscesses, whereas heterogeneous signals, progressive central enhancement, and higher diameter-to-capsule thickness ratios suggest gliomas. The addition of DWI and SWI sequences enhances diagnostic confidence, emphasizing the importance of comprehensive MRI protocols.
A–C, 1.5 T, transverse T1W FSE TR 500, TE 13 and transverse DWI/ADC TR 4233, TE 110, B value 1000) A 9-year-old maleneutered DSH cat with a right parietal lobe abscess secondary to a bite wound. An even, well-defined ring-enhancing lesion with a hypointensecenter (arrow) is visible on the T1 postcontrast sequence (A); right temporal myopathy and a calvarial defect are also visible (dashed arrow). On thetransverse DWI (B), the central portion of the abscess is strongly hyperintense to normal brain parenchyma (black asterisk), while it shows lowvalues (white asterisk) on the ADC map (C), consistent with restriction to diffusion. D–F, 1.5 T, transverse T1W FSE TR 465, TE 11 and transverseDWI/ADC TR 4288, TE 94, B value 1000) 5-year-old male French Bulldog with ring-enhancing glioma of the right frontoparietal lobe. The T1Wpostcontrast sequence shows an unevenly marginated ring-enhancing glioma (arrowheads) (D). On the transverse DWI (E), the central portion ofthe lesion is hypointense (white §) to normal brain parenchyma, while on the ADC map (F), it shows a high signal (black §), consistent withunrestricted diffusion. Note the difference between the even enhancing capsule of the brain abscess (A) compared to the unevenly marginatedring-enhancing glioma (D)
How did we do? |
Disclaimer: The summary generated in this email was created by an AI large language model. Therefore errors may occur. Reading the article is the best way to understand the scholarly work. The figure presented here remains the property of the publisher or author and subject to the applicable copyright agreement. It is reproduced here as an educational work. If you have any questions or concerns about the work presented here, reply to this email.