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Intracranial Mass Lesions: Dynamic Contrast-enhanced Susceptibility-weighted Echo-planar Perfusion MR Imaging¹

¹ From the Departments of Radiology (S.C., E.A.K., G.J., S.G.W., A.W.L.), Neurosurgery (E.A.K., D.Z.), and Pathology (D.Z.), New York University Medical Center, 530 First Ave, HCC-Basement, MRI Center, New York, NY 10016. Received March 12, 2001; revision requested April 27; revision received June 25; accepted July 16. S.C. supported in part by an RSNA Seed Grant 3; S.G.W. supported in part by Swiss National Science Foundation/Karger Stiftung and by Novartis Stiftung. Address correspondence to S.C. (e-mail: cha@mri.med.nyu.edu).

View larger version (28K): [in a new window]   Figure 1. Diagrams illustrate calculation of rCBV. A, Signal intensity decrease during passage of contrast agent bolus is measured from a series of gradient-echo echo-planar MR images. B, Change in the relaxation rate (R2*) is calculated from signal intensity, and a baseline subtraction method is applied to measured data. C, Corrected R2* curve. D, rCBV is proportional to the area under curve (shaded area).

View larger version (137K): [in a new window]   Figure 2a. (a-d) Transverse gradient-echo echo-planar (repetition time msec/echo time msec, 1,000/54) MR images in a 33-year-old woman with a choroid plexus carcinoma of the left lateral ventricle. (a) Image obtained before intravenous injection of gadopentetate dimeglumine. (b) Image obtained at peak arrival time (in this case, 10 seconds after injection of contrast agent) demonstrates marked signal intensity decrease in the tumor (arrow). (c) Image obtained 50 seconds after injection shows return of signal intensity to baseline except in areas of disruption or absence of the blood-brain barrier (arrows), where leakage has occurred. (d) Color overlay of rCBV map shows the intense hypervascularity (red) of the tumor. (e) Transverse contrast-enhanced T1-weighted (600/14) MR image demonstrates marked enhancement of the tumor (arrow) due to lack of a blood-brain barrier.

View larger version (142K): [in a new window]   Figure 2b. (a-d) Transverse gradient-echo echo-planar (repetition time msec/echo time msec, 1,000/54) MR images in a 33-year-old woman with a choroid plexus carcinoma of the left lateral ventricle. (a) Image obtained before intravenous injection of gadopentetate dimeglumine. (b) Image obtained at peak arrival time (in this case, 10 seconds after injection of contrast agent) demonstrates marked signal intensity decrease in the tumor (arrow). (c) Image obtained 50 seconds after injection shows return of signal intensity to baseline except in areas of disruption or absence of the blood-brain barrier (arrows), where leakage has occurred. (d) Color overlay of rCBV map shows the intense hypervascularity (red) of the tumor. (e) Transverse contrast-enhanced T1-weighted (600/14) MR image demonstrates marked enhancement of the tumor (arrow) due to lack of a blood-brain barrier.

View larger version (140K): [in a new window]   Figure 2c. (a-d) Transverse gradient-echo echo-planar (repetition time msec/echo time msec, 1,000/54) MR images in a 33-year-old woman with a choroid plexus carcinoma of the left lateral ventricle. (a) Image obtained before intravenous injection of gadopentetate dimeglumine. (b) Image obtained at peak arrival time (in this case, 10 seconds after injection of contrast agent) demonstrates marked signal intensity decrease in the tumor (arrow). (c) Image obtained 50 seconds after injection shows return of signal intensity to baseline except in areas of disruption or absence of the blood-brain barrier (arrows), where leakage has occurred. (d) Color overlay of rCBV map shows the intense hypervascularity (red) of the tumor. (e) Transverse contrast-enhanced T1-weighted (600/14) MR image demonstrates marked enhancement of the tumor (arrow) due to lack of a blood-brain barrier.

View larger version (140K): [in a new window]   Figure 2d. (a-d) Transverse gradient-echo echo-planar (repetition time msec/echo time msec, 1,000/54) MR images in a 33-year-old woman with a choroid plexus carcinoma of the left lateral ventricle. (a) Image obtained before intravenous injection of gadopentetate dimeglumine. (b) Image obtained at peak arrival time (in this case, 10 seconds after injection of contrast agent) demonstrates marked signal intensity decrease in the tumor (arrow). (c) Image obtained 50 seconds after injection shows return of signal intensity to baseline except in areas of disruption or absence of the blood-brain barrier (arrows), where leakage has occurred. (d) Color overlay of rCBV map shows the intense hypervascularity (red) of the tumor. (e) Transverse contrast-enhanced T1-weighted (600/14) MR image demonstrates marked enhancement of the tumor (arrow) due to lack of a blood-brain barrier.

View larger version (148K): [in a new window]   Figure 2e. (a-d) Transverse gradient-echo echo-planar (repetition time msec/echo time msec, 1,000/54) MR images in a 33-year-old woman with a choroid plexus carcinoma of the left lateral ventricle. (a) Image obtained before intravenous injection of gadopentetate dimeglumine. (b) Image obtained at peak arrival time (in this case, 10 seconds after injection of contrast agent) demonstrates marked signal intensity decrease in the tumor (arrow). (c) Image obtained 50 seconds after injection shows return of signal intensity to baseline except in areas of disruption or absence of the blood-brain barrier (arrows), where leakage has occurred. (d) Color overlay of rCBV map shows the intense hypervascularity (red) of the tumor. (e) Transverse contrast-enhanced T1-weighted (600/14) MR image demonstrates marked enhancement of the tumor (arrow) due to lack of a blood-brain barrier.

View larger version (66K): [in a new window]   Figure 3a. Transverse gradient-echo echo-planar (1,000/54) MR images show reduction of susceptibility artifacts when a smaller section thickness is used in a 34-year-old man with left temporal lobe radiation necrosis. (a) Images obtained with 6-mm section thickness and 20% intersection gap show extensive susceptibility artifacts (arrows) in the inferior frontal and temporal lobes. (b) Images obtained at same levels as in a but with 3-mm section thickness and 20% gap show the presence of a cavity (arrowheads) in the left middle cranial fossa. Susceptibility artifacts are markedly reduced.

View larger version (73K): [in a new window]   Figure 3b. Transverse gradient-echo echo-planar (1,000/54) MR images show reduction of susceptibility artifacts when a smaller section thickness is used in a 34-year-old man with left temporal lobe radiation necrosis. (a) Images obtained with 6-mm section thickness and 20% intersection gap show extensive susceptibility artifacts (arrows) in the inferior frontal and temporal lobes. (b) Images obtained at same levels as in a but with 3-mm section thickness and 20% gap show the presence of a cavity (arrowheads) in the left middle cranial fossa. Susceptibility artifacts are markedly reduced.

View larger version (150K): [in a new window]   Figure 4a. Left parietal lobe GBM in a 46-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows left parietal lobe mass with extensive surrounding edema (arrow). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows enhancement of the tumor (arrow). (c) rCBV map demonstrates marked hypervascularity (red) of the tumor.

View larger version (148K): [in a new window]   Figure 4b. Left parietal lobe GBM in a 46-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows left parietal lobe mass with extensive surrounding edema (arrow). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows enhancement of the tumor (arrow). (c) rCBV map demonstrates marked hypervascularity (red) of the tumor.

View larger version (133K): [in a new window]   Figure 4c. Left parietal lobe GBM in a 46-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows left parietal lobe mass with extensive surrounding edema (arrow). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows enhancement of the tumor (arrow). (c) rCBV map demonstrates marked hypervascularity (red) of the tumor.

View larger version (24K): [in a new window]   Figure 5. Signal intensity-time curve shows marked signal intensity decrease during peak arrival of the contrast agent, followed by partial recovery of the signal intensity loss (arrowheads). A second decrease in signal intensity (arrow) is due to recirculation. Recovery of signal intensity is incomplete due to leakage of contrast agent through a disrupted blood-brain barrier.

View larger version (129K): [in a new window]   Figure 6. Photomicrographs show histopathologic findings of the vascular hyperplasia of GBM. Top left: Early vascular hyperplasia remote from the glioblastoma "border." Note endothelial cell plumping (arrows). (Hematoxylin-eosin stain; original magnification, x200.) Bottom left: Angiogenesis at the edge of an infiltrating glioblastoma. Invading glioma cells (short arrows) can be seen between the hyperplastic vascular complexes (long arrows). (Hematoxylin-eosin stain; original magnification, x100.) Top right: Intratumoral neovascularization showing glomeruloid vessels (long arrows). Mitotic figures (short arrows) in vascular cells are evident. (Hematoxylin-eosin stain; original magnification, x100.) Bottom right: Azocarmine staining underscores the exuberant vascular proliferation (arrow) that is characteristic of GBM. (Original magnification, x100.)

View larger version (148K): [in a new window]   Figure 7a. Nonenhancing right frontal lobe tumor in a 32-year-old woman. (a) Transverse T2-weighted (3,400/119) MR image shows a hyperintense mass (arrow) with minimal surrounding edema (arrowheads). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a homogeneously hypointense right frontal lobe tumor (arrow). (c) rCBV map demonstrates an area of increased vascularity (arrow), and results of a biopsy directed to that area showed histologic vascular proliferation. The patient subsequently underwent surgical resection, and the diagnosis after pathologic examination was anaplastic astrocytoma.

View larger version (134K): [in a new window]   Figure 7b. Nonenhancing right frontal lobe tumor in a 32-year-old woman. (a) Transverse T2-weighted (3,400/119) MR image shows a hyperintense mass (arrow) with minimal surrounding edema (arrowheads). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a homogeneously hypointense right frontal lobe tumor (arrow). (c) rCBV map demonstrates an area of increased vascularity (arrow), and results of a biopsy directed to that area showed histologic vascular proliferation. The patient subsequently underwent surgical resection, and the diagnosis after pathologic examination was anaplastic astrocytoma.

View larger version (142K): [in a new window]   Figure 7c. Nonenhancing right frontal lobe tumor in a 32-year-old woman. (a) Transverse T2-weighted (3,400/119) MR image shows a hyperintense mass (arrow) with minimal surrounding edema (arrowheads). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a homogeneously hypointense right frontal lobe tumor (arrow). (c) rCBV map demonstrates an area of increased vascularity (arrow), and results of a biopsy directed to that area showed histologic vascular proliferation. The patient subsequently underwent surgical resection, and the diagnosis after pathologic examination was anaplastic astrocytoma.

View larger version (131K): [in a new window]   Figure 8a. Nonenhancing right frontal lobe tumor in a 29-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows a mild degree of surrounding edema (arrows). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a nonenhancing right frontal lobe tumor (arrow). (c) rCBV map demonstrates no evidence of increased tumor vascularity. The patient underwent surgical resection, and the final pathologic results revealed low-grade fibrillary astrocytoma.

View larger version (138K): [in a new window]   Figure 8b. Nonenhancing right frontal lobe tumor in a 29-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows a mild degree of surrounding edema (arrows). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a nonenhancing right frontal lobe tumor (arrow). (c) rCBV map demonstrates no evidence of increased tumor vascularity. The patient underwent surgical resection, and the final pathologic results revealed low-grade fibrillary astrocytoma.

View larger version (125K): [in a new window]   Figure 8c. Nonenhancing right frontal lobe tumor in a 29-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows a mild degree of surrounding edema (arrows). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a nonenhancing right frontal lobe tumor (arrow). (c) rCBV map demonstrates no evidence of increased tumor vascularity. The patient underwent surgical resection, and the final pathologic results revealed low-grade fibrillary astrocytoma.

View larger version (138K): [in a new window]   Figure 9a. Recurrent tumor in a 72-year-old man with previously resected and irradiated right frontal lobe GBM. (a) Transverse T2-weighted (3,400/119) MR image displays a large area of hyperintensity abnormality involving the right frontal lobe. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows nonenhancing right frontal lobe lesion (arrowheads) that extends into the genu of the corpus callosum (large arrow). Also note thick dural enhancement (small arrow) adjacent to the craniotomy site. (c) rCBV map demonstrates marked increase in vascularity in the right frontal lobe and genu of the corpus callosum, suggesting recurrent tumor. At repeat surgery, recurrence of GBM was confirmed.

View larger version (137K): [in a new window]   Figure 9b. Recurrent tumor in a 72-year-old man with previously resected and irradiated right frontal lobe GBM. (a) Transverse T2-weighted (3,400/119) MR image displays a large area of hyperintensity abnormality involving the right frontal lobe. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows nonenhancing right frontal lobe lesion (arrowheads) that extends into the genu of the corpus callosum (large arrow). Also note thick dural enhancement (small arrow) adjacent to the craniotomy site. (c) rCBV map demonstrates marked increase in vascularity in the right frontal lobe and genu of the corpus callosum, suggesting recurrent tumor. At repeat surgery, recurrence of GBM was confirmed.

View larger version (141K): [in a new window]   Figure 9c. Recurrent tumor in a 72-year-old man with previously resected and irradiated right frontal lobe GBM. (a) Transverse T2-weighted (3,400/119) MR image displays a large area of hyperintensity abnormality involving the right frontal lobe. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows nonenhancing right frontal lobe lesion (arrowheads) that extends into the genu of the corpus callosum (large arrow). Also note thick dural enhancement (small arrow) adjacent to the craniotomy site. (c) rCBV map demonstrates marked increase in vascularity in the right frontal lobe and genu of the corpus callosum, suggesting recurrent tumor. At repeat surgery, recurrence of GBM was confirmed.

View larger version (160K): [in a new window]   Figure 10a. Delayed radiation necrosis in an 82-year-old woman. (a) Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows extensive hyperintensity abnormality that extends into the genu of the corpus callosum (large arrow). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows heterogeneous, irregularly enhancing left frontal lobe mass (arrows). (c) rCBV map demonstrates no evidence of increased vascularity, suggesting radiation necrosis rather than recurrent tumor. The patient underwent surgical resection, and radiation necrosis without evidence of tumor was found.

View larger version (143K): [in a new window]   Figure 10b. Delayed radiation necrosis in an 82-year-old woman. (a) Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows extensive hyperintensity abnormality that extends into the genu of the corpus callosum (large arrow). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows heterogeneous, irregularly enhancing left frontal lobe mass (arrows). (c) rCBV map demonstrates no evidence of increased vascularity, suggesting radiation necrosis rather than recurrent tumor. The patient underwent surgical resection, and radiation necrosis without evidence of tumor was found.

View larger version (135K): [in a new window]   Figure 10c. Delayed radiation necrosis in an 82-year-old woman. (a) Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows extensive hyperintensity abnormality that extends into the genu of the corpus callosum (large arrow). (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows heterogeneous, irregularly enhancing left frontal lobe mass (arrows). (c) rCBV map demonstrates no evidence of increased vascularity, suggesting radiation necrosis rather than recurrent tumor. The patient underwent surgical resection, and radiation necrosis without evidence of tumor was found.

View larger version (125K): [in a new window]   Figure 11. Photomicrographs show angiocentric growth pattern of PCL. Top left: Low-power view shows tumor cells organized around a cerebral vessel (long arrows), as well as in the neuropil (short arrows). (Hematoxylin-eosin stain; original magnification, x50.) Bottom left: Medium-power magnification further emphasizes the perivascular growth of tumor cells that results in a narrowing of the vascular lumina (arrows). (Hematoxylin-eosin stain; original magnification, x100.) Top right: High-power view depicts cross sections of vascular channels (arrows) cuffed by lymphoma cells. (Hematoxylin-eosin stain; original magnification, x200.) Bottom right: Reticulin staining highlights angiocentric growth of the lymphoma and demonstrates reduplication of the vascular matrix (arrows). (Original magnification, x400.)

View larger version (157K): [in a new window]   Figure 12a. PCL in a 72-year-old man. (a) Transverse contrast-enhanced T1-weighted (600/14) MR image shows homogeneous enhancement and expansion of the splenium of the corpus callosum (arrows). (b) rCBV map demonstrates no evidence of a marked increase in vascularity (rCBV range, 0.89-1.10).

View larger version (118K): [in a new window]   Figure 12b. PCL in a 72-year-old man. (a) Transverse contrast-enhanced T1-weighted (600/14) MR image shows homogeneous enhancement and expansion of the splenium of the corpus callosum (arrows). (b) rCBV map demonstrates no evidence of a marked increase in vascularity (rCBV range, 0.89-1.10).

View larger version (154K): [in a new window]   Figure 13a. Atypical meningioma in an 81-year-old woman. (a) Transverse contrast-enhanced T1-weighted (600/14) MR image shows intense enhancement of a right frontal lobe tumor (arrow). (b) rCBV map shows increased vascularity (red) of the tumor.

View larger version (140K): [in a new window]   Figure 13b. Atypical meningioma in an 81-year-old woman. (a) Transverse contrast-enhanced T1-weighted (600/14) MR image shows intense enhancement of a right frontal lobe tumor (arrow). (b) rCBV map shows increased vascularity (red) of the tumor.

View larger version (21K): [in a new window]   Figure 14. Signal intensity-time curve of atypical meningioma (same patient as in Fig 13) displays immediate leakage of contrast agent (arrow) due to absence of a blood-brain barrier, which is characteristic of an extraaxial tumor. An example of a partially disrupted but not completely absent blood-brain barrier, as in the case of GBM, is shown in Figure 5.

View larger version (142K): [in a new window]   Figure 15a. Pyogenic abscess in a 45-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows a heterogeneous mass (arrowheads) with moderate edema (arrows) in the right parietal lobe. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows irregular rim enhancement (arrows). (c) rCBV map demonstrates zone of increased vascularity (arrows) is just outside the enhancing rim of the abscess.

View larger version (144K): [in a new window]   Figure 15b. Pyogenic abscess in a 45-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows a heterogeneous mass (arrowheads) with moderate edema (arrows) in the right parietal lobe. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows irregular rim enhancement (arrows). (c) rCBV map demonstrates zone of increased vascularity (arrows) is just outside the enhancing rim of the abscess.

View larger version (115K): [in a new window]   Figure 15c. Pyogenic abscess in a 45-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows a heterogeneous mass (arrowheads) with moderate edema (arrows) in the right parietal lobe. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows irregular rim enhancement (arrows). (c) rCBV map demonstrates zone of increased vascularity (arrows) is just outside the enhancing rim of the abscess.

View larger version (135K): [in a new window]   Figure 16a. Toxoplasma encephalitis in a 47-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows heterogeneous hyperintense signal intensity abnormality in both frontal lobes that extends into the genu of the corpus callosum. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows irregularly enhancing lesions (arrows) in the frontal lobes. (c) rCBV map demonstrates no evidence of increased vascularity, which is suggestive of a nonneoplastic lesion. The patient underwent stereotactic biopsy, the results of which showed toxoplasma encephalitis.

View larger version (147K): [in a new window]   Figure 16b. Toxoplasma encephalitis in a 47-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows heterogeneous hyperintense signal intensity abnormality in both frontal lobes that extends into the genu of the corpus callosum. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows irregularly enhancing lesions (arrows) in the frontal lobes. (c) rCBV map demonstrates no evidence of increased vascularity, which is suggestive of a nonneoplastic lesion. The patient underwent stereotactic biopsy, the results of which showed toxoplasma encephalitis.

View larger version (114K): [in a new window]   Figure 16c. Toxoplasma encephalitis in a 47-year-old man. (a) Transverse T2-weighted (3,400/119) MR image shows heterogeneous hyperintense signal intensity abnormality in both frontal lobes that extends into the genu of the corpus callosum. (b) Transverse contrast-enhanced T1-weighted (600/14) MR image shows irregularly enhancing lesions (arrows) in the frontal lobes. (c) rCBV map demonstrates no evidence of increased vascularity, which is suggestive of a nonneoplastic lesion. The patient underwent stereotactic biopsy, the results of which showed toxoplasma encephalitis.

View larger version (78K): [in a new window]   Figure 17a. TDL in a 46-year-old woman. (a) Left: Transverse T2-weighted (3,400/119) MR image shows multiple periventricular high-signal-intensity abnormalities, with a dominant masslike lesion (large arrow) in the right posterior frontal lobe region. Middle: Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows the smaller lesions (arrows) more distinctly. Right: Transverse contrast-enhanced T1-weighted (600/14) MR image shows thick rim enhancement (arrowheads) of the dominant lesion. (b) Series of transverse gradient-echo echo-planar (1,000/54) MR images obtained before (left), at peak arrival of (middle), and after (right) bolus injection of contrast agent display a prominent vessel-like structure (arrow) within the lesion.

View larger version (59K): [in a new window]   Figure 17b. TDL in a 46-year-old woman. (a) Left: Transverse T2-weighted (3,400/119) MR image shows multiple periventricular high-signal-intensity abnormalities, with a dominant masslike lesion (large arrow) in the right posterior frontal lobe region. Middle: Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows the smaller lesions (arrows) more distinctly. Right: Transverse contrast-enhanced T1-weighted (600/14) MR image shows thick rim enhancement (arrowheads) of the dominant lesion. (b) Series of transverse gradient-echo echo-planar (1,000/54) MR images obtained before (left), at peak arrival of (middle), and after (right) bolus injection of contrast agent display a prominent vessel-like structure (arrow) within the lesion.

View larger version (124K): [in a new window]   Figure 18a. Presumed infarct in a 35-year-old woman. (a) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a heterogeneously hypointense lesion (solid arrows) with irregular linear enhancement in the right frontoparietal region. Note fiducial marker (open arrow) for surgical planning. (b) Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows heterogeneous high-signal-intensity abnormality. (c) rCBV map shows an area of susceptibility (arrow) and no increase in vascularity, thus suggesting a nonneoplastic lesion. Surgery was canceled, and at 6-week follow-up MR examination, the lesion had almost completely disappeared without any intervening therapy.

View larger version (134K): [in a new window]   Figure 18b. Presumed infarct in a 35-year-old woman. (a) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a heterogeneously hypointense lesion (solid arrows) with irregular linear enhancement in the right frontoparietal region. Note fiducial marker (open arrow) for surgical planning. (b) Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows heterogeneous high-signal-intensity abnormality. (c) rCBV map shows an area of susceptibility (arrow) and no increase in vascularity, thus suggesting a nonneoplastic lesion. Surgery was canceled, and at 6-week follow-up MR examination, the lesion had almost completely disappeared without any intervening therapy.

View larger version (122K): [in a new window]   Figure 18c. Presumed infarct in a 35-year-old woman. (a) Transverse contrast-enhanced T1-weighted (600/14) MR image shows a heterogeneously hypointense lesion (solid arrows) with irregular linear enhancement in the right frontoparietal region. Note fiducial marker (open arrow) for surgical planning. (b) Transverse fluid-attenuated inversion recovery (9,000/110/2,500) MR image shows heterogeneous high-signal-intensity abnormality. (c) rCBV map shows an area of susceptibility (arrow) and no increase in vascularity, thus suggesting a nonneoplastic lesion. Surgery was canceled, and at 6-week follow-up MR examination, the lesion had almost completely disappeared without any intervening therapy.