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Difficulty: MediumInterpreting Imaging Results

Match each distinct pathognomonic finding on brain magnetic resonance imaging (MRI) with its corresponding neurological condition.

  • Glioblastoma multiformeIrregular, peripherally ring-enhancing intra-axial mass with central necrosis crossing the corpus callosum
  • MeningiomaExtra-axial, smoothly marginated, vividly enhancing mass with a prominent dural tail
  • Herpes simplex encephalitisAsymmetric bilateral or unilateral temporal lobe T2/FLAIR hyperintensity with associated edema
  • Multiple sclerosisOvoid, periventricular white matter T2/FLAIR hyperintensities oriented perpendicular to the lateral ventricles
  • Primary central nervous system lymphomaSolidly enhancing periventricular mass without significant central necrosis, frequently observed in immunocompromised patients

Answer

Glioblastoma multiforme pairs with the ring-enhancing mass crossing the corpus callosum. Meningioma pairs with the extra-axial mass with a dural tail. Herpes simplex encephalitis pairs with temporal lobe hyperintensity. Multiple sclerosis pairs with ovoid periventricular hyperintensities. Primary central nervous system lymphoma pairs with the solidly enhancing periventricular mass.
Each listed neurological condition possesses a classic MRI signature reflective of its underlying pathophysiology. Meningiomas grow from the meninges outward. HSV specifically targets the limbic system. MS causes characteristic demyelination along periventricular venules. GBM grows aggressively along tracts causing central necrosis, and PCNSL forms dense, solid tumors without necrotic centers.

Step-by-Step Solution

1
Analyze the finding describing temporal lobe T2/FLAIR hyperintensity.
Matched with Herpes simplex encephalitis.
HSV has a distinct predilection for infecting the medial temporal and inferior frontal lobes, causing classic inflammatory changes on MRI.
2
Evaluate the non-enhancing white matter lesions.
Matched the ovoid periventricular hyperintensities with Multiple sclerosis.
These lesions represent perivenular demyelinating plaques, classically known as Dawson fingers, which align perpendicular to the lateral ventricles.
3
Differentiate the intra-axial enhancing masses.
The ring-enhancing necrotic lesion matches Glioblastoma multiforme, while the solidly enhancing lesion matches Primary central nervous system lymphoma.
Central necrosis is a hallmark of high-grade gliomas like GBM, resulting in peripheral ring enhancement. Conversely, lymphomas are densely cellular and typically enhance uniformly without central necrosis.
4
Identify the extra-axial lesion.
Matched the vividly enhancing mass with a dural tail to Meningioma.
Meningiomas arise from arachnoid cap cells outside the brain parenchyma (extra-axial) and classically pull the dura mater, creating the dural tail sign.

Key Concept

Pathognomonic MRI findings for central nervous system pathologies
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Topics

Interpreting Imaging Results

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