J Korean Soc Radiol.  2014 Oct;71(4):155-159. 10.3348/jksr.2014.71.4.155.

Post-Traumatic Contrast Enhancing Brain Lesion

• Kim DJ
• Kim HS
• Jeong MS
• Kim DR
• Cho YK
• Choi YS

• KMID: 2097997
• DOI: http://doi.org/10.3348/jksr.2014.71.4.155

Abstract

Only a few studies have been reported on the MR contrast enhancement and the apparent diffusion coefficient (ADC) findings of the post-traumatic lesion of the brain. We report a case of the venous ischemia in the left frontal lobe observed in the MRI obtained one day after the incidence of trauma. Considering the presented slight increase in the ADC, the vasogenic edema was thought to be the major mechanism of the venous ischemia and excitotoxic injury. In spite of a slight increase in the ADC, the hyperintensity in the diffusion weighted imaging and contrast-enhanced areas eventually changed into hemorrhagic lesions.

MeSH Terms

Brain*
Diffusion
Edema
Frontal Lobe
Incidence
Ischemia
Magnetic Resonance Imaging

Figure

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  Fig. 1 Initial (A) and 8-days follow-up (B) axial CT images. A. Initial axial CT image shows subdural hematoma and brain swelling in the left frontal lobe with focal hyperattenuated spot, suggesting hemorrhage. B. Eight-days follow-up axial CT image shows progressive white matter edema in the left frontal lobe without gross change that suggests focal hemorrhage in the corticomedullary junction.

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  Fig. 2 A 40-year-old woman with acute trauma and seizure. A. Axial T1-weighted MR image shows hypointensity on the left frontal lobe. B. Axial gadolinium-enhanced T1-weighted MR image shows contrast-enhancement of the left frontal lobe. C. Axial gradient-echo MR image shows two hypointensities in the corticomedullary junction of the left frontal lobe, suggesting hemorrhage. D. Axial diffusion-weighted MR image shows cortical hyperintensity in the left frontal lobe. E. Axial apparent diffusion coefficient MR image shows slight cortical hyperintensity in the left frontal lobe with edema of adjacent white matter. F. Coronal T2-weighted MR image shows hyperintensity in the superior and middle frontal gyrus with edema of subcortical white matter. G. Coronal gadolinium-enhanced T1-weighted MR image shows gyral enhancement of the left frontal lobe. Asymmetric high signal intensity in the left side wall and lumen of the anterior superior sagittal sinus is seen.

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  Fig. 3 MR spectroscopy obtained 19 days later. Subtle increase of Choline (Cho)/Creatinine (Cr) ratio is seen to be 1.33.

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  Fig. 4 Follow-up MR image obtained two months later. Axial gadolinium-enhanced T1-weighted image shows a markedly improved left frontal lobe lesion.

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