ABSTRACT Background Ring-enhancing lesions (RELs) in the brain represent a diagnostic challenge due to their diverse etiologies, ranging from infections to neoplastic conditions. MRI offers superior imaging features to distinguish among these conditions. Purpose To evaluate the spectrum of ring-enhancing brain lesions and assess the role of MRI in differentiating these pathologies. Methods A retrospective study of 160 patients with RELs on contrast MRI was conducted from May 2022 to July 2025. MRI findings were analyzed with respect to lesion morphology, signal characteristics, and diffusion restriction. Results Infective lesions such as tuberculoma (40%) and neurocysticercosis (33%) were most common, followed by abscesses (10%), metastases (13%), and primary tumors (4%). Diffusion restriction was a key differentiator, with all abscesses showing restricted diffusion. Conclusion MRI, with its multiparametric capabilities, plays a pivotal role in the non-invasive differentiation of RELs and aids in formulating appropriate management strategies. Advances in MRI techniques—such as diffusion tensor imaging, perfusion imaging, MR spectroscopy, and functional MRI—hold promise for improving diagnostic accuracy and reducing the need for invasive procedures. Incorporating artificial intelligence and radiomics may further enhance lesion characterization and enable more precise, non-invasive differentiation of pathologies in the future.
Rajput et al. (Thu,) studied this question.