Weekly Image Challenge – August 14, 2023

What is the most likely diagnosis for this 33 years old patient who presented with fever, headache, and seizures?

  1. Glioblastoma
  2. Abscess
  3. Radiation necrosis
  4. Metastasis
  5. Demyelinating disease


Congratulations to those who selected ‘abscess’. The smooth ring enhancement on contrast differentiates it from glioblastoma & metastasis. Central diffusion restriction, hyper-intense cystic part on T2, & fever were other significant features favoring an abscess.

There is no history of previous radiation so that excludes radiation necrosis. Demyelinating lesions usually have incomplete ring enhancement on contrast (open ring sign).