Aim To evaluate the role of 3 Tesla MRI with MR Spectroscopy (MRS) in differentiating intracranial ring-enhancing lesions (RELs). Methods A prospective observational study was conducted over 18 months period at a tertiary care hospital in Lucknow. Seventy patients with clinically suspected ring enhancing lesions underwent 3T MRI and MR Spectroscopy. Imaging findings were assessed for morphology, distribution and metabolic profiles (choline, creatine, N-acetylaspartate [NAA], lactate, lipid). Radiological and spectroscopic results were correlated with clinical presentations. Results Most patients were ≤20 years (40%). Females slightly outnumbered males (52.9%). Seizures with fever were the most frequent presentation (50%). Tuberculoma (34.3%) and neurocysticercosis (32.9%) were the leading etiologies, followed by neoplasms (20%). Lactate (45.7%) and lipid (41.4%) peaks were the most common abnormal metabolites, while reduced NAA was observed in 48.6%. The addition of MRS enhanced the accuracy of distinguishing infectious from neoplastic etiologies. Conclusion 3T MRI combined with MR Spectroscopy enhances diagnostic accuracy in intracranial RELs, particularly in distinguishing tuberculoma from neurocysticercosis and neoplastic from non-neoplastic causes, thus guiding appropriate management.

Ring-enhancing lesions, MR Spectroscopy, Tuberculoma, Neurocysticercosis, Brain neoplasms.