Gyral enhancement

Last revised by Craig Hacking ◉ ◈ on 18 Aug 2021

Citation, DOI, disclosures and article data

Citation:

Deng F, Hacking C, Fortin F, et al. Gyral enhancement. Reference article, Radiopaedia.org (Accessed on 05 Jun 2023) https://doi.org/10.53347/rID-73596

DOI:

https://doi.org/10.53347/rID-73596

Permalink:

https://radiopaedia.org/articles/73596

rID:

73596

Article created:

15 Jan 2020, Francis Deng ◉

Disclosures:

At the time the article was created Francis Deng had no recorded disclosures.

View Francis Deng's current disclosures

Last revised:

18 Aug 2021, Craig Hacking ◉ ◈

Disclosures:

At the time the article was last revised Craig Hacking had no recorded disclosures.

View Craig Hacking's current disclosures

Revisions:

14 times, by 5 contributors - see full revision history and disclosures

Systems:

Central Nervous System

Sections:

Gamuts

Synonyms:

Gyriform enhancement
Grey matter enhancement
Cortical enhancement

Gyral enhancement, also known as gyriform, cortical, or grey matter enhancement, is a pattern of contrast enhancement in the superficial brain parenchyma that conforms to the serpentine morphology of the cerebral gyri. It should be distinguished from leptomeningeal enhancement, which is also serpentine but occurs on the brain surface rather than within the parenchyma.

The causes are most commonly vascular or inflammatory, with subacute infarction being the most well described ¹:

vascular
- recent cerebral (cortical) infarction ^2-7
  - subacute infarct with luxury perfusion and/or cortical laminar necrosis (after 6 days until up to 4 months following stroke ^26,27)
  - acute ischemic stroke after thrombolysis/thrombectomy
  - venous infarct ^8-10
- epileptic seizures (vasodilatory postictal state) ^11,12
- migraine
  - migrainous infarction ^15-18
  - hemiplegic migraine ^19,20
  - stroke-like migraine attacks after radiation therapy (SMART) syndrome ^21-23
- posterior reversible encephalopathy syndrome ^24,25
inflammatory/infectious
- viral encephalitis
  - herpes
- cerebritis
  - tuberculosis ¹³
neoplastic
- glioblastoma ⁴
- metastases ⁴
toxic
- cortical laminar necrosis related to drug toxicity (immunosuppressants and chemotherapy)¹⁴

These causes may be distinguished by clinical history and brain location.

References

1. Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. (2007) Radiographics : a review publication of the Radiological Society of North America, Inc. 27 (2): 525-51. doi:10.1148/rg.272065155 - Pubmed
2. Weisberg LA. Computerized tomographic enhancement patterns in cerebral infarction. (1980) Archives of neurology. 37 (1): 21-4. doi:10.1001/archneur.1980.00500500051006 - Pubmed
3. Imakita S, Nishimura T, Naito H, Yamada N, Yamamoto K, Takamiya M, Yamada Y, Sakashita Y, Minamikawa J, Kikuchi H. Magnetic resonance imaging of human cerebral infarction: enhancement with Gd-DTPA. (1987) Neuroradiology. 29 (5): 422-9. doi:10.1007/bf00341737 - Pubmed
4. Masdeu JC. Infarct versus neoplasm on CT: four helpful signs. (1983) AJNR. American journal of neuroradiology. 4 (3): 522-4. Pubmed
5. Cordes M, Henkes H, Roll D, Eichstädt H, Christe W, Langer M, Felix R. Subacute and chronic cerebral infarctions: SPECT and gadolinium-DTPA enhanced MR imaging. (1989) Journal of computer assisted tomography. 13 (4): 567-71. doi:10.1097/00004728-198907000-00003 - Pubmed
6. Castillo M, Scatliff JH, Kwock L, Green JJ, Suzuki K, Chancellor K, Smith JK. Postmortem MR imaging of lobar cerebral infarction with pathologic and in vivo correlation. (1996) Radiographics : a review publication of the Radiological Society of North America, Inc. 16 (2): 241-50. doi:10.1148/radiographics.16.2.8966284 - Pubmed
7. Hornig CR, Busse O, Buettner T, Dorndorf W, Agnoli A, Akengin Z. CT contrast enhancement on brain scans and blood-CSF barrier disturbances in cerebral ischemic infarction. (1985) Stroke. 16 (2): 268-73. doi:10.1161/01.str.16.2.268 - Pubmed
8. Buonanno FS, Moody DM, Ball MR, Laster DW. Computed cranial tomographic findings in cerebral sinovenous occlusion. (1978) Journal of computer assisted tomography. 2 (3): 281-90. doi:10.1097/00004728-197807000-00008 - Pubmed
9. Rao KC, Knipp HC, Wagner EJ. Computed tomographic findings in cerebral sinus and venous thrombosis. (1981) Radiology. 140 (2): 391-8. doi:10.1148/radiology.140.2.7255715 - Pubmed
10. Renowden S. Cerebral venous sinus thrombosis. (2004) European radiology. 14 (2): 215-26. doi:10.1007/s00330-003-2021-6 - Pubmed
11. Silverstein AM, Alexander JA. Acute postictal cerebral imaging. (1998) AJNR. American journal of neuroradiology. 19 (8): 1485-8. Pubmed
12. Dillon W, Brant-Zawadzki M, Sherry RG. Transient computed tomographic abnormalities after focal seizures. (1984) AJNR. American journal of neuroradiology. 5 (1): 107-9. Pubmed
13. Jinkins JR. Focal tuberculous cerebritis. (1988) AJNR. American journal of neuroradiology. 9 (1): 121-4. Pubmed
14. Bargalló N, Burrel M, Berenguer J, Cofan F, Buñesch L, Mercader JM. Cortical laminar necrosis caused by immunosuppressive therapy and chemotherapy. (2000) AJNR. American journal of neuroradiology. 21 (3): 479-84. Pubmed
15. Liang Y, Scott TF. Migrainous infarction with appearance of laminar necrosis on MRI. (2007) Clinical neurology and neurosurgery. 109 (7): 592-6. doi:10.1016/j.clineuro.2007.04.005 - Pubmed
16. Khardenavis V, Karthik DK, Kulkarni S, Deshpande A. Cortical laminar necrosis in a case of migrainous cerebral infarction. (2018) BMJ case reports. doi:10.1136/bcr-2017-221483 - Pubmed
17. Sharma SR, Massaraf H, Das S, Kalita A. Cortical Laminar Necrosis as a Presenting Manifestation of Migraine in an Apparently Normal Patient: A Rare Case Report. (2019) Journal of neurosciences in rural practice. 10 (3): 559-562. doi:10.1055/s-0039-1698009 - Pubmed
18. Arboix A, González-Peris S, Grivé E, Sánchez MJ, Comes E. Cortical laminar necrosis related to migrainous cerebral infarction. (2013) World journal of clinical cases. 1 (8): 256-9. doi:10.12998/wjcc.v1.i8.256 - Pubmed
19. Tee TY, Khoo CS, Raymond AA, Syazarina SO. Teaching NeuroImages: Neuroimaging in hemiplegic migraine. (2019) Neurology. 93 (6): e626-e627. doi:10.1212/WNL.0000000000007905 - Pubmed
20. Cha YH, Millett D, Kane M, Jen J, Baloh R. Adult-onset hemiplegic migraine with cortical enhancement and oedema. (2007) Cephalalgia : an international journal of headache. 27 (10): 1166-70. doi:10.1111/j.1468-2982.2007.01369.x - Pubmed
21. Black DF, Bartleson JD, Bell ML, Lachance DH. SMART: stroke-like migraine attacks after radiation therapy. (2006) Cephalalgia : an international journal of headache. 26 (9): 1137-42. doi:10.1111/j.1468-2982.2006.01184.x - Pubmed
22. Kerklaan JP, Lycklama á Nijeholt GJ, Wiggenraad RG, Berghuis B, Postma TJ, Taphoorn MJ. SMART syndrome: a late reversible complication after radiation therapy for brain tumours. (2011) Journal of neurology. 258 (6): 1098-104. doi:10.1007/s00415-010-5892-x - Pubmed
23. Maloney PR, Rabinstein AA, Daniels DJ, Link MJ. Surgically induced SMART syndrome: case report and review of the literature. (2014) World neurosurgery. 82 (1-2): 240.e7-12. doi:10.1016/j.wneu.2013.01.028 - Pubmed
24. McKinney AM, Short J, Truwit CL, McKinney ZJ, Kozak OS, SantaCruz KS, Teksam M. Posterior reversible encephalopathy syndrome: incidence of atypical regions of involvement and imaging findings. (2007) AJR. American journal of roentgenology. 189 (4): 904-12. doi:10.2214/AJR.07.2024 - Pubmed
25. Lamy C, Oppenheim C, Méder JF, Mas JL. Neuroimaging in Posterior Reversible Encephalopathy Syndrome. (2004) Journal of Neuroimaging. 14 (2): 89. doi:10.1111/j.1552-6569.2004.tb00223.x
26. Crain MR, Yuh WT, Greene GM, Loes DJ, Ryals TJ, Sato Y, Hart MN. Cerebral ischemia: evaluation with contrast-enhanced MR imaging. (1991) AJNR. American journal of neuroradiology. 12 (4): 631-9. Pubmed
27. Allen LM, Hasso AN, Handwerker J, Farid H. Sequence-specific MR imaging findings that are useful in dating ischemic stroke. (2012) Radiographics : a review publication of the Radiological Society of North America, Inc. 32 (5): 1285-97; discussion 1297-9. doi:10.1148/rg.325115760 - Pubmed