On T1-weighted images, epidermoids are generally slightly hyperintense or isointense relative to gray matter. The lesions are usually isointense relative to CSF on T2-weighted images, but they may be slightly hyperintense. The center of these lesions usually has an internal architecture with areas of heterogeneity. Enhancement of portions of the rim may be seen after the administration of contrast material. The remainder of the lesion does not enhance. Diffusion-weighted imaging can now be used for these lesions epidermoids have markedly restricted diffusion and, therefore, high signal intensity on the diffusion-weighted trace images.
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