Clinical Efficacy of Multiparametric Magnetic Resonance Imaging and Proton Spectroscopy in the Evaluation of Complex Ring-Enhancing Intracranial Lesions: A Four-Case Series from Pacific International Hospital, Papua New Guinea

Abstract Background: Ring-enhancing lesions (RELs) remain a persistent diagnostic challenge in neuroradiology, as neoplastic, infectious, and granulomatous processes frequently overlap in their conventional MRI appearance. Accurate differentiation is critical for guiding management, particularly in resource-limited settings such as Papua New Guinea (PNG), where access to advanced neuroimaging is concentrated in a few centers and specialist manpower is limited. Study setting and design: This retrospective case series was conducted at Pacific International Hospital (PIH), Port Moresby, PNG, over four months (June–September 2026). Four brain MRI cases were included: three presenting as ring-enhancing masses, and one miscellaneous nerve sheath tumour at the craniocervical junction and C1–C2 level.