On a contrasted CT scan and MRI scan,  this phenomenon of luxury perfusion is perceived as an area of enhancement at the margin of the infarct, with a gyriform pattern or in the deep parenchyma. This can have a confused and bizarre appearance, mimicking tumors, and be misinterpreted as contrast uptake from a malignant tumor, especially so if prior knowledge of the infarct is not known and in younger patients.

Primary and secondary brain tumors can imitate luxury perfusion because of their contrast enhancement. The main difference is the nodular and ring-like enhancing pattern in case of tumors and the gyral pattern in case of luxury perfusion. Vasogenic edema in tumors and cytotoxic edema in ischemia should not be overlooked.

Also, in case of ischemia, enhancement is generally seen at a stage where much of the mass effect is resolving. An enhancing lesion with mass effect and midline shift is more likely a tumor.

Another important differential diagnostic is cortical laminar necrosis and mineralization. Cortical laminar necrosis is a permanent brain injury that typically develops two weeks after ischemia. Histopathologically, it is a pannecrosis of specific layers of the cerebral neocortex caused by vulnerability to hypoxia and metabolic disturbances.

 It is usually seen in the subacute stage of the infarct on a CT head without contrast enhancement illustrating a gyral pattern hyperdensity, superimposed on a hypodense ischemic lesion. It is important to not confuse this pattern with hemorrhagic transformation.

Cortical mineralization is usually seen in the chronic stage of ischemia, appearing as an intense gyral hyperdensity mimicking calcification.