Comparison of tumefactive demyelinating lesions and glioma by clinical presentations and neuroimaging studies

Abstract

To explore the clinical and imaging features of tumefactive demyelinating lesions (TDL) and glioma. The brain computed tomography (CT), magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H-MRS) features of 60 pathologically confirmed TDL patients and 65 glioma ones, hospitalized at Navy General Hospital from 2005 to 2013, were reviewed and analyzed. The mean onset age of glioma was significantly older than that of TDL. The onset symptom was headache for TDL and headache and epilepsy for glioma. The features of lesions on brain CT scan: no hyperdensity in TDL group and 39 with hyperdense lesions in glioma group. Tissue necrosis was more frequently found in lesions of glioma than TDL, especially for higher grade glioma. And increased β and γ-Glx on (1)H-MRS was most frequently found in TDL. The onset age of glioma is older than TDL. The headache is the top onset symptoms of TDL and epiplesy occurs frequently only in glioma. The hyperdense lesions on CT scan support more the diagnosis of glioma. The lesions with tissue necrosis may be a diagnostic clue for high grade glioma. On (1)H-MRS, increased β and γ-Glx are most frequently found in TDL. Dynamic observation of imaging changes may be more important for facilitating the diagnosis of TDL, especially in conjunctions with imaging characteristics and clinical features.