Abstract
Tumefactive demyelinating lesions (TDLs) are often misdiagnosed as brain tumors. To identify imaging characteristics of TDLs for their proper diagnosis, their differences from malignant gliomas, etc., were investigated based on 3-Tesla magnetic resonance imaging (MRI) and MR spectroscopy data that was obtained from 5 patients diagnosed with TDLs in our hospital. MfRI displayed a paraventricular lesion with a maximum diameter of ≥2 cm. Diffusion-weighted imaging (DWI) displayed a region of bright signal intensity at the margin of the lesion, and apparent diffusion coefficient (ADC) imaging displayed high signal intensity at the core of the lesion. The mass effect was mild relative to the size of the lesion, and the edema around the lesion was mild to moderate. Gadolinium-enhanced MRI displayed a characteristic open-ring sign, in which the ring of enhancement was incomplete (open towards the cortex), with the medullary vein running through the lesion, resulting in the enhancement of the surrounding area. MR spectroscopy displayed an increase in the choline peak, a decrease in the N-acetyl aspartate (NAA) peak, the presence of lactate/lipid peaks, and the presence of β, γ-glutamate-glutamine (GLX) peaks that are slightly shifted to a higher resonance frequency (2.1 - 2.4 ppm) from the NAA peak. Taken together, the following main characteristics were identified as imaging features of TDLs: bright rim on DWI, a high signal core on ADC imaging, an open-ring sign, and β, γ-GLX peaks on proton MR spectroscopy. We concluded that the key to the improvement of neurological symptoms of patients is the prompt initiation of steroid treatment following the accurate diagnosis of TDLs.
Highlights
Patients with neurological symptoms whose diagnosis and subsequent choice of treatment are difficult due to theHow to cite this paper: Akimoto, J., Suda, T., Hashimoto, R., Fukuhara, H. and Kohno, M. (2015) Magnetic Resonance Imaging Characteristics of Tumefactive Demyelinating Lesions
We aimed to identify the imaging characteristics of tumefactive demyelinating lesions (TDLs), which are crucial for its accurate diagnosis, as well as for the differential diagnosis of pseudo-tumor diseases [1]-[4]
Contrast-enhanced magnetic resonance imaging (MRI) showed irregular contrast enhancement that appeared to delineate the border of the surrounding area of the lesion
Summary
Patients with neurological symptoms whose diagnosis and subsequent choice of treatment are difficult due to theHow to cite this paper: Akimoto, J., Suda, T., Hashimoto, R., Fukuhara, H. and Kohno, M. (2015) Magnetic Resonance Imaging Characteristics of Tumefactive Demyelinating Lesions. Patients with neurological symptoms whose diagnosis and subsequent choice of treatment are difficult due to the. (2015) Magnetic Resonance Imaging Characteristics of Tumefactive Demyelinating Lesions. The differential diagnosis made by the attending physician is crucial for the accurate diagnosis of and to provide appropriate treatment to patients displaying atypical imaging features. We recently encountered 5 patients who were referred to our hospital with a diagnosis of malignant glioma, but were diagnosed as having tumefactive demyelinating lesions (TDLs). We aimed to identify the imaging characteristics of TDLs, which are crucial for its accurate diagnosis, as well as for the differential diagnosis of pseudo-tumor diseases [1]-[4]
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