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Magnetic Resonance Imaging Characteristics of tumefactive Demyelinating Lesions

Journal of Biomedical Science and Engineering 2015年第5期8卷 321-326页

作者： Jiro Akimoto Tomohiro Suda Ryo Hashimoto Hirokazu Fukuhara Michihiro Kohno Department of Neurosurgery Tokyo Medical University Tokyo Japan

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.

关键词： tumefactive Demyelinating Lesions Open-Ring Sign MRI MR Spectroscopy

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Variant of multiple sclerosis with dementia and tumefactive demyelinating brain lesions

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World Journal of Clinical Cases 2015年第6期3卷 525-532页

作者： Sherifa A Hamed Department of Neurology and Psychiatry Hospital of Neurology and Psychiatry Assiut University Hospital

We describe an unusual clinical and diagnostic featureof a patient with multiple sclerosis(MS). A 25-yearold woman was admitted to the Neurology department(December 2009) with one month history of rapid cognitive deterioration. She had poor cognition, dysphasia, reduction in visual acuity and temporal pallor of the optic discs. She had prolonged latencies of P100 component of visual evoked potentials(VEPs). Magnetic resonance imaging(MRI)-brain showed multifocal large(≥ 3 cm) white-matter hypointense lesions in T1 W and hyperintense in T2 W and fluid-attenuated inversion recovery images and patchy enhancement. A diagnosis of tumefactive MS was given. She received two consecutive 5-d courses of 1 g daily intravenous methylprednisolone for 2 mo and oral prednisolone in dose of 80 mg twice/daily in between. At the 3rd month, Mini Mental State Examination and VEPs returned to normal but not the MRI. Patient continued oral steroids after hospital discharge(March 2010) for 9 mo with significant MRI improvement after which tapering of steroids started for a year. The patient refused immunomodulation therapy due to her low socioeconomic status. Neither clinical relapse nor new MRI lesions were observed throughout the next 4 years. In spite of the aggressive course of tumefactive MS variant, good prognosis may be seen in some patients.

关键词： tumefactive multiple sclerosis Acute dementia

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