Metabolite findings in tumefactive demyelinating lesions utilizing short echo. Mri is the method of choice for imaging demyelination lesions, tumefactive or not. Seeing demyelination on mri dr garys multiple sclerosis. We therefore set out to assess the contribution of repeated conventional magnetic resonance imaging mri, 1 hmr spectroscopy and magnetization transfer imaging in establishing a correct diagnosis of tumefactive demyelinating lesions tdls. Adrenoleukodystrophy can mimick tumorlike demyelination clinically and on ct mri. Proton magnetic resonance spectroscopy differentiates. A tumefactive multiple sclerosis lesion in the brain. Saindane am, soonmee c, meng l, xiaonan x, knopp ea, zagzag d. This case report highlights important diagnostic clues in the differential.
Proton mr spectroscopy of tumefactive demyelinating. Dec 09, 2015 imaging of demyelinating diseases final 1. Tumefactive demyelinating tdl lesions are focal zones of demyelination in the central nervous system and they often mimic the neuroimaging features of an intraxial neoplasm. As the underlying pathophysiology of neoplasms is different from that of demyelinating disease, one may expect the metabolic composition of neoplasms to be significantly different. Learn more about types of demyelination and why it happens. Imaging of demyelinating diseases final linkedin slideshare.
Inflammatory demyelinating disease mimicking malignant glioma. Background multiple sclerosis ms is a chronic inflammatory disease of the central nervous system in which there is focal demyelination. Objective to investigate the utility of proton magnetic resonance spectroscopy mrs in differentiating tdls from gliomas. Rk gupta br lufkin, eds, mr imaging and spectroscopy of central nervous system. Illustrate the role of multimodal mri with a focus on spectroscopy, diffusion and perfusion imaging to increase diagnostic confidence. Conventional and advanced magnetic resonance imaging in tumefactive demyelination jitender saini, somenath chatterjee, bejoy thomas, and chandrasekharan kesavadas acta radiologica 2011 52. Tumefactive demyelinating lesions are a rare manifestation of multiple sclerosis ms. This is the best way to tell what the severity of the demyelination is, what the.
Hmrs and conventional magnetic resonance imaging mri. Proton mr spectroscopy and 201 tl spect showed findings supportive of the diagnosis of malignant glioma in all cases. Certain features on standard as well as advanced mri can potentially promote the diagnosis of tumefactive demyelination and obviate the need for biopsy. Tumefactive demyelinating lesion radiology reference.
It plays a part in several chronic conditions, including multiple sclerosis. Tumefactive demyelinating lesions prove to be a diagnostic dilemma to neurosurgeons, radiologists, and pathologists. Magnetic resonance imaging mri is a medical imaging technique used in radiology to visualize internal structures of the body in detail. An uncommon site with atypical magnetic resonance image findings journal of the korean society of radiology, vol. Tumefactive demyelinating lesions on conventional mri may be. To investigate the utility of proton magnetic resonance spectroscopy mrs in differentiating tdls from gliomas. Utility of proton mr spectroscopy for differentiating typical and atypical primary. Tumefactive multiple sclerosis requiring emergent biopsy and. Tumefactive multiple sclerosis is a condition in which the central nervous system of a person has multiple demyelinating lesions with atypical characteristics for those of standard multiple sclerosis ms. Mri is the most useful tool available, showing some characteristics like the incomplete ring enhancement pattern, very specific to demyelination.
It is often difficult to accurately differentiate tumefactive demyelinating lesions tdls from gliomas using mri. Metabolite findings in tumefactive demyelinating lesions. All spectra were obtained by using the automatic mr spectroscopy software with spinecho technique, tr 1500 msec, 1024 point acquisition, hz bandwidth. Lowgrade glioma and reactive gliosis were among the likely differential diagnoses. Patients who have abnormal evoked responses are more likely to harbor a demyelinating lesion. On advanced mr imaging, tumefactive demyelinating lesions showed. Distinguishing tumefactive demyelinating lesions from. Tumefactive demyelination is a demyelinating condition considered as intermediate between multiple sclerosis and acute demyelinating encephalomyelitis. Oct 01, 2006 31 bitsch a, bruhn h, vougioukas v, et al. White matter lesions may be demyelinating with loss of normally formed myelin.
Proton mr spectroscopy of tumefactive demyelinating lesions. The international magnetic resonance imaging in ms collaboration categorizes the different mri appearances of tumefactive demyelination. Mri makes use of the property of nuclear magnetic resonance nmr to image nuclei of atoms inside the body. Tumefactive demyelinating lesion tdl, also sometimes referred to as monofocal acute inflammatory demyelination maid, is a locally aggressive form of demyelination, usually manifesting as a solitary lesion or sometimes a couple of lesions greater than 2 cm that may mimic a neoplasm on imaging. Given the age of the patient, the diagnosis was confirmed with a biopsy. Magnetic resonance imaging and spectroscopic imaging. Pitfalls in the diagnosis of a tumefactive demyelinating. Demyelination in the central nervous system sometimes presents with large pseudotumoral lesions mimicking brain neoplasm. Tumefactive demyelinating lesion, a variant of multiple sclerosis, is a solitary large. Accurate diagnosis of tumefactive demyelinating lesions is. Programs in chemistry and biochemistry, the graduate center of the city. Although the gray matter primarily contains neurons and their processes, the. The mri appearance of these lesions can aid in preoperative diagnosis and assist with the final pathologic interpretation, potentially sparing the patient unnecessary and possibly debilitating procedures and therapies.
Mr imaging initially revealed parenchymal mass lesions. Actually, the diagnostic conundrum has more to do with separating tumefactive demyelination from neoplasm and infection. Metabolite findings in tumefactive demyelinating lesions utilizing short echo time proton magnetic resonance spectroscopy. Mr spectroscopy evaluation of white matter signal abnormalities of. Tumefactive demyelinating lesions have been misinterpreted as gliomas, with the correct diagnosis being revealed only after histologic evaluation 2, 3. Mri showed a mass lesion with prolonged t1 and t2 values and gadolinium enhancement in all cases. Request pdf characterization of tumefactive demyelinating lesions using mr imaging and invivo proton mr spectroscopy diagnosis of tumefactive. It is important for medical professionals and patients to know that seeing demyelination on mri scans is the only way to properly identify it and see what parts of the body it is affecting. This is the best way to tell what the severity of the demyelination is, what the demyelination could be caused by, and what disease the demyelination could. Distinguishing tumefactive demyelinating lesions from glioma. Tumefactive multiple sclerosis is a demyelinating disease that demonstrates tumorlike features on magnetic resonance imaging.
Although the usual appearance of ms is that of multiple, small, demyelinating plaques, in some cases, it can simulate a mass lesion, which it would be hard to distinguish from a brain tumor 2. Our aim was to evaluate the efficacy of mr spectroscopy in characterization of. Mass effect and contrast enhancement on neuroimaging make it difficult to distinguish this type of lesion from highgrade gliomas. Mr imaging of the brain was obtained in 4 patients who presented clinically with focal neurologic deficits. Proton magnetic resonance spectroscopy and diffusion. Spectrum of disease, diagnosis and treatment article pdf available in current neurobiology 0701 january 2016 with 1,001 reads how we measure reads. Proton mr spectroscopy has been applied in assessing various intracranial diseases and is increasingly used in diagnosis and clinical management. Tumefactive multiple sclerosis is a rare form of multiple sclerosis ms. Clinical and radiological characteristics of tumefactive demyelinating. Differential diagnosis of such space occupying lesions may not be straightforward and sometimes necessitate brain biopsy. Proton magnetic resonance spectroscopy of focal intracranial. Oct 01, 2019 demyelination is damage to the myelin sheath around nerves. This method is reliable because mris assess changes in proton density. Advanced mr imaging techniques in the diagnosis of intraaxial.
Myelin and white matter the gray and white matter of the central nervous system cns differ not only in gross morphology but also in water content and macromolecular components, notably membrane lipids. Tumefactive demyelinating lesion tdl is defined as a solitary demyelinating lesion greater than 2 cm. In this report we describe the clinical, neuroimaging and neuropathological features of six cases of tdl. Create a file for external citation management software. The patient underwent a diagnostic stereotactic brain biopsy.
Conventional and advanced magnetic resonance imaging in. Jan 27, 2009 when a single large or multiple small tumefactive demyelinating lesions are present, the correct presurgical diagnosis is often difficult, as the mri appearance, comprising enhanced t1weighted images, t2weighted images, and even proton mr spectroscopy, is not specific for these lesions. Conventional mr imaging findings may help differentiate tumefactive demyelinating lesions. Characterization of tumefactive demyelinating lesions using mr. Description of a tumefactive demyelinating lesion studied with advanced. Although diagnostic challenges without biopsy have been tried by employing radiological studies and cerebrospinal fluid examinations, histological investigation is still necessary for certain diagnosis in some complicated cases. Mri is often sufficient to make a diagnosis of tumefactive demyelination and the results of biopsy can be inconclusive or misleading. Not all commercial mrs postprocessing software used in clinical practice. Spectroscopic magnetic resonance imaging of a tumefactive. To use mr spectroscopy to aid in the diagnosis of demyelinating disease and to help differentiate tumefactive demyelinating lesions from neoplastic processes.
Jan 10, 2016 whether tumefactive demyelination is another manifestation of ms or represents a distinct entity is apparently a matter of contention. Clinical pitfalls related to short and long echo times in cerebral mr. It is called tumefactive as the lesions are tumorlike and they mimic tumors clinically, radiologically and sometimes pathologically. Impaired cognition is the second most common clinical manifestation of tumefactive ms. However, surgical biopsy revealed inflammatory demyelinating disease. We report a patient with a spaceoccupying lesion in the parietal lobe, which presented a serious diagnostic dilemma, between a rare tumefactive demyelinating disease, such as balo concentric sclerosis and a glioma. In rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors.
Magnetic resonance imaging scans showed a large right frontal mass with surrounding edema and a mild midline shift fig. The mri appearance of tumefactive demyelinating lesions. Demyelination is something that occurs in several different diseases. Ms is a disabling and progressive disease that affects the central nervous system. Whether tumefactive demyelination constitutes a disease variant within the broad spectrum of multiple sclerosis or rather depicts a different entity is still matter of debate. Thus, the preoperative diagnosis, or at least consideration, of a demyelinating process is imperative to avoid unnecessary resection or adjunctive therapy 2. Additional white matter lesions are present in 85% of patients with td and these may be reassuring if their distribution is typical for ms and if the tumefactive lesions have radiological characteristics in.
It is defined as demyelinating plaques 2 cm in diameter. We report a case of tumefactive demyelinating lesion tdl diagnosed using 1hmagnetic resonance spectroscopy. This is a good example of tumefactive demyelination with the typical advancing edge of enhancement. Functional mri sequences such as perfusion or spectroscopy are increasingly used and provide valuable information that can narrow the differential diagnosis. Tsanaclis abstract five patients with a tumefactive lesion were clinically followed from 1992 to 1993. Our purpose was to determine if multivoxel proton mr spectroscopy can be. Proton mr spectroscopy has been increasingly used to characterize intracranial pathology. Another mri brain was performed along with proton mr spectroscopy. Tumefactive demyelinating lesions can present with features similar, clinically and radiologically, to those of brain tumours. We studied two females and one male, who presented with tdls that led to brain biopsy in two cases, for.
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