Premium
Characteristic Neuroimaging in Patients with Tumefactive Demyelinating Lesions Exceeding 30 mm
Author(s) -
Kiriyama Takao,
Kataoka Hiroshi,
Taoka Toshiaki,
Tonomura Yasuyo,
Terashima Mari,
Morikawa Masami,
Tanizawa Emi,
Kawahara Makoto,
Furiya Yoshiko,
Sugie Kazuma,
Kichikawa Kimihiko,
Ueno Satoshi
Publication year - 2011
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2010.00502.x
Subject(s) - medicine , multiple sclerosis , magnetic resonance imaging , radiology , neuroimaging , differential diagnosis , lesion , angiography , radiological weapon , edema , nuclear medicine , pathology , surgery , psychiatry
BACKGROUND AND PURPOSE Features of tumefactive demyelinating lesion (TDL) on magnetic resonance imaging (MRI) can facilitate the differential diagnosis of TDL and neoplastic lesions, but vary considerably among patients. The larger TDL grows, the more difficult it becomes to differentiate TDL from neoplastic lesions. The purpose of this study was to elucidate typical MRI features in 12 patients with large TDL (>30 mm in diameter).METHODS We identified 12 patients with large TDL (six men, six women; age range 17‐64 years, median age 27 years) and studied the clinical histories and the results of laboratory and various radiological studies in these patients. All cases of clinically definite multiple sclerosis were diagnosed in accordance with McDonald's revised criteria.RESULTS Common MRI features of large TDLs included variable degrees of mass effect (71%) and edema (100%), a T2 hypointense rim (79%), venular enhancement (57%), and peripheral restriction on diffusion‐weighted images (50%). Ring enhancement (38%), open‐ring enhancement (31%), or decreased N‐acetylaspartate ratios on magnetic resonance spectroscopy (22%) were less frequently observed. Brain angiography demonstrated venous dilatations on and around the TDL.CONCLUSIONS The diagnosis of large TDL is challenging. Our findings suggest that multiple venous dilatations on and around TDLs on angiography can facilitate diagnosis.