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Martinez JA, Yu VY, Tringale KR, Otazo R, Cohen O. Phase-sensitive deep reconstruction method for rapid multiparametric MR fingerprinting and quantitative susceptibility mapping in the brain. Magn Reson Imaging 2024; 109:147-157. [PMID: 38513790 PMCID: PMC11042874 DOI: 10.1016/j.mri.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION This study explores the potential of Magnetic Resonance Fingerprinting (MRF) with a novel Phase-Sensitivity Deep Reconstruction Network (PS-DRONE) for simultaneous quantification of T1, T2, Proton Density, B1+, phase and quantitative susceptibility mapping (QSM). METHODS Data were acquired at 3 T in vitro and in vivo using an optimized EPI-based MRF sequence. Phantom experiments were conducted using a standardized phantom for T1 and T2 maps and a custom-made agar-based gadolinium phantom for B1 and QSM maps. In vivo experiments included five healthy volunteers and one patient diagnosed with brain metastasis. PSDRONE maps were compared to reference maps obtained through standard imaging sequences. RESULTS Total scan time was 2 min for 32 slices and a resolution of [1 mm, 1 mm, 4.5 mm]. The reconstruction of T1, T2, Proton Density, B1+ and phase maps were reconstructed within 1 s. In the phantoms, PS-DRONE analysis presented accurate and strongly correlated T1 and T2 maps (r = 0.99) compared to the reference maps. B1 maps from PS-DRONE showed slightly higher values, though still correlated (r = 0.6) with the reference. QSM values showed a small bias but were strongly correlated (r = 0.99) with reference data. In the in vivo analysis, PS-DRONE-derived T1 and T2 values for gray and white matter matched reference values in healthy volunteers. PS-DRONE B1 and QSM maps showed strong correlations with reference values. CONCLUSION The PS-DRONE network enables concurrent acquisition of T1, T2, PD, B1+, phase and QSM maps, within 2 min of acquisition time and 1 s of reconstruction time.
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Affiliation(s)
- Jessica A Martinez
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York 10065, NY, USA.
| | - Victoria Y Yu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York 10065, NY, USA
| | - Kathryn R Tringale
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York 10065, NY, USA
| | - Ricardo Otazo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York 10065, NY, USA
| | - Ouri Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York 10065, NY, USA
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2
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Zhang Y, Zhang T, Zhang X, Yan X, Lei J, Liu R, Yang Y, Zhang C, Zhang J, Zhang Y, Yue W. Clinical spectrum and prognosis of pathologically confirmed atypical tumefactive demyelinating lesions. Sci Rep 2023; 13:7773. [PMID: 37179394 PMCID: PMC10183015 DOI: 10.1038/s41598-023-34420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
To describe the clinical spectrum and prognosis of atypical tumefactive demyelinating lesions (TDLs), which were confirmed by pathology. A total of 11 patients were diagnosed with atypical TDLs confirmed by brain biopsy and surgery between January 2006 and December 2017. The clinical spectrum and prognosis in these patients were analyzed. The patients' ages ranged from 29 to 62 years, with a mean age of 48.9 years; 72.7% were males. The Expanded Disability Status Scale (EDSS) of the patients with first onset was 2.36. Most of the patients started with limb numbness and weakness (45.5%) or alalia (27.2%). The mean time from symptom onset to biopsy or surgery was 12.9 days (3-30 days). Most of the patients had solitary lesions (72.7%), supratentorial lesions (90.9%, particularly predominant in the frontal, temporal, and parietal lobes), moderate edema (63.6%), mild mass effect (54.5%), and patchy lesions (54.5%). Among them, three patients were positive for myelin basic protein (MBP) and one patient was positive for myelin oligodendrocyte glycoprotein (MOG). The patients were followed up for an average of 6.9 years (2-14 years), and recurrent TDLs were observed in 2 patients. Except for the 2 patients who relapsed, only 1 of the 9 patients died; the other 8 patients improved or maintained the status quo (the EDSS scores were lower or unchanged). The patients did not have any serious nervous system injury at onset, and the main presentation included extremity weakness, headache or dizziness, and alalia. The most common form was patchy on MRI enhancement. Cerebrospinal fluid and demyelination test can be an indicator of TDLs, and seizures may be a poor prognostic indicator. Most atypical TDLs have monophasic courses and good outcomes. The effect of neurosurgery alone was good in our group, and the effect of surgery on atypical TDLs can be further studied.
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Affiliation(s)
- Yajing Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Ting Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Xuebin Zhang
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiaoling Yan
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin, China
| | - Jing Lei
- Imaging Department, Tianjin Huanhu Hospital, Tianjin, China
| | - Ran Liu
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Yun Yang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Chao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Jun Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Ying Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China.
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Proton MR Spectroscopy of Pediatric Brain Disorders. Diagnostics (Basel) 2022; 12:diagnostics12061462. [PMID: 35741272 PMCID: PMC9222059 DOI: 10.3390/diagnostics12061462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
In vivo MR spectroscopy is a non -invasive methodology that provides information about the biochemistry of tissues. It is available as a “push-button” application on state-of-the-art clinical MR scanners. MR spectroscopy has been used to study various brain diseases including tumors, stroke, trauma, degenerative disorders, epilepsy/seizures, inborn errors, neuropsychiatric disorders, and others. The purpose of this review is to provide an overview of MR spectroscopy findings in the pediatric population and its clinical use.
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Neurosurgical Mimics. Neurol Clin 2022; 40:455-469. [DOI: 10.1016/j.ncl.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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5
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Sánchez P, Chan F, Hardy TA. Tumefactive demyelination: updated perspectives on diagnosis and management. Expert Rev Neurother 2021; 21:1005-1017. [PMID: 34424129 DOI: 10.1080/14737175.2021.1971077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tumefactive demyelination (TD) can be a challenging scenario for clinicians due to difficulties distinguishing it from other conditions, such as neoplasm or infection; or with managing the consequences of acute lesions, and then deciding upon the most appropriate longer term treatment strategy. AREAS COVERED The authors review the literature regarding TD covering its clinic-radiological features, association with multiple sclerosis (MS), and its differential diagnosis with other neuroinflammatory and non-inflammatory mimicking disorders with an emphasis on atypical forms of demyelination including acute disseminated encephalomyelitis (ADEM), MOG antibody-associated demyelination (MOGAD) and neuromyelitis spectrum disorders (NMOSD). We also review the latest in the acute and long-term treatment of TD. EXPERT OPINION It is important that the underlying cause of TD be determined whenever possible to guide the management approach which differs between different demyelinating and other inflammatory conditions. Improved neuroimaging and advances in serum and CSF biomarkers should one day allow early and accurate diagnosis of TD leading to better outcomes for patients.
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Affiliation(s)
- Pedro Sánchez
- Department of Neurology, Alexianer St. Josefs-Krankenhaus, Potsdam, Germany
| | - Fiona Chan
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia.,Brain & Mind Centre, University of Sydney, Nsw, Australia
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6
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Kahovec C, Saini A, Levin MC. Diagnostic Dilemma: An Atypical Case of Astrocytoma in a Patient with Relapsing-Remitting Multiple Sclerosis. Neurol Int 2021; 13:240-251. [PMID: 34204935 PMCID: PMC8293366 DOI: 10.3390/neurolint13020025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Distinguishing between tumefactive demyelinating lesions (TDLs) and brain tumors in multiple sclerosis (MS) can be challenging. A progressive course is highly common with brain tumors in MS and no single neuroimaging technique is foolproof when distinguishing between the two. We report a case of a 41-year-old female with relapsing–remitting multiple sclerosis, who had a suspicious lesion within the left frontal hemisphere, without a progressive course. The patient experienced paresthesias primarily to her right hand but remained stable without any functional decline and new neurological symptoms over the four years she was followed. The lesion was followed with brain magnetic resonance imaging (MRI) scans, positron emission tomography–computed tomography scans, and magnetic resonance spectroscopy. Together, these scans favored the diagnosis of a TDL, but a low-grade tumor was difficult to rule out. Examination of serial brain MRI scans showed an enlarging lesion in the left middle frontal gyrus involving the deep white matter. Neurosurgery was consulted and an elective left frontal awake craniotomy was performed. Histopathology revealed a grade II astrocytoma. This case emphasizes the importance of thorough and continuous evaluation of atypical MRI lesions in MS and contributes important features to the literature for timely diagnosis and treatment of similar cases.
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Affiliation(s)
- Chantal Kahovec
- Saskatoon Multiple Sclerosis Clinic, Saskatchewan Health Authority, Saskatoon, SK S7K 0M7, Canada;
| | - Aman Saini
- Office of the Saskatchewan Multiple Sclerosis Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatoon, SK S7K 0M7, Canada;
| | - Michael C. Levin
- Saskatoon Multiple Sclerosis Clinic, Saskatchewan Health Authority, Saskatoon, SK S7K 0M7, Canada;
- Office of the Saskatchewan Multiple Sclerosis Clinical Research Chair, College of Medicine, University of Saskatchewan, Saskatoon, SK S7K 0M7, Canada;
- Department of Medicine, Neurology Division, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 0X8, Canada
- Department of Anatomy, Physiology and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
- Correspondence: ; Tel.: +1-(306)-655-8350
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Abstract
OBJECTIVE. Tumefactive demyelination mimics primary brain neoplasms on imaging, often necessitating brain biopsy. This article reviews the literature for the clinical and radiologic findings of tumefactive demyelination in various disease processes to facilitate identification of tumefactive demyelination on imaging. CONCLUSION. Both clinical and radiologic findings must be integrated to distinguish tumefactive demyelinating lesions from similarly appearing lesions on imaging. Further research on the immunopathogenesis of tumefactive demyelination and associated conditions will elucidate their interrelationship.
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Xie N, Sun Q, Yang J, Zhou Y, Xu H, Zhou L, Zhou Y. High clinical heterogeneity in a Chinese pedigree of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S). Orphanet J Rare Dis 2021; 16:56. [PMID: 33516249 PMCID: PMC7847589 DOI: 10.1186/s13023-021-01712-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Being a newly defined disease, RVCL-S is underrecognized by clinicians globally. It is an autosomal dominantly inherited small vessel disease caused by the heterozygous C-terminal frameshift mutation in TREX1 gene. RVCL-S is featured by cerebral dysfunction, retinopathy, and vasculopathy in multiple internal organs. Misdiagnosis may cause devastating consequences in patients, such as iatrogenic PML caused by misuse of immunosuppressants. Thus, increasing awareness of this disease is in urgent need. Results We uncovered a large Chinese origin RVCL-S pedigree bearing the TREX1 mutation. A comprehensive characterization combining clinical, genetic, and neuropathological analysis was performed. The Intrafamilial comparison showed highly heterogeneous clinical phenotypes. Mutation carriers in our pedigree presented with retinopathy (8/13), seizures (2/13), increased intracranial pressure (1/13), mild cognitive impairment (3/13), stroke-like episode (3/13), mesenteric ischemia (1/13), nephropathy (9/13), ascites (3/13), hypertension (9/13), hyperlipidemia (3/8), hypoalbuminemia (3/8), normocytic anemia (3/8), subclinical hypothyroidism (1/8), hyperfibrinogenemia (1/8), hyperparathyroidism (2/8), and abnormal inflammatory markers (4/8). The constellation of symptoms is highly varied, making RVCL-S a challenging diagnosis. Comparison with reported RVCL-S pedigrees further revealed that the mesenteric ischemia is a novel clinical finding and the MRS pattern of brain lesions is emulating neoplasm and tumefactive demyelination. Conclusion Our reports characterize a highly heterogeneous RVCL-S pedigree, highlight the probability of misdiagnosis in clinical practice, and broaden the clinical spectrum of RVCL-S.
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Affiliation(s)
- Nina Xie
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Qiying Sun
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Jinxia Yang
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yangjie Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hongwei Xu
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Lin Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China
| | - Yafang Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Changsha, 410078, Hunan, China.
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9
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Di Gregorio M, Torri Clerici VLA, Fenu G, Gaetani L, Gallo A, Cavalla P, Ragonese P, Annovazzi P, Gajofatto A, Prosperini L, Landi D, Nicoletti CG, Di Carmine C, Totaro R, Nociti V, De Fino C, Ferraro D, Tomassini V, Tortorella C, Righini I, Amato MP, Manni A, Paolicelli D, Iaffaldano P, Lanzillo R, Moccia M, Buttari F, Fantozzi R, Cerqua R, Zagaglia S, Farina D, De Luca G, Buscarinu MC, Pinardi F, Cocco E, Gasperini C, Solaro CM, Di Filippo M. Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study. Eur J Neurol 2021; 28:1299-1307. [PMID: 33305459 DOI: 10.1111/ene.14672] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Tumefactive multiple sclerosis (TuMS) (i.e., MS onset presenting with tumefactive demyelinating lesions [TDLs]) is a diagnostic and therapeutic challenge. We performed a multicentre retrospective study to describe the clinical characteristics and the prognostic factors of TuMS. METHODS One hundred two TuMS patients were included in this retrospective study. Demographic, clinical, magnetic resonance imaging (MRI), laboratory data and treatment choices were collected. RESULTS TuMS was found to affect women more than men (female:male: 2.4), with a young adulthood onset (median age: 29.5 years, range: 11-68 years, interquartile range [IQR]: 38 years). At onset, 52% of TuMS patients presented with the involvement of more than one functional system and 24.5% of them with multiple TDLs. TDLs most frequently presented with an infiltrative MRI pattern (38.7%). Cerebrospinal fluid immunoglobulin G oligoclonal bands were often demonstrated (76.6%). In 25.3% of the cases, more than one acute-phase treatment was administered, and almost one-half of the patients (46.6%) were treated with high-efficacy treatments. After a median follow-up of 2.3 years (range: 0.1-10.7 years, IQR: 3.4 years), the median Expanded Disability Status Scale (EDSS) score was 1.5 (range: 0-7, IQR: 2). Independent risk factors for reaching an EDSS score ≥3 were a higher age at onset (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03-1.14, p < 0.01), a higher number of TDLs (OR: 1.67, 95% CI: 1.02-2.74, p < 0.05) and the presence of infiltrative TDLs (OR: 3.34, 95% CI: 1.18-9.5, p < 0.001) at baseline. CONCLUSIONS The management of TuMS might be challenging because of its peculiar characteristics. Large prospective studies could help to define the clinical characteristics and the best treatment algorithms for people with TuMS.
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Affiliation(s)
- Maria Di Gregorio
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy.,Azienda Ospedaliero-Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | - Giuseppe Fenu
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Lorenzo Gaetani
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
| | - Antonio Gallo
- Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Cavalla
- Dipartimento di Neuroscienze e Salute Mentale, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paolo Ragonese
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Pietro Annovazzi
- U.O.C. Centro Sclerosi Multipla, ASST Valle Olona, Varese, Italy
| | - Alberto Gajofatto
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Luca Prosperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Doriana Landi
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Carolina Gabri Nicoletti
- Dipartimento di Medicina dei Sistemi, Università Tor Vergata, Rome, Italy.,U.O.S.D Sclerosi Multipla, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Rocco Totaro
- Centro Malattie Demielinizzanti, Ospedale San Salvatore, L'Aquila, Italy
| | - Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara De Fino
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diana Ferraro
- Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze, Università di Modena e Reggio Emilia, Modena, Italy
| | - Valentina Tomassini
- Institute for Advanced Biomedical Technologies (ITAB), Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.,Division of Psychological Medicine and Clinical Neurosciences, University Hospital of Wales, Cardiff University School of Medicine, Cardiff, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Carla Tortorella
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | - Isabella Righini
- UO Neurologia-Dipartimento di Specialità Mediche- Nuovo Ospedale delle Apuane, Massa, Italy
| | - Maria Pia Amato
- Dipartimento NEUROFARBA, Sezione di Neuroscienze, Università degli Studi di Firenze, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Alessia Manni
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Damiano Paolicelli
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Pietro Iaffaldano
- Dipartimento di Scienze Mediche di base, Neuroscienze ed Organi di Senso, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - Roberta Lanzillo
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy
| | - Marcello Moccia
- Dipartimento di Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, Università degli Studi "Federico II", Naples, Italy.,UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Fabio Buttari
- Unità di Neurologia, IRCCS Neuromed, Pozzilli, Italy
| | | | - Raffaella Cerqua
- Clinica Neurologica, Dipartimento di Medicina Sperimentale e Clinica, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Sara Zagaglia
- Department of Clinical and Experimental Epilepsy, Queen Square, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, UK
| | - Deborah Farina
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giovanna De Luca
- Multiple Sclerosis Centre, Neurology Unit, SS Annunziata University Hospital, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Maria Chiara Buscarinu
- Dipartimento di Neuroscienze, Salute Mentale ed Organi di Senso, Università degli Studi di Roma "LaSapienza", Rome, Italy
| | - Federica Pinardi
- IRCCS Istituto delle scienze neurologiche di Bologna, UOSI riabilitazione SM, Bologna, Italy
| | - Eleonora Cocco
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.,Centro Regionale Sclerosi Multipla, ASSL Cagliari, ATS Sardegna, Cagliari, Italy
| | - Claudio Gasperini
- Dipartimento di Neuroscienze, Ospedale San Camillo-Forlanini, Rome, Italy
| | | | - Massimiliano Di Filippo
- Clinica Neurologica, Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italy
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Differentiation of multiple sclerosis lesions and low-grade brain tumors on MRS data: machine learning approaches. Neurol Sci 2021; 42:3389-3395. [PMID: 33411201 DOI: 10.1007/s10072-020-04950-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
Some multiple sclerosis (MS) lesions may have great similarities with neoplastic brain lesions in magnetic resonance (MR) imaging and thus wrong diagnoses may occur. In this study, differentiation of MS and low-grade brain tumors was performed with computer-aided diagnosis (CAD) methods by magnetic resonance spectroscopy (MRS) data. MRS data belonging to 51 MS and 39 low-grade brain tumor patients were obtained. The feature extraction from MRS data was performed by the help of peak integration (PI) and full spectra (FS) methods and the most significant features were identified. For the classification step, artificial neural network (ANN), support vector machine (SVM), and linear discriminant analysis (LDA) methods were used and the differentiation between MS and brain tumor was performed automatically. Examining the results, one can conclude that data which belong to MS and low-grade brain tumor cases were automatically differentiated from each other with the help of ANN with 100% accuracy, 100% sensitivity, and 100% specificity. Using of MR spectroscopy and artificial intelligence methods may be useful as a complementary imaging technique to MR imaging in the differentiation of MS lesions and low-grade brain tumors.
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11
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Pérez CA, Patnaik A, Oommen S, Redko A, Mathis SB. Tumefactive Demyelinating Lesions in Children: A Rare Case of Conus Medullaris Involvement and Systematic Review of the Literature. J Child Neurol 2020; 35:690-699. [PMID: 32552343 DOI: 10.1177/0883073820924147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tumefactive demyelinating lesions are an uncommon manifestation of demyelinating disease that mimic primary central nervous system neoplasms and can pose a diagnostic challenge in patients without a pre-existing diagnosis of multiple sclerosis. Although a biopsy may be required to distinguish TDL from neoplasms or infection, certain ancillary and radiographic findings may preclude the need for invasive diagnostic procedures. We describe the case of a 15-year-old boy with a tumefactive demyelinating lesion involving the conus medullaris. An exhaustive systematic literature search of pediatric cases of TDL yielded an additional 78 cases. This review summarizes the current knowledge and recommendations for the diagnosis and management of this condition, highlighting the clinical, demographic, and radiologic features of 79 reported cases, including our own. Furthermore, it underscores areas of the literature where evidence is still lacking. Further research is needed to optimize clinical detection and medical management of this condition.
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Affiliation(s)
- Carlos A Pérez
- Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Anish Patnaik
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sherwin Oommen
- Division of Child and Adolescent Neurology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alissa Redko
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Scott B Mathis
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
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12
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Gopakumar S, Daou M, Gadot R, Ropper AE, Mandel J. Spinal meningioma in a patient with multiple sclerosis. Surg Neurol Int 2020; 11:196. [PMID: 32754367 PMCID: PMC7395551 DOI: 10.25259/sni_221_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Multiple sclerosis (MS) is the most common immune-mediated inflammatory demyelinating disease of the central nervous system. Multiple brain and spinal tumors have been linked to MS, but a causal relationship between the two has not been determined. Here, we report a case of spinal meningioma in a patient with MS and review literature discussing the possible connection between these two disease entities. Case Description: A 58-year-old female with MS presented with a 1-year history of progressively worsening back pain in conjunction with worsening right upper and lower extremity weakness. The patient was diagnosed with MS 19 months prior and had multiple known demyelinating plaques in her cervical spine. New MRI revealed an intradural extramedullary thoracic tumor with characteristics consistent with meningioma. She underwent T6- T8 laminectomies for tumor resection and pathology confirmed the radiological diagnosis. At 3-month follow- up, the patient reported complete resolution of her back pain and persistence of weakness-related gait issues. Conclusion: CNS neoplasms including meningioma should be considered in MS patients presenting with newly onset neurological symptoms not entirely consistent with demyelinating disease. Both disease processes should be addressed with appropriate long-term follow-up.
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Affiliation(s)
| | - Marc Daou
- Department of Neurosurgery, University of Texas, MD Anderson Cancer Center
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine
| | | | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas, United States
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Sawlani V, Patel MD, Davies N, Flintham R, Wesolowski R, Ughratdar I, Pohl U, Nagaraju S, Petrik V, Kay A, Jacob S, Sanghera P, Wykes V, Watts C, Poptani H. Multiparametric MRI: practical approach and pictorial review of a useful tool in the evaluation of brain tumours and tumour-like lesions. Insights Imaging 2020; 11:84. [PMID: 32681296 PMCID: PMC7367972 DOI: 10.1186/s13244-020-00888-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/24/2020] [Indexed: 12/17/2022] Open
Abstract
MRI has a vital role in the assessment of intracranial lesions. Conventional MRI has limited specificity and multiparametric MRI using diffusion-weighted imaging, perfusion-weighted imaging and magnetic resonance spectroscopy allows more accurate assessment of the tissue microenvironment. The purpose of this educational pictorial review is to demonstrate the role of multiparametric MRI for diagnosis, treatment planning and for assessing treatment response, as well as providing a practical approach for performing and interpreting multiparametric MRI in the clinical setting. A variety of cases are presented to demonstrate how multiparametric MRI can help differentiate neoplastic from non-neoplastic lesions compared to conventional MRI alone.
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Affiliation(s)
- Vijay Sawlani
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK.
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Markand Dipankumar Patel
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Nigel Davies
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Robert Flintham
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Roman Wesolowski
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Ismail Ughratdar
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Ute Pohl
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Santhosh Nagaraju
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Vladimir Petrik
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Andrew Kay
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Saiju Jacob
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Paul Sanghera
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
| | - Victoria Wykes
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Colin Watts
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK
- University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Harish Poptani
- Centre for Pre-Clinical Imaging, Department of Cellular and Molecular Physiology, University of Liverpool, Crown Street, Liverpool, L69 3BX, UK
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14
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Codjia P, Ayrignac X, Carra-Dalliere C, Cohen M, Charif M, Lippi A, Collongues N, Corti L, De Seze J, Lebrun C, Vukusic S, Durand-Dubief F, Labauge P. Multiple sclerosis with atypical MRI presentation: Results of a nationwide multicenter study in 57 consecutive cases. Mult Scler Relat Disord 2019; 28:109-116. [DOI: 10.1016/j.msard.2018.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 12/22/2022]
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15
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Barbosa BC, Marchiori E, Leal Leidersnaider C, Brandao L, Castillo M. Demyelinating lesions behaving like aggressive tumours on advanced MRI techniques. Neuroradiol J 2019; 32:103-107. [PMID: 30667319 DOI: 10.1177/1971400919826394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tumefactive demyelinating lesions are a rare disorder in which inflammatory demyelination manifests as solitary or multiple focal brain lesions (greater than 2 cm in size), which can be mistaken for glioma, lymphoma, metastasis and in some cases even brain abscess. The symptomatology of tumefactive demyelinating lesions depends on the white matter area involved and includes quickly progressing neurological deterioration of motor, sensory and visual function, praxis, language and mood impairment, as well as seizures. Recognising the key imaging features in a patient with a prior history of demyelination may expedite appropriate management. Preoperative diagnosis or at least the consideration of a demyelinating process is important to avoid unnecessary surgery. We report three patients with demyelinating lesions who presented with findings suggestive of demyelination on conventional magnetic resonance imaging studies. However, in all patients the lesions showed high perfusion and in two high permeability, which are findings generally seen with high-grade neoplasias. In rare instances, tumefactive demyelinating lesions may show increased perfusion and high permeability, imaging findings more commonly seen in high-grade gliomas. We suggest that if white matter lesions on conventional magnetic resonance imaging are compatible with tumefactive demyelinating lesions, atypical findings of high perfusion/permeability should not dissuade the radiologist from suggesting the presence of tumefactive demyelinating lesions rather than high-grade gliomas.
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Affiliation(s)
- Brainner Campos Barbosa
- 1 Department of Radiology, Pontifical Catholic University of Goias School of Medicine, Goiania, Brazil
| | - Edson Marchiori
- 2 Department of Radiology, Federal University of Rio de Janeiro, Brazil
| | | | - Lara Brandao
- 3 Department of Radiology, Grupo Fleury Rio de Janeiro, Brazil
| | - Mauricio Castillo
- 4 Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, USA
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16
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Suh CH, Kim HS, Jung SC, Choi CG, Kim SJ. MRI Findings in Tumefactive Demyelinating Lesions: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:1643-1649. [PMID: 30115676 DOI: 10.3174/ajnr.a5775] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/09/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Accurate diagnosis of tumefactive demyelinating lesions is clinically important to avoid unnecessary invasive biopsy or inappropriate treatment. PURPOSE We aimed to evaluate conventional and advanced MR imaging findings of tumefactive demyelinating lesions and determine the diagnostic performance of MR imaging for differentiating tumefactive demyelinating lesions from primary brain tumor. DATA SOURCES A systematic search of Ovid MEDLINE and EMBASE up to December 6, 2017, was conducted. STUDY SELECTION Original articles describing MR imaging findings in patients with tumefactive demyelinating lesions were selected. DATA ANALYSIS The pooled incidences of conventional MR imaging findings of tumefactive demyelinating lesions were obtained with the DerSimonian and Liard random-effects model. The pooled sensitivity and specificity of MR imaging for differentiating tumefactive demyelinating lesions from primary brain tumor were obtained using the bivariate random-effects model. DATA SYNTHESIS Nineteen eligible studies with 476 patients with tumefactive demyelinating lesions were included. The pooled incidence of open ring or incomplete rim enhancement was 35% (95% CI, 24%-47%), which was significantly higher than the incidence of closed ring or complete rim enhancement (18% [95% CI, 11%-29%]; P = .0281). The pooled incidences of T2 hypointense rim, absent or mild mass effect, and absent or mild perilesional edema were 48%, 67%, and 57%, respectively. On advanced MR imaging, tumefactive demyelinating lesions showed a high apparent diffusion coefficient, peripheral restricted diffusion, and low cerebral blood volume. The pooled sensitivity and specificity of MR imaging for differentiating tumefactive demyelinating lesions from primary brain tumor were 89% (95% CI, 82%-93%) and 94% (95% CI, 89%-97%), respectively. LIMITATIONS Seventeen of 19 studies were retrospective studies. CONCLUSIONS Conventional MR imaging findings may help differentiate tumefactive demyelinating lesions from primary brain tumor, though further study is needed to determine the added value of advanced MR imaging.
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Affiliation(s)
- C H Suh
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H S Kim
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - S C Jung
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - C G Choi
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S J Kim
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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17
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A Blind Spot in the Diagnostic Field: The Challenging Diagnosis of Tumefactive Multiple Sclerosis. Case Rep Neurol Med 2018; 2018:6841291. [PMID: 30050706 PMCID: PMC6040262 DOI: 10.1155/2018/6841291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/07/2018] [Indexed: 11/18/2022] Open
Abstract
Tumefactive Multiple Sclerosis (TMS) is a rare variant with 1 per 1000 cases of MS and 3 per million cases per year. TMS can mimic clinical and radiological features of a neoplasm, infarction, or abscess and therefore can be diagnostically challenging for clinicians. We present a clinical scenario of a patient presenting with left homonymous hemianopia with atypical radiological features initially thought to be more consistent with neoplasm or infraction. Ultimately, biopsy was done which led to the diagnosis of tumefactive multiple sclerosis.
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18
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Balloy G, Pelletier J, Suchet L, Lebrun C, Cohen M, Vermersch P, Zephir H, Duhin E, Gout O, Deschamps R, Le Page E, Edan G, Labauge P, Carra-Dallieres C, Rumbach L, Berger E, Lejeune P, Devos P, N'Kendjuo JB, Coustans M, Auffray-Calvier E, Daumas-Duport B, Michel L, Lefrere F, Laplaud DA, Brosset C, Derkinderen P, de Seze J, Wiertlewski S. Inaugural tumor-like multiple sclerosis: clinical presentation and medium-term outcome in 87 patients. J Neurol 2018; 265:2251-2259. [PMID: 30054790 DOI: 10.1007/s00415-018-8984-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tumefactive demyelinating lesions of the central nervous system can be the initial presentation in various pathological entities [multiple sclerosis (the most common), Balo's concentric sclerosis, Schilder's disease and acute disseminated encephalomyelitis] with overlapping clinical presentation. The aim of our study was to better characterize these patients. METHODS Eighty-seven patients (62 women and 25 men) from different MS centers in France were studied retrospectively. Inclusion criteria were (1) a first clinical event (2) MRI showing one or more large demyelinating lesions (20 mm or more in diameter) with mass-like features. Patients with a previous demyelinating event (i.e. confirmed multiple sclerosis) were excluded. RESULTS Mean age at onset was 26 years. The most common initial symptoms (67% of the patients) were hemiparesis or hemiplegia. Aphasia, headache and cognitive disturbances (i.e. atypical symptoms for demyelinating diseases) were observed in 15, 18 and 15% of patients, respectively. The mean largest diameter of the tumefactive lesions was 26.9 mm, with gadolinium enhancement in 66 patients (81%). Twenty-one patients (24%) had a single tumefactive lesion. During follow-up (median time 5.7 years) 4 patients died, 70 patients improved or remained stable and 12 worsened. 86% of patients received initial corticosteroid treatment, and 73% received disease-modifying therapy subsequently. EDSS at the end of the follow-up was 2.4 ± 2.6 (mean ± SD). CONCLUSION This study provides further evidence that the clinical course of MS presenting with large focal tumor-like lesions does not differ from that of classical relapsing-remitting MS, once the noisy first relapsing occurred.
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Affiliation(s)
- G Balloy
- Neurology Department, University of Nantes Hospital, Nantes, France. .,Service de Neurologie, Hopital Laennec, Boulevard Jacques Monod, 44800, Saint Herblain, France.
| | - J Pelletier
- Neurosciences Unit, Neurology Department, Timone Hospital, Aix Marseille University, APHM, Marseille, France
| | - L Suchet
- Neurosciences Unit, Neurology Department, Timone Hospital, Aix Marseille University, APHM, Marseille, France
| | - C Lebrun
- University of Nice Hospital, Nice, France
| | - M Cohen
- University of Nice Hospital, Nice, France
| | | | - H Zephir
- University of Lille Hospital, Lille, France
| | - E Duhin
- University of Lille Hospital, Lille, France
| | - O Gout
- Rothschild Foundation, Paris, France
| | | | - E Le Page
- University of Rennes Hospital, Rennes, France
| | - G Edan
- University of Rennes Hospital, Rennes, France
| | - P Labauge
- University of Montpellier Hospital, Montpellier, France
| | | | - L Rumbach
- University Besançon Hospital, Besançon, France
| | - E Berger
- University Besançon Hospital, Besançon, France
| | - P Lejeune
- La Roche sur Yon Hospital, La Roche-sur-Yon, France
| | - P Devos
- Boulogne-sur-Mer Hospital, Boulogne-sur-Mer, France
| | | | | | | | - B Daumas-Duport
- Radiology Department, University of Nantes Hospital, Nantes, France
| | - L Michel
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - F Lefrere
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - D A Laplaud
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - C Brosset
- Military Hospital, Marseille, France
| | - P Derkinderen
- Neurology Department, University of Nantes Hospital, Nantes, France
| | - J de Seze
- University of Strasbourg Hospital, Strasbourg, France
| | - S Wiertlewski
- Neurology Department, University of Nantes Hospital, Nantes, France
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19
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Primary CNS Lymphomas: Challenges in Diagnosis and Monitoring. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3606970. [PMID: 30035121 PMCID: PMC6033255 DOI: 10.1155/2018/3606970] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 04/12/2018] [Accepted: 05/17/2018] [Indexed: 12/22/2022]
Abstract
Primary Central Nervous System Lymphoma (PCNSL) is a rare neoplasm that can involve brain, eye, leptomeninges, and rarely spinal cord. PCNSL lesions most typically enhance homogeneously on T1-weighted magnetic resonance imaging (MRI) and appear T2-hypointense, but high variability in MRI features is commonly encountered. Neurological symptoms and MRI findings may mimic high grade gliomas (HGGs), tumefactive demyelinating lesions (TDLs), or infectious and granulomatous diseases. Advanced MRI techniques (MR diffusion, spectroscopy, and perfusion) and metabolic imaging, such as Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) or amino acid PET (usually employing methionine), may be useful in distinguishing these different entities and monitoring the disease course. Moreover, emerging data suggest a role for cerebrospinal fluid (CSF) markers in predicting prognosis and response to treatments. In this review, we will address the challenges in PCNSL diagnosis, assessment of response to treatments, and evaluation of potential neurotoxicity related to chemotherapy and radiotherapy.
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20
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Rapalino O, Mullins ME. Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies. Neurosurgery 2018; 81:10-28. [PMID: 28575459 DOI: 10.1093/neuros/nyx201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/22/2017] [Indexed: 12/28/2022] Open
Abstract
There are many infectious and inflammatory processes affecting the central nervous system that can simulate other neurosurgical pathologies (e.g. tumor) and may precipitate a brain biopsy for definitive diagnosis if not suspected a priori. The challenge for the healthcare team is to recognize imaging features that support a nonsurgical pathology to avoid unnecessary interventions. This review aims to give a general overview of some common inflammatory and infectious entities that affect the central nervous system, with illustrative examples and highlighting important pearls and pitfalls.
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Affiliation(s)
- Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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21
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Atypical inflammatory demyelinating lesions and atypical multiple sclerosis. Rev Neurol (Paris) 2018; 174:408-418. [PMID: 29673573 DOI: 10.1016/j.neurol.2018.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 02/06/2023]
Abstract
Atypical idiopathic inflammatory demyelinating disorders (IIDDs) of the brain have long been known to be disorders closely related to multiple sclerosis (MS), despite having distinctive clinical and radiological characteristics. Originally, they mostly corresponded to acute-onset variants of MS that classically had poor prognoses, such as Baló's concentric sclerosis, Marburg variant of MS and Schilder's disease, and their relationship with MS was based on their shared pathological findings and the co-occurrence of these variants in patients with typical MS. More recently, other atypical disorders, such as solitary sclerosis, have also been described as belonging to the MS spectrum, raising the question of their links with MS. Meanwhile, multiple MS mimics have been described and need to be considered in the differential diagnosis of MS. In addition, thorough characterization of these atypical entities, including advanced MRI and biological studies, is now warranted to further improve their management.
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De Simone M, Brogna B, Spitaleri DL, Cicarelli G, Fantozzi R, Guida B. Progression of tumefactive demyelinating lesion in a child demonstrated with MRI. Radiol Case Rep 2017; 13:254-260. [PMID: 29487664 PMCID: PMC5826469 DOI: 10.1016/j.radcr.2017.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022] Open
Abstract
Tumefactive demyelinating lesions (TDLs) are atypical presentations of various demyelinating diseases. They can mimic brain tumors in their clinical and radiological features and usually respond favorably to corticosteroid therapy. We report a case of a 17-year-old girl with a single TDL suddenly increasing in size even under steroid therapy. She underwent very strict follow-up examinations with conventional magnetic resonance and diffusion-weighted imaging, perfusion-weighted imaging, proton-magnetic resonance spectroscopy. The behavior of the lesion during the different follow-up sessions posed a diagnostic challenge as it expanded its size during the final examination, in stark contrast to what we forecast. Diagnosis of TDL was initially hypothesized, but the aggressive behavior of the lesion required biopsy.
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Affiliation(s)
- Marta De Simone
- Neuroradiology Unit "San Giuseppe Moscati" Hospital Avellino, Amoretta Street, 83100, Avellino, Italy
| | - Barbara Brogna
- Department of Internal and Experimental Medicine "Magrassi-Lanzara", Institute of Radiology, Second University of Naples, Naples, Italy
| | | | - Giulio Cicarelli
- Neurology Unit "San Giuseppe Moscati", Hospital Avellino, Avellino, Italy
| | - Roberta Fantozzi
- Neurology Unit Mediterranean Neurological Institute "Neuromed", Pozzilli (IS), Italy
| | - Bruno Guida
- Neuroradiology Unit "San Giuseppe Moscati" Hospital Avellino, Amoretta Street, 83100, Avellino, Italy
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23
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Abrishamchi F, Khorvash F. Coexistence of Multiple Sclerosis and Brain Tumor: An Uncommon Diagnostic Challenge. Adv Biomed Res 2017; 6:101. [PMID: 28900612 PMCID: PMC5583647 DOI: 10.4103/abr.abr_625_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nonneoplastic demyelinating processes of the brain with mass effect on magnetic resonance imaging can cause diagnostic difficulties. It requires differential diagnosis between the tumefactive demyelinating lesion and the coexistence of neoplasm. We document the case of 41-year-old woman with clinical and radiological findings suggestive of multiple sclerosis. Additional investigations confirmed the coexistence of astrocytoma. This report emphasizes the importance of considering brain tumors in the differential diagnosis of primary demyelinating disease presenting with a cerebral mass lesion.
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Affiliation(s)
- Fatemeh Abrishamchi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Sánchez P, Meca-Lallana V, Barbosa A, Manzanares R, Palmí I, Vivancos J. Tumefactive demyelinating lesions of 15 patients: Clinico-radiological features, management and review of the literature. J Neurol Sci 2017; 381:32-38. [PMID: 28991707 DOI: 10.1016/j.jns.2017.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Tumefactive demyelinating lesions (TDLs) are large inflammatory lesions that can mimic tumors or other space-occupying lesions. Differential diagnosis and management of these lesions remain challenging for neurologists. We aim to review the clinico-radiological features of patients with TDLs, as well as their management. METHODS We performed a retrospective review of cases of TDLs treated in our center from January 2010 to February 2017. We reviewed the literature. RESULTS Out of 711 patients, we found 15 with TDLs (12 women and 3 men), with a mean age of TDL onset of 36years. Out of the 15 patients, 9 had TDLs as a first demyelinating event and 44% (4/15) of these converted to MS by McDonald 2010 criteria in a mean time of 8months (SD 3.10). Clinical presentation was polysymptomatic and the most common radiological findings included solitary lesions (66.66%), located primarily in the frontal (40%) or parietal (33%) lobes, showing mostly an infiltrative morphological pattern (50%) and an open-ring enhancement (43%). Multiple Sclerosis was the most common diagnosis (67%, 10/15). Acute treatment included steroids, plasmapheresis, rituximab and cyclophosphamide. CONCLUSIONS Prevalence of tumefactive demyelination in MS was higher than expected in MS patients, according to literature. Time to conversion to MS was significantly shorter than other published series. Clinical presentation was polysymptomatic and the most common radiological findings were isolated frontal lesions with an open-ring enhancement.
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Affiliation(s)
- Pedro Sánchez
- Demyelinating Disorders Unit, Neurology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
| | - Virginia Meca-Lallana
- Demyelinating Disorders Unit, Neurology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Antonio Barbosa
- Neuroradiology Section, Radiodiagnostic Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Rafael Manzanares
- Neuroradiology Section, Radiodiagnostic Department, Hospital Universitario de La Princesa, Madrid, Spain
| | - Itziar Palmí
- Demyelinating Disorders Unit, Neurology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - José Vivancos
- Demyelinating Disorders Unit, Neurology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
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25
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Chinese Guidelines for the Diagnosis and Management of Tumefactive Demyelinating Lesions of Central Nervous System. Chin Med J (Engl) 2017; 130:1838-1850. [PMID: 28748858 PMCID: PMC5547837 DOI: 10.4103/0366-6999.211547] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Indexed: 01/15/2023] Open
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26
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Ikeguchi R, Shimizu Y, Shimizu S, Kitagawa K. CSF and clinical data are useful in differentiating CNS inflammatory demyelinating disease from CNS lymphoma. Mult Scler 2017; 24:1212-1223. [DOI: 10.1177/1352458517717804] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: It is often difficult to diagnose central nervous system (CNS) inflammatory demyelinating diseases (IDDs) because they are similar to CNS lymphoma and glioma. Objective: To evaluate whether cerebrospinal fluid (CSF) analysis can differentiate CNS IDDs from CNS lymphoma and glioma. Methods: We measured CSF cell counts; concentrations of proteins, glucose, interleukin (IL)-6, IL-10, soluble IL-2 receptor (sIL-2R), and myelin basic protein; and IgG index in patients with multiple sclerosis (MS, n = 64), neuromyelitis optica spectrum disorder (NMOSD, n = 35), tumefactive demyelinating lesion (TDL, n = 17), CNS lymphoma ( n = 12), or glioma ( n = 10). We detected diagnostic markers using logistic regression and receiver operating characteristic (ROC) analyses. Results: Median CSF IL-10 and sIL-2R levels were higher in CNS lymphoma patients than in MS, NMOSD, or TDL patients. Logistic regression revealed that CSF sIL-2R levels predicted CNS lymphoma. In the ROC analysis of CSF sIL-2R levels, the area under the curve was 0.867, and the sensitivity and specificity were 83.3% and 90.0%, respectively. Conclusion: CSF sIL-2R levels can be used to differentiate CNS lymphoma from CNS IDDs. Further studies may identify other applications of CSF as a diagnostic biomarker.
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Affiliation(s)
- Ryotaro Ikeguchi
- Department of Neurology, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yuko Shimizu
- Department of Neurology, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Satoru Shimizu
- Medical Research Institute, Tokyo Women’s Medical University, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
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Ma M, Chen JY, Plowey ED, Fischbein N, Iv M. Tumefactive demyelination associated with developmental venous anomaly: Report of two cases. Clin Imaging 2017; 43:194-198. [PMID: 28364723 DOI: 10.1016/j.clinimag.2017.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/25/2017] [Indexed: 11/18/2022]
Abstract
We present two cases of tumefactive demyelination (TD) occurring in close association with a developmental venous anomaly (DVA). Our purpose is to describe the association between demyelinating lesions and venous anomalies, as only one case of TD associated with a DVA has been published in the literature. Appropriate recognition of this "do not touch" lesion may avoid invasive and potentially harmful procedures such as biopsy or resection.
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Affiliation(s)
- Mingming Ma
- Department of Radiology, Stanford University Medical Center, Stanford, CA, United States.
| | - James Y Chen
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Edward D Plowey
- Department of Pathology, Stanford University Medical Center, Stanford, CA, United States
| | - Nancy Fischbein
- Department of Radiology, Stanford University Medical Center, Stanford, CA, United States
| | - Michael Iv
- Department of Radiology, Stanford University Medical Center, Stanford, CA, United States
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Lin X, Yu WY, Liauw L, Chander RJ, Soon WE, Lee HY, Tan K. Clinicoradiologic features distinguish tumefactive multiple sclerosis from CNS neoplasms. Neurol Clin Pract 2017; 7:53-64. [PMID: 29849229 PMCID: PMC5964866 DOI: 10.1212/cpj.0000000000000319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are limited data to guide clinicians in differentiating tumefactive multiple sclerosis (TMS) from CNS neoplasms. Identifying distinguishing features will inform diagnosis and management and avoid unnecessary diagnostic biopsy. Our study aimed to determine the clinical and radiologic features that differentiate TMS from glioma and CNS lymphoma (CNSL) in patients who present with tumefactive lesions. METHODS We retrospectively reviewed all patients with tumefactive lesions and histologically proven or clinically diagnosed TMS, glioma, or CNSL at our tertiary center from 1999 to 2012. Two independent blinded neuroradiologists rated MRI brain scans at presentation. We correlated patients' demographic, clinical, laboratory, and radiologic data to final diagnosis. RESULTS A total of 133 patients (10 TMS, 85 glioma, 38 CNSL) were analyzed. Patients with TMS were younger and a greater proportion were women. Presenting symptoms did not distinguish between diagnoses. TMS lesions were smaller compared to glioma and CNSL, had no or mild mass effect, and were always associated with contrast enhancement. Radiologic features that were more frequent in TMS lesions were incomplete rim (open-ring) enhancement, incomplete peripheral diffusion restriction, and mixed T2 signal and CT hypoattenuation of MRI-enhancing components (all p < 0.05). CONCLUSIONS Radiologic features but not presenting symptoms are useful in distinguishing TMS from CNS neoplasms.
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Affiliation(s)
- Xuling Lin
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Wai-Yung Yu
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Lishya Liauw
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Russell Jude Chander
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Weiling E Soon
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Hwei Yee Lee
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
| | - Kevin Tan
- National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore
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Differentiating Primary Central Nervous System Lymphomas From Glioblastomas and Inflammatory Demyelinating Pseudotumor Using Relative Minimum Apparent Diffusion Coefficients. J Comput Assist Tomogr 2017; 41:904-909. [DOI: 10.1097/rct.0000000000000636] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Radue EW, Weigel M, Wiest R, Urbach H. Introduction to Magnetic Resonance Imaging for Neurologists. Continuum (Minneap Minn) 2016; 22:1379-1398. [PMID: 27740981 DOI: 10.1212/con.0000000000000391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW In neuroradiology, highly sophisticated methods such as MRI are implemented to investigate different entities of the central nervous system and to acquire miscellaneous images where tissues display varying degrees of characteristic signal intensity or brightness. Compared to x-ray, CT, and ultrasound, MRI produces clearer images of tissues, body fluids, and fat. The basics of MRI may be unknown to neurologists; this article introduces MRI physics, techniques, and interpretation guidelines. RECENT FINDINGS This article discusses the basics of MRI to provide clinicians with the scientific underpinning of MRI technology and to help them better understand image features and improve their diagnosis and differential diagnosis by combining MRI characteristics with their knowledge of pathology and neurology. SUMMARY This article will help neurologists deepen their knowledge and understanding of MRI by introducing the basics of MRI physics, technology, image acquisition, protocols, and image interpretation.
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Conforti R, Capasso R, Galasso R, Cirillo M, Taglialatela G, Galasso L. A challenging diagnosis of late-onset tumefactive multiple sclerosis associated to cervicodorsal syringomyelia: doubtful CT, MRI, and bioptic findings: Case report and literature review. Medicine (Baltimore) 2016; 95:e4585. [PMID: 27603348 PMCID: PMC5023870 DOI: 10.1097/md.0000000000004585] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 03/08/2016] [Accepted: 07/21/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tumefactive multiple sclerosis (MS) is an unusual variant of demyelinating disease characterized by lesions with pseudotumoral appearance on radiological imaging mimicking other space-occupying lesions, such as neoplasms, infections, and infarction. Especially when the patient's medical history is incompatible with MS, the differential diagnosis between these lesions constitutes a diagnostic challenge often requiring histological investigation. An older age at onset makes distinguishing tumefactive demyelinating lesion (TDL) from tumors even more challenging. METHODS We report a case of brain TDL as the initial manifestation of late-onset MS associated with cervico-dorsal syringomyelia. A 66-year-old Caucasian woman with a 15-day history headache was referred to our hospital because of the acute onset of paraphasia. She suffered from noncommunicating syringomyelia associated to basilar impression and she reported a 10-year history of burning dysesthesia of the left side of the chest extended to the internipple line level. RESULTS Computed tomography (CT) and magnetic resonance imaging (MRI) examinations revealed a left frontal lesion with features suspicious for a tumor. Given the degree of overlap with other pathologic processes, CT and MRI findings failed to provide an unambiguous diagnosis; furthermore, because of the negative cerebrospinal fluid analysis for oligoclonal bands, the absence of other lesions, and the heightened suspicion of neoplasia, the clinicians opted to perform a stereotactic biopsy. Brain specimen analysis did not exclude the possibility of perilesional reactive gliosis and the patient, receiving anitiedemigen therapy, was monthly followed up. In the meanwhile, the second histological opinion of the brain specimen described the absence of pleomorphic glial cells indicating a tumor. These findings were interpreted as destructive inflammatory demyelinating disease and according to the evolution of MRI lesion burden, MS was diagnosed. CONCLUSION TDL still remains a problematic entity clinically, radiologically, and sometimes even pathologically. A staged follow-up is necessary, and in our case, it revealed to be the most important attitude to define the nature of the lesion, confirming the classic MS diagnostic criteria of disseminate lesions in time and space. We discuss our findings according to the recent literature.
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Affiliation(s)
- Renata Conforti
- Neuroradiology Service, Department of Radiology, Second University of Naples, Naples, Italy
| | - Raffaella Capasso
- Department of Internal Clinical and Experimental Medicine and Surgery, “F. Magrassi-A. Lanzara” Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Rosario Galasso
- Department of Internal Clinical and Experimental Medicine and Surgery, “F. Magrassi-A. Lanzara” Second University of Naples, Piazza Miraglia, Naples, Italy
| | - Mario Cirillo
- Neuroradiology Service, Department of Radiology, Second University of Naples, Naples, Italy
| | - Gemma Taglialatela
- Neuroradiology Service, Department of Radiology, Second University of Naples, Naples, Italy
| | - Luigi Galasso
- Neuroradiology Department, “San Luca” Hospital, Vallo della Lucania, Salerno, Italy
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Occurrence and long-term outcome of tumefactive demyelinating lesions in multiple sclerosis. Neurol Sci 2016; 37:1113-7. [PMID: 27083895 DOI: 10.1007/s10072-016-2558-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/16/2016] [Indexed: 01/31/2023]
Abstract
Although tumefactive multiple sclerosis is a well recognized variant of multiple sclerosis, prognostic uncertainty still exists about long term prognosis. The aim of this study was to estimate the occurrence and long term outcome of tumefactive demyelinating lesions (TDLs) in a cohort of multiple sclerosis patients. We reviewed brain MRI of 443 patients referred to our MS clinic. All patients meeting the McDonald criteria for multiple sclerosis and showing at least one TDL were included. Kaplan-Meier estimates of disease-free survival in patient cohort were compared with control group without TDLs using a log-rank test. Seven cases with TDLs were identified (occurrence 1.58 %). Tumefactive demyelinating lesion recurrence was 16.6 %. Cumulative proportion of patients free from clinical relapse and from new T2 lesions was lower in the control group although not reaching statistical significance (30 vs 50 %; P = 0.666 and 21.7 vs 33.3 %; P = 0.761, respectively). Disability progression analysis showed a not significant trend towards lower probability of remaining progression free for TDL patients (50 vs 61 %; P = 0.295). Occurrence of tumefactive demyelinating lesions in our cohort was higher than those reported in other studies. Overall, TDLs were not predictive of poor outcome in terms of disability progression.
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Performance of Apparent Diffusion Coefficient Values and Conventional MRI Features in Differentiating Tumefactive Demyelinating Lesions From Primary Brain Neoplasms. AJR Am J Roentgenol 2016; 205:1075-85. [PMID: 26496556 DOI: 10.2214/ajr.14.13970] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Tumefactive demyelinating lesions (TDLs) remain one of the most common brain lesions to mimic a brain tumor, particularly primary CNS lymphoma (PCNSL) and high-grade gliomas. The purpose of our study was to evaluate the ability of apparent diffusion coefficient (ADC) values and conventional MRI features to differentiate TDLs from PCNSLs and high-grade gliomas. MATERIALS AND METHODS Seventy-five patients (24 patients with TDLs, 28 with PCNSLs, and 23 with high-grade gliomas) with 168 brain lesions (70 TDLs, 68 PCNSLs, and 30 high-grade gliomas) who underwent DWI before surgery or therapy were included in the study. Minimum ADC (ADC(min)) and average ADC (ADC(avg)) values were calculated for each lesion. ANOVA and ROC analyses were performed. ROC analyses were also performed for the presence of incomplete rim enhancement and for the number of lesions. Multiple-variable logistic regression with ROC analysis was then performed to evaluate performance in multiple-variable models. RESULTS ADC(min) was statistically significantly higher (p < 0.01) in TDLs (mean, 0.886; 95% CI, 0.802-0.931) than in PCNSLs (0.547; 95% CI, 0.496-0.598) and high-grade gliomas (0.470; 95% CI, 0.385-0.555). (All ADC values in this article are reported in units of × 10(-3) mm(2)/s.) ADC(avg) was statistically significantly higher (p < 0.01) in TDLs (mean, 1.362; 95% CI, 1.268-1.456) than in PCNSLs (0.990; 95% CI, 0.919-1.061) but not in high-grade gliomas (1.216; 95% CI, 1.074-1.356). Multiple-variable models showed statistically significant individual effects and superior diagnostic performance on ROC analysis. CONCLUSION TDLs can be diagnosed on preoperative MRI with a high degree of specificity; MRI features of incomplete rim enhancement, high ADC values, and a large number of lesions individually increase the probability and diagnostic confidence that a lesion is a TDL.
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Preziosa P, Martinelli V, Moiola L, Radaelli M, Gerevini S, Guidetti D, Immovilli P, Michieletti E, Scagnelli P, Comola M, Rocca M, Filippi M, Comi G. Dynamic pattern of clinical and MRI findings in a tumefactive demyelinating lesion: A case report. J Neurol Sci 2016; 361:184-6. [DOI: 10.1016/j.jns.2015.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/14/2015] [Accepted: 12/23/2015] [Indexed: 01/17/2023]
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Wu CJ, Wang Q, Zhang J, Wang XN, Liu XS, Zhang YD, Shi HB. Readout-segmented echo-planar imaging in diffusion-weighted imaging of the kidney: comparison with single-shot echo-planar imaging in image quality. Abdom Radiol (NY) 2016; 41:100-8. [PMID: 26830616 DOI: 10.1007/s00261-015-0615-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the image quality of readout-segmented echo-planar imaging (RS-EPI) and that of standard single-shot echo-planar imaging (SS-EPI) in the kidney in a rat model. MATERIALS AND METHODS Twelve Wistar rats undergoing MRI examinations were imaged with two diffusion-weighted (DW) imaging protocols: a standard SS-EPI and a new RS-EPI protocol, both with a 1.0 × 1.0 × 3.0 mm voxel. The two groups of diffusion-weighted images were independently scored on geometric distortion, image blurring, signal dropout, and the overall image quality by two radiologists. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) were measured on both sequences. Inter-rater agreement (IRA) was evaluated by Fleiss kappa (κ) and inter-class correlation coefficient (ICC) statistics. Comparisons of image qualities were made by Wilcoxon signed-rank test and paired-sample t test. RESULTS Both RS-EPI and SS-EPI had good IRAs in scoring image qualities (κ = 0.607-0.833) and measuring renal ADCs (ICC = 0.828-0.945). Compared to SS-EPI, RS-EPI produced less geometric distortion (median score 1.5 versus 2.5, p < 0.0001), less image blurring (1.75 versus 2.0, p = 0.0003), less signal dropout (1.0 versus 3.0, p = 0.0001), and a lower score in overall image artifacts (4.25 versus 7.25; p < 0.0001). RS-EPI had higher SNR of renal DW images than SS-EPI (p < 0.001). The intra-variability of ADCs in cortex, outer medulla, and inner medulla ranged from 9.6% to 11.1% (Pearson correlation coefficient ρ = 0.675-0.729; p < 0.001) between the two protocols. CONCLUSION We showed that for DWI of the kidney at 1.0 × 1.0 × 3.0 mm(3) voxel sizes, the new protocol provided better image quality than standard SS-EPI protocol.
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Affiliation(s)
- Chen-Jiang Wu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Qing Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xiao-Ning Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xi-Sheng Liu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
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Yao J, Huang D, Gui Q, Chen X, Lou X, Wu L, Cheng C, Li J, Wu W. Clinical and radiological characteristics of 17 Chinese patients with pathology confirmed tumefactive demyelinating diseases: Follow-up study. J Neurol Sci 2015; 348:153-9. [DOI: 10.1016/j.jns.2014.11.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/11/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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Rovira A. Tumefactive idiopathic inflammatory demyelinating lesions: a diagnostic challenge. Mult Scler 2013; 20:634-5. [PMID: 24368756 DOI: 10.1177/1352458513517282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- Daniel J Boulter
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Pamela W Schaefer
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA.
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Abstract
OBJECTIVE This article addresses questions that radiologists frequently ask when planning, performing, processing, and interpreting MRI perfusion studies in CNS imaging. CONCLUSION Perfusion MRI is a promising tool in assessing stroke, brain tumors, and neurodegenerative diseases. Most of the impediments that have limited the use of per-fusion MRI can be overcome to allow integration of these methods into modern neuroimaging protocols.
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Adamek D, Radwanska E, Rog T, Grzywna E, Herman-Sucharska I. Tumefactive demyelinating lesion. Trying to find unity in diversity. Comparison of two cases. Clin Neurol Neurosurg 2013; 116:90-2. [PMID: 24269051 DOI: 10.1016/j.clineuro.2013.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 10/09/2013] [Accepted: 10/26/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Dariusz Adamek
- Department of Neuropathology, Medical College Jagiellonian Univ. Krakow, ul. Grzegórzecka 16, 31-531 Krakow, Poland.
| | - Edyta Radwanska
- Department of Neuropathology, Medical College Jagiellonian Univ. Krakow, Krakow, Poland
| | - Teresa Rog
- Department of Neurology, University Hospital Krakow, Krakow, Poland
| | - Ewelina Grzywna
- Department of Neurosurgery, Medical College Jagiellonian Univ. Krakow, Krakow, Poland
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Koelblinger C, Fruehwald-Pallamar J, Kubin K, Wallner-Blazek M, van den Hauwe L, Macedo L, Puchner SB, Thurnher MM. Atypical idiopathic inflammatory demyelinating lesions (IIDL): conventional and diffusion-weighted MR imaging (DWI) findings in 42 cases. Eur J Radiol 2013; 82:1996-2004. [PMID: 23993757 DOI: 10.1016/j.ejrad.2013.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 07/31/2013] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate MR imaging characteristics with conventional and advanced MR imaging techniques in patients with IIDL. METHODS MR images of the brain in 42 patients (20 male, 22 female) with suspected or known multiple sclerosis (MS) from four institutions were retrospectively analyzed. Lesions were classified into five different subtypes: (1) ring-like lesions; (2) Balo-like lesions; (3) diffuse infiltrating lesions; (4) megacystic lesions; and (5) unclassified lesions. The location, size, margins, and signal intensities on T1WI, T2WI, and diffusion-weighted images (DWI), and the ADC values/ratios for all lesions, as well as the contrast enhancement pattern, and the presence of edema, were recorded. RESULTS There were 30 ring-like, 10 Balo-like, 3 megacystic-like and 16 diffuse infiltrating-like lesions were detected. Three lesions were categorized as unclassified lesions. Of the 30 ring-like lesions, 23 were hypointense centrally with a hyperintense rim. The mean ADC, measured centrally, was 1.50 ± 0.41 × 10(-3) mm(2)/s. The mean ADC in the non-enhancing layers of the Balo-like lesions was 2.29 ± 0.17 × 10(-3) mm(2)/s, and the mean ADC in enhancing layers was 1.03 ± 0.30 × 10(-3) mm(2)/s. Megacystic lesions had a mean ADC of 2.14 ± 0.26 × 10(-3)mm(2)/s. Peripheral strong enhancement with high signal on DWI was present in all diffuse infiltrating lesions. Unclassified lesions showed a mean ADC of 1.43 ± 0.13 mm(2)/s. CONCLUSION Restriction of diffusion will be seen in the outer layers of active inflammation/demyelination in Balo-like lesions, in the enhancing part of ring-like lesions, and at the periphery of infiltrative-type lesions.
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Affiliation(s)
- Claus Koelblinger
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
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Lu SS, Kim SJ, Kim HS, Choi CG, Lim YM, Kim EJ, Kim DY, Cho SH. Utility of proton MR spectroscopy for differentiating typical and atypical primary central nervous system lymphomas from tumefactive demyelinating lesions. AJNR Am J Neuroradiol 2013; 35:270-7. [PMID: 23928144 DOI: 10.3174/ajnr.a3677] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE It may be challenging to differentiate primary CNS lymphomas, especially primary CNS lymphomas with atypical MR features, from tumefactive demyelinating lesions by the use of conventional MR. This study aimed to investigate the usefulness of (1)H-MR spectroscopy for making this discrimination. MATERIALS AND METHODS Forty-four patients with primary CNS lymphomas and 21 with tumefactive demyelinating lesions were enrolled. Single-voxel (TE = 144 ms) (1)H-MR spectroscopy scans with the use of the point-resolved spectroscopy sequence were retrospectively analyzed. The Cho/Cr and Cho/NAA area ratios were calculated. The lipid and/or lactate peak was visually categorized into 5 grades on the basis of comparison with the height of the Cr peak. The (1)H-MR spectroscopy findings were compared in all of the primary CNS lymphomas and the tumefactive demyelinating lesions and in the subgroup of atypical primary CNS lymphomas and tumefactive demyelinating lesions. The thresholds and added value of (1)H-MR spectroscopy to conventional MR were calculated by use of receiver operating characteristic curves. RESULTS Discrepancies between all of the primary CNS lymphomas and tumefactive demyelinating lesions were found in the Cho/Cr ratio (P = .000), Cho/NAA ratio (P = .000), and the lipid and/or lactate peak grade (P = .000). Lymphoma rather than tumefactive demyelinating lesions was suggested when the Cho/Cr ratio was >2.58, the Cho/NAA ratio was >1.73, and a high lipid and/or lactate peak grade (grade >3) was seen. Higher Cho/Cr ratios, Cho/NAA ratios, and lipid and/or lactate peak grades were found in atypical primary CNS lymphomas when compared with those of tumefactive demyelinating lesions. The area under the receiver operating characteristic curve of conventional MR was improved from 0.827 to 0.870 when Cho/NAA ratio was added in the uncertain cases. CONCLUSIONS (1)H-MR spectroscopy may be useful for differentiating primary CNS lymphomas from tumefactive demyelinating lesions. Cho/NAA ratio could provide added value to conventional MR imaging.
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Affiliation(s)
- S-S Lu
- From the Department of Radiology and Research Institute of Radiology (S.-S.L. S.J.K., H.S.K., C.G.C., D.Y.K., S.H.C.)
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Wallner-Blazek M, Rovira A, Fillipp M, Rocca MA, Miller DH, Schmierer K, Frederiksen J, Gass A, Gama H, Tilbery CP, Rocha AJ, Flores J, Barkhof F, Seewann A, Palace J, Yousry T, Montalban X, Enzinger C, Fazekas F. Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis. J Neurol 2013; 260:2016-22. [PMID: 23620065 DOI: 10.1007/s00415-013-6918-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/03/2013] [Accepted: 04/05/2013] [Indexed: 12/26/2022]
Abstract
Atypical lesions of a presumably idiopathic inflammatory demyelinating origin present quite variably and may pose diagnostic problems. The subsequent clinical course is also uncertain. We, therefore, wanted to clarify if atypical idiopathic inflammatory demyelinating lesions (AIIDLs) can be classified according to previously suggested radiologic characteristics and how this classification relates to prognosis. Searching the databases of eight tertiary referral centres we identified 90 adult patients (61 women, 29 men; mean age 34 years) with ≥ 1 AIIDL. We collected their demographic, clinical and magnetic resonance imaging data and obtained follow-up (FU) information on 77 of these patients over a mean duration of 4 years. The AIIDLs presented as a single lesion in 72 (80 %) patients and exhibited an infiltrative (n = 35), megacystic (n = 16), Baló (n = 10) or ring-like (n = 16) lesion appearance in 77 (86 %) patients. Additional multiple sclerosis (MS)-typical lesions existed in 48 (53 %) patients. During FU, a further clinical attack occurred rarely (23-35 % of patients) except for patients with ring-like AIIDLs (62 %). Further attacks were also significantly more often in patients with coexisting MS-typical lesions (41 vs. 10 %, p < 0.005). New AIIDLs developed in six (7 %), and new MS-typical lesions in 29 (42 %) patients. Our findings confirm the previously reported subtypes of AIIDLs. Most types confer a relatively low risk of further clinical attacks, except for ring-like lesions and the combination with MS-typical lesions.
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Affiliation(s)
- Mirja Wallner-Blazek
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, 8036 Graz, Austria
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Liu X, Almast J, Ekholm S. Lesions masquerading as acute stroke. J Magn Reson Imaging 2013; 37:15-34. [PMID: 23255413 DOI: 10.1002/jmri.23647] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 02/21/2012] [Indexed: 11/11/2022] Open
Abstract
Rapid and accurate recognition of lesions masquerading as acute stroke is important. Any incorrect or delayed diagnosis of stroke mimics will not only increase the risk of being exposed to unnecessary and possibly dangerous interventional therapies, but will also delay proper treatment. In this article, written from a neuroradiologist's perspective, we classified these lesions masquerading as acute stroke into three groups: lesions that may have "normal imaging," lesions that are "symptom mimics" but on imaging clearly not a stroke, and lesions that are "symptom and imaging mimics" with imaging findings similar to stroke. We focused the review on neuroimaging findings of the latter two groups ending with a suggestion for a diagnostic approach in the form of an algorithm.
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Affiliation(s)
- Xiang Liu
- Division of Diagnostic & Interventional Neuroradiology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York 14642-8638, USA
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45
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Rovira A, Alonso J. 1H magnetic resonance spectroscopy in multiple sclerosis and related disorders. Neuroimaging Clin N Am 2013; 23:459-74. [PMID: 23928200 DOI: 10.1016/j.nic.2013.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H-MRS) is an unconventional technique that allows noninvasive characterization of metabolic abnormalities in the central nervous system. (1)H-MRS provides important insights into the chemical-pathologic changes that occur in patients with multiple sclerosis (MS). In this review article we present the main brain and spinal cord (1)H-MRS features in MS, their diagnostic value in differentiating pseudotumoral demyelinating lesions from primary brain tumors, and their relationship with clinical variables. Last, some data related to the use of (1)H-MRS in therapeutic trials is presented.
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Affiliation(s)
- Alex Rovira
- Department of Radiology, Magnetic Resonance Unit (IDI), Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona 08035, Spain.
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The magnetic resonance imaging appearance of monophasic acute disseminated encephalomyelitis: an update post application of the 2007 consensus criteria. Neuroimaging Clin N Am 2013; 23:245-66. [PMID: 23608688 PMCID: PMC7111644 DOI: 10.1016/j.nic.2012.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Verhey LH, Branson HM, Laughlin S, Shroff MM, Benseler SM, Feldman BM, Streiner DL, Sled JG, Banwell B. Development of a standardized MRI scoring tool for CNS demyelination in children. AJNR Am J Neuroradiol 2013; 34:1271-7. [PMID: 23348761 DOI: 10.3174/ajnr.a3382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE The degree to which MR imaging is useful in the diagnosis of MS is predicated on standardized and reliable evaluation of MR imaging parameters. We aimed to devise items for an MR imaging scoring tool that would have high inter-rater agreement and would be straightforward to apply. MATERIALS AND METHODS On the basis of a literature search and consensus of an expert panel, we identified 48 parameters that describe acute CNS demyelination, predict MS diagnosis, or characterize demyelinating disorder mimics. MR images of children with clinically confirmed MS, monophasic ADEM, and angiography-negative biopsy-positive small-vessel primary angiitis of the CNS were scored by 2 neuroradiologists independently, using the preliminary 48-parameter tool. Parameters with Cohen κ ≥ 0.6 and deemed important in predicting diagnosis were retained. Parameters not visualized on routine clinical imaging or not important in differentiating MS, ADEM, and SV-cPACNS were discarded. RESULTS Of 65 eligible patients, 55 children were enrolled (16 with monophasic ADEM, 27 with MS, 12 with SV-cPACNS); 10 were excluded (6 had hard-copy films, 4 did not meet MR imaging quality requirements). Of the 48 parameters, 16 were retained in the final scoring tool. The remaining 28 parameters were discarded: 4 had κ < 0.6 and were not deemed useful in predicting diagnosis; 9 were not visible on routinely acquired clinical images; and 15 had inter-rater agreement ≥0.6 but were not useful in differentiating monophasic ADEM, MS, and SV-cPACNS. CONCLUSIONS We propose a 16-parameter MR imaging scoring tool that is straightforward to apply in the clinical setting and demonstrates high inter-rater agreement.
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Affiliation(s)
- L H Verhey
- Program in Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
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48
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Bolcaen J, Acou M, Mertens K, Hallaert G, Van den Broecke C, Achten E, Goethals I. Structural and Metabolic Features of Two Different Variants of Multiple Sclerosis: A PET/MRI Study. J Neuroimaging 2012; 23:431-6. [DOI: 10.1111/j.1552-6569.2012.00760.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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49
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Catalucci A, Anselmi M, Splendiani A, Smith JD, Limbucci N, Giangaspero F, Gallucci M. Pediatric inflammatory diseases. Part I: multiple sclerosis. Neuroradiol J 2012; 25:684-94. [PMID: 24029182 DOI: 10.1177/197140091202500608] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/15/2012] [Indexed: 10/23/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory CNS disease characterized by multifocal areas of demyelination; usually it arises in young adults, but can also occur in children (under the age of 10) and adolescents (under the age of 18). As in adult, pediatric MS (PMS) diagnosis is based on the demonstration of multiple demyelination episodes separated in time and spaces. Diagnostic criteria realized for childhood are similar to those employed for adults. Although clinical and imaging features of PMS can be similar to those of adults, the disease is often characterized by a more aggressive course and atypical imaging findings, with giant and pseudotumoral plaques. Differential diagnosis between PMS and ADEM could be difficult: clinical findings and MRI are necessary; sometimes MRI follow-up is required for definitive diagnosis.
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Affiliation(s)
- A Catalucci
- Chair and Unit of Neuroradiology, University of L'Aquila; L'Aquila, Italy -
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50
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Altintas A, Petek B, Isik N, Terzi M, Bolukbasi F, Tavsanli M, Saip S, Boz C, Aydin T, Arici-Duz O, Ozer F, Siva A. Clinical and radiological characteristics of tumefactive demyelinating lesions: follow-up study. Mult Scler 2012; 18:1448-53. [PMID: 22419670 DOI: 10.1177/1352458512438237] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Demyelinating lesions over 20 mm in size, referred to as tumefactive demyelinating lesions, can be misdiagnosed as being either a tumor or an abscess. Although some radiological characteristics can help make a differential diagnosis easier, a cerebral biopsy may still be necessary. OBJECTIVE Our objective was to assess the clinical characteristics of tumefactive lesions, with or without a diagnosis of multiple sclerosis (MS), and present follow-up data for 54 patients with tumefactive lesions. METHODS Demographic, clinical, radiological and laboratory data were gathered and treatment responses were evaluated in a total of 54 patients from five medical centers. RESULT Twenty-nine patients were diagnosed with tumefactive lesions at the onset, whereas 25 patients were diagnosed with tumefactive lesions after a diagnosis of MS. Median follow-up was 38.12 months. At final examination, 19 of the patients with a tumefactive lesion diagnosis at the onset eventually developed relapsing-remitting MS, while 10 remained with the condition as a clinically isolated syndrome. The tumefactive lesions studied were mostly focal, with closed-ring enhancement. We found that oligoclonal band positivity was less frequent in the patients with tumefactive onset. CONCLUSION Although our demographic data were similar to formerly collected Turkish MS data, we found that the distribution of the patients' clinical course differed if there was an absence of primary progressive MS and that there was a lower frequency of secondary progressive MS cases in our group of patients. We believe that less frequent oligoclonal band positivity and the difference we witnessed in the clinical course of disease in our study groups suggest that there is a need for further studies to compare all the biological and immunological differences between MS and tumefactive lesion cases, in order to reveal whether there are different pathogenetic mechanisms involved.
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Affiliation(s)
- A Altintas
- Department of Neurology, Istanbul University, Turkey
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