Demyelinating lesions behaving like aggressive tumours on advanced MRI techniques

Magnetic Resonance Imaging and Clinical Features of the Demyelinating Degeneration of White Matter in Young Patients

Objective

Magnetic resonance imaging (MRI) of brain white matter demyelination often focuses on demyelinating disease, cerebral small vascular disease diagnosis, and follow-up of cognitive dysfunction for observation. This study explored MRI findings and clinical manifestations of demyelinating degeneration of white matter in young patients.

Methods

A total of ninety-four patients with white matter degeneration diagnosed with MRI were enrolled in this study from January 2014 to July 2018. These patients were divided into two groups: the demyelinating disease group (n = 43) and the non-demyelinating disease group (n = 51). The imaging findings and clinical manifestations of the two groups were analyzed.

Results

Compared with the non-demyelinating group, there were more female than male patients in the demyelinating group (P < 0.05). In addition, of the 45 patients with an imaging result of “demyelinating degeneration of white matter and multiple sclerosis,” 39 patients met the diagnosis of multiple sclerosis (86.7%). In comparison, of the 49 patients with an imaging result of “demyelinating degeneration of white matter,” only four patients met the diagnosis for demyelinating disease (8.2%).

Conclusion

In patients complaining of headaches, dizziness, vertigo, and other symptoms and in the case of an imaging result showing the demyelinating degeneration of white matter alone, the possibility of a clinical diagnosis of a demyelinating disease is minimal.

Differential imaging of atypical demyelinating lesions of the central nervous system

The detection of atypical and sometimes aggressive or tumefactive demyelinating lesions of the central nervous system often poses difficulties in the differential diagnosis. The clinical presentation is generally aspecific, related to the location and similar to a number of different lesions, including neoplasms and other intracranial lesions with mass effect. CSF analysis may also be inconclusive, especially for lesions presenting as a single mass at onset. As a consequence, a brain biopsy is frequently performed for characterization. Advanced MRI imaging plays an important role in directing the diagnosis, reducing the rate of unnecessary biopsies and allowing a prompt start of therapy that is often crucial, especially in the case of infratentorial lesions. In this review, the main pattern of presentation of atypical inflammatory demyelinating diseases is discussed, with particular attention on the differential diagnosis and how to adequately define the correct etiology.

Clinical manifestations and imaging features of white matter demyelination in older patients

Objective

To investigate the clinical manifestations and imaging features of older patients with white matter demyelination diagnosed by magnetic resonance imaging (MRI).

Methods

Ninety-six patients with leukoaraiosis diagnosed by MRI were divided by their clinical diagnoses into a demyelinating group (40 cases) and a non-demyelinating group (56 cases). The imaging and clinical features of the patients in the two groups were analyzed.

Results

Compared with the non-demyelinating group, there were significantly more women in the demyelinating group than men. There was no significant difference in age between the two groups. Of the 37 cases who had an imaging report of “white matter demyelination and multiple sclerosis,” 36 cases had a clinical diagnosis in accordance with white matter demyelination (97.3%). Of the 59 cases who had an imaging report of “white matter demyelination”, only four cases had a clinical diagnosis in accordance with demyelination (6.8%).

Conclusion

In older patients with headaches, vertigo, other head symptoms, and unilateral numbness as the chief complaints, a clinical diagnosis of demyelinating disease is very unlikely when the imaging report states white matter demyelination only.