Background multiple sclerosis ms is a chronic inflammatory disease of the central nervous system in which there is focal demyelination. Magnetic resonance imaging characteristics of tumefactive. Clinical and magnetic resonance imaging mri distinctions between tumefactive demyelination and brain tumors in children. Jitender saini, somenath chatterjee, bejoy thomas, and chandrasekharan kesavadas. Background and objectivesdiagnosis of tumefactive demyelinating lesions tdls is.
Tumefactive multiple sclerosis requiring emergent biopsy. Proton mr spectroscopy of tumefactive demyelinating lesions article pdf available in american journal of neuroradiology 238. Because of its tumorlike features on magnetic resonance imaging mri 1, 2, histological investigation had played an important role for definite diagnosis of tms 3, 4. A tumefactive demyelinating lesion tdl is defined as a solitary demyelinating lesion greater than 2 cm. Tumefactive multiple sclerosis tms is a demyelinating disease. Neuroimaging of tumefactive multiple sclerosis with. Differential diagnosis of such space occupying lesions may not be straightforward and sometimes necessitate brain biopsy.
A 21yearold man presented to eye casualty complaining of altered vision associated with headache and vomiting upon waking. Mass effect and contrast enhancement on neuroimaging make it difficult to distinguish this type of. Characterization of tumefactive demyelinating lesions using mr. In rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors. Conventional and advanced magnetic resonance imaging in tumefactive demyelina tion. Demyelination in the central nervous system sometimes presents with large pseudotumoral lesions mimicking brain neoplasm.
The mri scan of the brain revealed a space occupying lesion within the occipital lobe and mr spectroscopy highlighted this to be inflammatory in nature, most likely a tumefactive. Demyelinating processes involving the central nervous system have a variety of aetiologies and can be separated into primary and secondary demyelinating processes. The classic example of primary demyelination is multiple sclerosis. Tumefactive demyelinating lesion tdl is defined as a solitary demyelinating lesion greater than 2 cm. Clinical examination was unremarkable except for a rightsided homonymous hemianopia. Tumefactive multiple sclerosis ms is a rare form of demyelinating disease. Tdls are defined as demyelinating lesions larger than 2 cm that often have conventional mr imaging. Often, it is difficult to distinguish a tumefactive demyelinating lesion from neoplastic lesions at mr spectroscopy. Mri brain done in september 2007 showed multiple ring enhancing lesions with significant perilesional oedema, reported as tumefactive demyelination. In particular, differential diagnosis between tumefactive demyelinating lesions tdls and brain tumours is often challenging lucchinetti et al. A fulminant tumefactive demyelinating lesion may show high choline and low naa signals as well as presence of lactate, 31. Impaired cognition is the second most common clinical manifestation of tumefactive. Tumefactive demyelinating lesions tdl are a frequent differential dilemma. Proton magnetic resonance spectroscopy differentiates.
Differential diagnosis of intracranial masses springerlink. Tumefactive multiple sclerosis, demyelinating disease, spinal cord, magnetic resonance imaging mri date received. Central nervous system cns inflammatory demyelinating diseases idds, such as multiple sclerosis, can be easily diagnosed based on imaging examinations, such as mri. Tms can mimic clinical and radiological features of a neoplasm, infarction, or abscess. Tumefactive demyelinating lesions tdls are atypical presentations of various. Ms is a disabling and progressive disease that affects the central nervous system. Conventional and advanced magnetic resonance imaging in. Glioblastoma multiforme presenting with an open ring. Even the advanced mri techniques, such as mr spectroscopy, led to equivocal results because both normalized choline increase and nacetyl. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Magnetic resonance spectroscopy can also help identify these lesions. Progression of tumefactive demyelinating lesion in a child. Proton mr spectroscopy of tumefactive demyelinating lesions.
Tumefactive multiple sclerosis ms is an unusual variant of demyelinating disease characterized by lesions with pseudotumoral appearance on radiological imaging mimicking other. Perfusion imaging of tumefactive demyelinating lesions compared to high. Tumefactive demyelinating lesions tdls can simulate intracranial neoplasms in clinical presentation and mr imaging appearance, and surgical biopsy is often performed in suspected tumors. Tumefactive multiple sclerosis tms is a rare variant with 1 per cases of ms and 3 per million cases per year. Tumefactive multiple sclerosis or tumefactive demyelinating lesion tdl is one of the rare variants of multiple sclerosis ms posing a diagnostic challenge and a therapeutic enigma since it is difficult to distinguish from a true central nervous system cns neoplasm or other cns lesions on magnetic resonance imaging mri. Proton mr spectroscopy of tumefactive demyelinating.
Article information, pdf download for characterization of tumefactive. Tumefactive demyelinating lesions tdls are large usually 2 cm demyelinating brain lesions that mimic primary brain tumors, including primary central nervous system lymphoma pcnsl. Conventional and advanced magnetic resonance imaging in tumefactive demyelina tion show all authors. Differential diagnosis of such space occupying lesions may. Tumefactive multiple sclerosis is a rare form of multiple sclerosis ms. Tumefactive demyelinating lesion tdl or monofocal acute inflammatory demyelination is a locally aggressive form of demyelination usually manifesting as a solitary lesion mimicking a neoplasm on. Whether tumefactive demyelination constitutes a disease variant within. Tumefactive multiple sclerosis is a condition in which the central nervous system of a person has multiple demyelinating lesions with atypical characteristics for those of standard multiple sclerosis ms. We present a case of a large solitary demyelinating plaque in the brain masquerading as tumour. Tumefactive multiple sclerosis is a condition in which the central nervous system of a person. Approximately half of tumefactive demyelinating lesions have pathologic contrast enhancement, usually in the form of ring enhancement 2, 4 figs. Perfusion imaging of tumefactive demyelinating lesions compared.
Tumefactive demyelinating lesions are a rare manifestation of multiple sclerosis ms. Advanced mr imaging techniques in the diagnosis of. A challenging diagnosis of lateonset tumefactive multiple. Large focal tumorlike demyelinating lesions of the fig.
To identify imaging characteristics of tdls for their proper diagnosis, their differences from malignant gliomas, etc. However, demyelinating lesions seen in multiple sclerosis or tumefactive demyelination during the active phase of inflammation can also enhance, though the enhancement pattern of these lesions. On magnetic resonance spectroscopy, decreased nacetylaspartate naa levels and other patterns proposed by some authors may aid in differentiation of tumefactive demyelination from neoplasm. Mri brain was suggestive of tumefactive demyelination mass lesion involving right occipitoparietal region. The natural course of the disease has been characterized as presenting with a masslike demyelinating lesion. We reported a case of a 49yearold woman with well controlled hypertension, who presented. Differentiation of tumefactive demyelinating lesions from high. Request pdf characterization of tumefactive demyelinating lesions using mr imaging and invivo proton mr spectroscopy diagnosis of tumefactive. The mri appearance of tumefactive demyelinating lesions. Tumefactive demyelinating lesion tdl is defined as a solitary demyelinating lesion. Proton magnetic resonance spectroscopy differentiates tumefactive demyelinating lesions from gliomas ryotaro ikeguchi et al. Imaging evaluation of demyelinating processes of the. Article information, pdf download for tumefactive demyelinating lesions.
Spectroscopic magnetic resonance imaging of a tumefactive. A 34 year old healthy woman presented with sudden onset of left hemiparesis. Pdf tumefactive demyelinating lesions are a rare manifestation of multiple sclerosis ms. Tumefactive multiple sclerosis is a form of demyelinating disease which patient can present with acute stroke. Pitfalls in the diagnosis of a tumefactive demyelinating. Tumefactive demyelinating lesions tdl are defined as solitary demyelinating lesion with a dimension of 2 cm. Tumefactive demyelinating lesions tdls are often misdiagnosed as brain tumors. Tumefactive multiple sclerosis clinically mimicking acute.
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