Benign course of tumour-like multiple sclerosis. Report of five cases and literature review

Open-Ring Enhancement in Pseudotumoral Multiple Sclerosis: Important Radiological Aspect

“…According to some studies, one-third (1/3) to two-thirds (2/3) of those who initially develop a tumefactive MS lesion progress to the recurrent, remittent course typical of MS [1, 2]. …”

“…Its prevalence is estimated to be 1-2 cases per 1000 cases of MS [1, 2]. There seems to be no predominance between genders; greater frequency is reported in patients aged 10–30 [1].…”

Chinese Guidelines for the Diagnosis and Management of Tumefactive Demyelinating Lesions of Central Nervous System

“…For the clinical symptoms and signs,[2155354] three of the four items need to be satisfied: (1) young adults or adults onset; (2) acute or subacute onset; (3) headache as the initial symptom; (4) the severity of the disease is consistent with neuroimaging findings (for some infectious diseases, the clinical symptoms and signs are more obvious than neuroimaging findings, while the glioma is the opposite).For laboratory workups,[2] three of the five items need to be satisfied: (1) normal or mild elevation of intracranial pressure (usually ≤240 mmH 2 O); (2) normal or mildly elevated cell count (usually ≤50/mm 3 ); (3) normal or mildly to moderately elevated protein in CSF (usually ≤10,000 mg/L); (4) positive CSF-OB and/or elevated MBP; (5) positive serum AQP4.For neuroimaging,[271526] one of the following two items needs to be satisfied: (1) multiple foci, but not miliary, two hemispheres involved; (2) clear margin of the lesion (sometimes hypointense margin on T2WI).Dynamics of the lesions on contrast-enhanced MRI develop in different clinical stages (≤3 weeks, 4–6 weeks, and >7 weeks):[28] the same lesion shows “nodular”- or “patchy”- to “circular”- (“open-ring-shaped,” “rosette-shaped,” “flame-shaped”) shaped enhancement, and then the enhancement reduced gradually.Lesion with “ring”-shaped enhancement in morphology is detected on contrast-enhanced MRI,[21725545556] with the following features: the “ring” is not continuous, with one or multiple openings, and thus showing “open-ring”-, “C”- or inverse “C”-shaped enhancement.Positive “comb” sign: “comb”-shaped dilated venules within the paraventricular lesions on contrast-enhanced MRI. [225]…”

“…For the clinical symptoms and signs,[2155354] three of the four items need to be satisfied: (1) young adults or adults onset; (2) acute or subacute onset; (3) headache as the initial symptom; (4) the severity of the disease is consistent with neuroimaging findings (for some infectious diseases, the clinical symptoms and signs are more obvious than neuroimaging findings, while the glioma is the opposite).…”

Everything Old is New Again

“…These features included lesion size greater than 2 cm on T2-weighted images, with edema and mass effect and incomplete ring enhancement with the ring opening towards either the cortical gray matter or the basal ganglia 1 3 , 4 Lesions were typically supratentorial and involved the frontal white matter most commonly, followed by the parietal subcortical white matter 1 3 A nonspecific butterfly configuration with involvement of the splenium of the corpus callosum was less commonly seen 1 …”