Clinicoradiologic features distinguish tumefactive multiple sclerosis from CNS neoplasms

Lin, Xuling; Yu, Wai‐Yung; Liauw, Lishya; Chander, Russell J.; Soon, Weiling E.; Lee, Hwei Yee; Tan, Kevin

doi:10.1212/cpj.0000000000000319

Cited by 19 publications

(20 citation statements)

References 24 publications

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“…There were also differences in symptom type as TDL more commonly presented with ataxia, hemi-sensory disturbance, and diplopia, whereas GTC seizures and dysphasia were more common in patients with HGG. Previous research has found no difference in the presentation of patients with TDL and HGG,[ 9 ] but this study demonstrated significant differences in the presentation of both entities. This aids with differentiating between TDL and HGG, although the differences are not pathognomonic.…”

Section: Discussioncontrasting

confidence: 88%

Tumefactive multiple sclerosis versus high-grade glioma: A diagnostic dilemma

French¹

2021

Surgical Neurology International

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Background: Tumefactive demyelinating lesions (TDLs) share similar clinical features and MRI characteristics with high-grade glioma (HGG). This study develops an approach to navigating this diagnostic dilemma, with significant treatment implications as the management of both entities is drastically different. Methods: A retrospective analysis of 41 TDLs and 91 HGG with respect to demographics, presentation, and classical MRI characteristics was performed. A diagnostic pathway was then developed to help diagnose TDLs based on whole neuraxis MRI and cerebrospinal fluid (CSF) examination. Results: The diagnosis of TDL is more likely than HGG in younger females who present with subacute or chronic symptoms. MRI characteristics favoring TDL over HGG include smaller size, open rim enhancement, little or no associated edema or mass effect, and the presence of a T2 hypointense rim. MRI of the whole neuraxis for detection of other lesions typical of multiple sclerosis (MS), in combination with a lumbar puncture (LP) showing positive CSF-specific oligoclonal bands (OCB), was positive in 90% of the TDL cohort. Conclusion: The diagnostic pathway, proposed on the basis of specific clinicoradiological features, should be followed in patients with suspected TDL. If MRI demonstrates other lesions typical of MS and LP demonstrates positive CSF-specific OCBs, then patients should undergo a short course of IV steroids to look for clinical improvement. Patients who continue to deteriorate, do not demonstrate other lesions on MRI or where the LP is negative for CSF-specific OCB, should be considered for biopsy if safe to do so. This pathway will give the patients the best chance at neurological preservation.

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Section: Discussioncontrasting

confidence: 88%

Tumefactive multiple sclerosis versus high-grade glioma: A diagnostic dilemma

French¹

2021

Surgical Neurology International

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“…Most of the TDL and CNSL demonstrate hypointensity or mixed signal intensity relative to white matter on T1W images. Both TDL and CNSL also demonstrate hyperintensity or mixed signal intensity compared to grey matter on T2W images (9). In our cases, the lesions demonstrated T1W hypointensity as compared to white matter and T2W hyperintensity as compared to grey matter.…”

Section: Discussionsupporting

confidence: 51%

Magnetic Resonance Imaging (MRI) Features in Diagnosing Tumefactive Demyelinating Lesion.

Foo¹,

Rahim²,

Mustapha³

et al. 2022

CVNS

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Background: A demyelinating lesion can present as a space occupying lesion in Magnetic Resonance Imaging (MRI) brain. Lesions that have diameter greater than 2 cm is referred as tumefactive demyelinating lesion. These lesions can mimic a brain tumor, namely glioma or primary central nervous system lymphoma. Case presentation: We present two female patients over 30 years old who presented with limb weakness. Their MRI demonstrated typical appearance of a solitary, incomplete rim enhancing lesion that involved the subcortical white matter with minimal mass effect. Also, the rim of enhancement opened to the grey matter. Due to their typical appearance, biopsy was not performed. The lesions in both patients reduced in size upon follow up after treatment commencement and currently recovering. Conclusion: In this case report, we focus on discussing the MRI features of tumefactive demyelinating lesion and its main differentials, which are central nervous system lymphoma (CNSL) and glioma.

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“…As evidenced in this case, we caution against overinterpreting the specificity of the ‘open-ring’ enhancement pattern, with no restricted diffusion, as a sign of inflammatory aetiology 1 2. The lack of response to immunosuppressive treatment and EBV positivity were unusual for an inflammatory disease process and prompted histological confirmation with a brain biopsy.…”

Section: Descriptionmentioning

confidence: 64%