Is size an essential criterion to define tumefactive plaque? MR features and clinical correlation in multiple sclerosis

Abstract

Tumefactive multiple sclerosis is an inflammatory demyelinating disease of the central nervous system. It has recently been described as a rare subtype of multiple sclerosis (MS) characterised by the appearance of solitary or multiple space-occupying lesions associated with imaging characteristics mimicking neoplasm. Atypical features include plaque size >2 cm with mass effect, oedema, and/or ring enhancement on magnetic resonance (MR) images.This study is a retrospective review designed to evaluate the prevalence of tumefactive plaques in a selected population of 440 MS patients referred to our MS centre in Southern Italy between 2005 and 2014. We analysed the radiographic features of lesions ranging in size from 0.5 to 2 cm to establish whether smaller plaques with MR characteristics similar to tumefactive plaques present different symptoms, disease evolution and prognosis. We also aimed to ascertain if MR features suggestive of biological aggressiveness could be useful prognostic criteria for a correct diagnosis of the disease and subsequent treatment. Our data suggest that lesions 0.5-2 cm and >2 cm have similar MR features and clinical evolution.

Value of 18F-FET PET in Patients With Suspected Tumefactive Demyelinating Disease—Preliminary Experience From a Retrospective Analysis

“…TMS is defined as a large (>2 cm) lesion on radiologic imaging, which is often accompanied by edema and mass effect and shows ring enhancement. 1,7,8 However, a recent trial showed that lesions <2 cm may exhibit similar imaging characteristics, reflecting the ambiguity of the definition of TMS lesions. 8 So far, no large-scale epidemiological data is available on TDD.…”

“…1,7,8 However, a recent trial showed that lesions <2 cm may exhibit similar imaging characteristics, reflecting the ambiguity of the definition of TMS lesions. 8 So far, no large-scale epidemiological data is available on TDD. 1,7 In older trials, the incidence of TDD was estimated 0.3 cases per 100,000 population per year, and the prevalence 1-2 per 1000 cases of MS, [9][10][11] with a slight female predominance.…”

Demyelinating lesions behaving like aggressive tumours on advanced MRI techniques

“…7 TDLs are most frequently encountered in women, usually young to middle aged with an average disease onset at 37 years of age. 3 Symptoms depend on location and usually include focal neurological deficits, seizures and aphasia.…”

“…Tumefactive demyelinating lesions (TDLs) are a locally aggressive form of demyelination usually manifesting as a solitary lesion greater than 2 cm in size that may mimic a neoplasm on imaging studies 1,2 and may pose a diagnostic challenge in patients without a pre-existing diagnosis of multiple sclerosis. 3 These lesions more commonly occur in women with an average age of 37 years. 4 However, they may occur at any age, including in children.…”

A Blind Spot in the Diagnostic Field: The Challenging Diagnosis of Tumefactive Multiple Sclerosis

“…TMS can mimic the clinical and radiological features of a neoplasm, cerebral abscess, or inflammatory process and can be diagnostically challenging for clinicians. It is often misdiagnosed, and while neuroimaging may narrow the differential, a biopsy may be needed to make the definitive diagnosis [ 5 , 6 ]. TMS is characterized by well-demarcated hypointense lesions on computed tomography (CT) and is hyperdense on T2 and relatively hypodense on TI.…”