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Characterization of tumefactive demyelinating lesions using MR imaging and in-vivo proton MR spectroscopy

Department of Neurology, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

KK Jain

Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

A Agarwal

Department of Neurology, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

MK Singh

Department of Neurology, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

SK Yadav

Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

M Husain

Department of Neurosurgery, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India

N Krishnani

Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

RK Gupta

Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India rgupta{at}sgpgi.ac.in

Background and Objectives

Diagnosis of tumefactive demyelinating lesions (TDLs) is challenging to both clinicians and radiologists. Our objective in this study was to analyze and characterize these lesions clinically, biochemically, electrophysiologically, and on imaging.

Methods

A retrospective analysis with prospective follow-up of 18 cases of TDLs was performed. Imaging included T2-, T1-weighted, fluid-attenuated inversion recovery (FLAIR), post-contrast T1-weighted, diffusion weighted imaging (DWI), and proton magnetic resonance spectroscopy (PMRS).

Results

All the lesions appeared hyperintense on T2 and FLAIR images. Increased Apparent diffusion coefficient (ADC) (0.93–2.21 x 10^–3 mm²/s) in centre of the lesion was seen in 14/18 cases; however, peripheral restriction (ADC values 0.55–0.64 x 10^–3 mm²/s) was noted in 11/18 cases. In all, 13/18 cases showed contrast enhancement with open ring (n = 5), complete ring (n = 1), minimal (n = 4), and infiltrative (n = 3) pattern of enhancement. Nine of these 13 cases also showed venular enhancement. On PMRS, nine showed glutamate/glutamine (Glx) at 2.4 ppm.

Conclusion

Clinical features along with several MRI characteristics such as open ring enhancement, peripheral restriction on DWI, venular enhancement, and presence of Glx on spectroscopy may be rewarding in differentiating TDLs from neoplastic lesions.

Key Words: apparent diffusion coefficient • diffusion weighted imaging • glutamate • magnetic resonance imaging • proton magnetic resonance spectroscopy • tumefactive demyelinating lesions

Multiple Sclerosis, Vol. 15, No. 2, 193-203 (2009)
DOI: 10.1177/1352458508097922


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