Malhotra H S, Jain K K, Agarwal A, Singh M K, Yadav S K, Husain M, Krishnani N, Gupta R K
Department of Neurology, Chhatrapati Sahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
Mult Scler. 2009 Feb;15(2):193-203. doi: 10.1177/1352458508097922.
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.
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).
All the lesions appeared hyperintense on T2 and FLAIR images. Increased Apparent diffusion coefficient (ADC) (0.93-2.21 x 10(-3) mm(2)/s) in centre of the lesion was seen in 14/18 cases; however, peripheral restriction (ADC values 0.55-0.64 x 10(-3) mm(2)/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.
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.
肿瘤样脱髓鞘病变（TDLs）的诊断对临床医生和放射科医生来说都具有挑战性。本研究的目的是从临床、生化、电生理及影像学方面对这些病变进行分析和特征描述。
对18例TDLs患者进行回顾性分析并进行前瞻性随访。影像学检查包括T2加权、T1加权、液体衰减反转恢复序列（FLAIR）、增强T1加权、扩散加权成像（DWI）和质子磁共振波谱（PMRS）。
所有病变在T2加权和FLAIR图像上均表现为高信号。14/18例患者病变中心表观扩散系数（ADC）升高（0.93 - 2.21×10⁻³ mm²/s）；然而，11/18例患者病变周边出现扩散受限（ADC值为0.55 - 0.64×10⁻³ mm²/s）。13/18例患者出现强化，强化方式包括开环（n = 5）、闭环（n = 1）、轻度（n = 4）和浸润性（n = 3）。这13例患者中有9例还出现了小静脉强化。在PMRS上，9例患者在2.4 ppm处显示谷氨酸/谷氨酰胺（Glx）。
临床特征以及一些MRI特征，如开环强化、DWI上的周边扩散受限、小静脉强化和波谱上Glx的存在，可能有助于将TDLs与肿瘤性病变区分开来。
