De Simone Marta, Brogna Barbara, Spitaleri Daniele Litterio, Cicarelli Giulio, Fantozzi Roberta, Guida Bruno
Neuroradiology Unit "San Giuseppe Moscati" Hospital Avellino, Amoretta Street, 83100, Avellino, Italy.
Department of Internal and Experimental Medicine "Magrassi-Lanzara", Institute of Radiology, Second University of Naples, Naples, Italy.
Radiol Case Rep. 2017 Dec 8;13(1):254-260. doi: 10.1016/j.radcr.2017.10.026. eCollection 2018 Feb.
Tumefactive demyelinating lesions (TDLs) are atypical presentations of various demyelinating diseases. They can mimic brain tumors in their clinical and radiological features and usually respond favorably to corticosteroid therapy. We report a case of a 17-year-old girl with a single TDL suddenly increasing in size even under steroid therapy. She underwent very strict follow-up examinations with conventional magnetic resonance and diffusion-weighted imaging, perfusion-weighted imaging, proton-magnetic resonance spectroscopy. The behavior of the lesion during the different follow-up sessions posed a diagnostic challenge as it expanded its size during the final examination, in stark contrast to what we forecast. Diagnosis of TDL was initially hypothesized, but the aggressive behavior of the lesion required biopsy.
瘤样脱髓鞘病变（TDLs）是各种脱髓鞘疾病的非典型表现。它们在临床和放射学特征上可模仿脑肿瘤，并且通常对皮质类固醇治疗反应良好。我们报告一例17岁女孩，其单个TDL即使在类固醇治疗下尺寸仍突然增大。她接受了非常严格的随访检查，包括传统磁共振成像、扩散加权成像、灌注加权成像和质子磁共振波谱分析。病变在不同随访阶段的表现带来了诊断挑战，因为在最后一次检查时其尺寸增大，与我们的预测形成鲜明对比。最初推测为TDL诊断，但病变的侵袭性表现需要进行活检。
