Article Figures & Data
Figures
- Fig 1.
Images in a 50-year-old woman with biopsy-proven tumefactive demyelinating lesion.
A, Contrast-enhanced axial T1-weighted image (600/14/1) demonstrates an ill-defined enhancing mass (arrow) in the left frontoparietal periventricular white matter.
B, Axial T2-weighted image (3400/119/1) shows increased signal intensity (arrow) around the lesion.
C, Localizing image (600/14/1) for proton MR spectroscopy displays a voxel in the central portion of the lesion.
D, Proton MR spectrum obtained by using PRESS (1500/144) demonstrates an elevated Cho value, a decreased NAA value, and a Lac doublet.
- Fig 2.
Images in an 81-year-old man with a high-grade mixed glioma.
A, Contrast-enhanced axial T1-weighted image (600/14/1) demonstrates an ill-defined enhancing mass (arrow) in the left temporal region.
B, Axial T2-weighted image (3400/119/1) shows increased signal intensity (arrow) around the lesion.
C, Localizing image (600/14/1) for proton MR spectroscopy displays a voxel in the central portion of the lesion.
D, Proton MR spectrum obtained by using PRESS (1500/144) demonstrates an elevated Cho value and a decreased NAA value.
- Fig 3.
Photomicrographs of a biopsy specimen from a tumefactive demyelinating lesion in a 50-year-old woman. Left, A Luxol fast blue stain demonstrates extensive myelin loss. The lower left corner (arrow) shows a relatively normal pattern of myelination. Right, Silver stain demonstrates relative preservation of axis cylinders.
Tables
- TABLE 1:
MR imaging characteristics of tumefactive demyelinating lesions and glioma patients
Patient No. Age (y)/Sex Lesion Lesion Size (cm) Enhancement Edema Mass Effect Necrosis/Cystic Degeneration Lesion Delineation Heterogeneity Additional Lesions 1 50/F TDL 2.9 50% +++ + Yes Ill Yes No 2 46/F TDL 1.7 30% − − No Well No Yes 3 25/M TDL 1.8 10% + + Yes Ill Yes Yes 4 57/M TDL 1.2 <5% + − Yes Ill Yes Yes 5 41/F TDL 2.8 <5% + + No Ill No No 6 49/F TDL 2.1 30% + + Yes Well No No 7 51/M AA 2.7 50% ++ ++ Yes Intermediate Yes Yes 8 39/M AA 1.4 90% + + No Ill Yes Yes 9 44/M AO 4.3 50% +++ +++ Yes Ill Yes No 10 28/M AA 1.9 90% + + No Ill No Yes 11 38/M AMG 1.4 90% ++ + No Intermediate No No 12 38/M AA 1.7 10% + + Yes Ill Yes Yes 13 80/M AMG 3.5 80% + ++ Yes Well Yes No 14 25/F AA 4.8 50% ++ ++ Yes Ill Yes No 15 60/M GBM 2.3 80% + + Yes Ill Yes Yes 16 34/M GBM 5.2 50% +++ +++ Yes Ill Yes Yes Note.—TDL indicates tumefactive demyelinating lesion; AA, anaplastic astrocytoma; AO, anaplastic oligodendroglioma; AMG, anaplastic mixed glioma; GBM, glioblastoma multiforme.
- TABLE 2:
MR spectroscopy characteristics of tumefactive demyelinating lesions and glioma patients
Patient No. Lesion Enhancing Region Central Region Perilesional T2 Region Contralateral Normal Brain Cho/Cr NAA/Cr Lac Cho/Cr NAA/Cr Lac Cho/Cr NAA/Cr Lac Cho/Cr NAA/Cr Lac 1 TDL 4.6 1.0 ++ 3.5 1.0 ++ 1.7 1.2 + 0.5 1.6 − 2 TDL 1.8 1.9 + 3.0 3.2 ++ 1.6 2.9 + 0.9 1.6 − 3 TDL 1.7 0.7 − 4.9 2.3 + 1.9 1.2 − 0.7 1.6 − 4 TDL 2.4 1.3 − 3.3 2.7 − 1.5 0.3 − 0.8 2.0 − 5 TDL 2.8 1.9 − 1.6 2.5 − 1.4 2.6 − 1.4 3.0 − 6 TDL 1.7 1.7 + 2.3 1.4 − 1.1 1.7 − 0.9 1.9 − 7 AA 3.3 1.2 − 1.5 1.2 − 1.8 2.0 − 0.5 1.7 − 8 AA 3.3 0.7 − 9.0 1.1 − 1.0 0.9 − 0.7 1.2 − 9 AO 0.9 0.7 − 2.1 1.1 − 1.3 0.9 + 0.9 1.1 − 10 AA 4.3 0.9 − 3.8 0.8 − 2.0 1.4 − 0.7 1.7 − 11 AMG 2.5 0.6 − 2.5 0.6 − 2.0 1.3 − 1.6 3.6 − 12 AA 1.3 0.6 − 1.6 0.5 − 1.2 0.9 − 0.9 1.4 − 13 AMG 10.3 0.8 + 11.3 1.6 − 1.2 2.1 + 0.8 2.0 − 14 AA 12.7 0.6 − 4.7 0.8 + 1.5 1.3 − 1.1 1.5 − 15 GBM 1.8 0.7 − 2.2 0.9 − 1.5 1.2 − 1.0 1.5 − 16 GBM 10.0 1.0 − 4.4 0.8 − 2.3 1.0 − 1.2 2.1 − Note.—TDL indicates tumefactive demyelinating lesion; AA, anaplastic astrocytoma; AO, anaplastic oligodendroglioma; AMG, anaplastic mixed glioma; GBM, glioblastoma multiforme.
- TABLE 3:
Comparison of spectroscopic characteristics of tumefactive demyelinating lesions and gliomas
Region TDL (n = 6) Glioma (n = 10) P Value Median Range Median Range Enhancing Region Cho/Cr 2.1 1.7–4.6 3.3 0.9–12.7 .328 NAA/Cr 1.5 0.7–1.9 0.7 0.6–1.2 .014 Central Region Cho/Cr 3.2 1.6–4.9 3.2 1.5–11.3 .914 NAA/Cr 2.4 1.0–3.2 0.9 0.5–1.6 .008 Perilesional T2 Region Cho/Cr 1.6 1.1–1.9 1.5 1.0–2.3 .956 NAA/Cr 1.5 0.3–2.9 1.3 0.9–2.1 .478 Contralateral Normal Brain Cho/Cr 0.9 0.5–1.4 0.9 0.5–1.6 .621 NAA/Cr 1.8 1.6–3.0 1.6 1.1–3.6 .383 Note.—Using the Wilcoxon rank-sum test and a Bonferroni correction for multiple comparisons, P < .0125 is considered statistically significant.
Region Cho/Cr P Value NAA/Cr P Value TDL (n = 6) Enhancing Region .031 .094 Central Region .031 .400 Perilesional T2 Region .045 .293 Glioma (n = 10) Enhancing Region .007 .006 Central Region .006 .007 Perilesional T2 Region .006 .041
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