iBet uBet web content aggregator. Adding the entire web to your favor.
iBet uBet web content aggregator. Adding the entire web to your favor.



Link to original content: https://doi.org/10.1007/s00415-014-7437-1
Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology | Journal of Neurology Skip to main content

Advertisement

Springer Nature Link
Log in

Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Tumefactive demyelinating lesions (TDLs) can mimic brain tumors on radiological images. TDLs are often referred to as tumefactive multiple sclerosis (TMS), but the heterogeneous nature and monophasic course of TDLs do not fulfill clinical and magnetic resonance imaging (MRI) criteria for multiple sclerosis. Redefining TDLs, TMS and other inflammatory brain lesions is essential for the accurate clinical diagnosis of extensive demyelinating brain lesions. We retrospectively analyzed MRI from nine TDL cases that underwent brain biopsy. Patterns of gadolinium enhancement on MRI were categorized as homogenous, inhomogeneous, patchy and diffuse, open ring or irregular rim, and were compared with pathological hallmarks including demyelination, central necrosis, macrophage infiltration, angiogenesis and perivascular lymphocytic cuffing. All cases had coexistence of demyelinating features and axonal loss. Open-ring and irregular rim patterns of gadolinium enhancement were associated with macrophage infiltrations and angiogenesis at the inflammatory border. An inhomogeneous pattern of gadolinium enhancement was associated with perivascular lymphocytic cuffing. Central necrosis was seen in cases of severe multiple sclerosis and hemorrhagic leukoencephalopathy. These results suggest that the radiological features of TDLs may be related to different pathological processes, and indicate that MRI may be useful in understanding their pathophysiology. Further investigation is needed to determine the precise disease entity of these inflammatory demyelinating brain lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lucchinetti CF, Gavrilova RH, Metz I et al (2008) Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain 131:1759–1775

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Siva A (2006) The spectrum of multiple sclerosis and treatment decisions. Clin Neurol Neurosurg 108:333–338

    Article  PubMed  Google Scholar 

  3. Dagher AP, Smirniotopoulos J (1996) Tumefactive demyelinating lesions. Neuroradiology 38:560–565

    Article  CAS  PubMed  Google Scholar 

  4. Kiriyama T, Kataoka H, Taoka T et al (2011) Characteristic neuroimaging in patients with tumefactive demyelinating lesions exceeding 30 mm. J Neuroimaging 21:e69–e77

    Article  PubMed  Google Scholar 

  5. Brück W, Bitsch A, Kolenda H et al (1997) Inflammatory central nervous system demyelination: correlation of magnetic resonance imaging findings with lesion pathology. Ann Neurol 42:783–793

    Article  PubMed  Google Scholar 

  6. Nesbit GM, Forbes GS, Scheithauer BW et al (1991) Multiple sclerosis: histopathological and MR and/or CT correlation in 37 cases at biopsy and three cases at autopsy. Radiology 180:467–474

    Article  CAS  PubMed  Google Scholar 

  7. Takahashi T, Fujihara K, Nakashima I et al (2006) Establishment of a new sensitive assay for anti-human aquaporin-4 antibody in neuromyelitis optica. Tohoku J Exp Med 210:307–313

    Article  CAS  PubMed  Google Scholar 

  8. Noseworthy JH, Lucchinetti C, Rodrequez M et al (2000) Multiple sclerosis. N Engl J Med 343:938–952

    Article  CAS  PubMed  Google Scholar 

  9. Wingerchuk DM, Lennon VA, Lucchinetti CF et al (2007) The spectrum of neuromyelitis optica. Lancet Neurol 6:805–815

    Article  CAS  PubMed  Google Scholar 

  10. Wingerchuk DM, Hogancamp WF, O’Brien PC et al (1999) The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 53:1107–1114

    Article  CAS  PubMed  Google Scholar 

  11. Tintore M, Rovira A, Rio J et al (2003) New diagnostic criteria for multiple sclerosis: application in first demyelinating episode. Neurology 60:27–30

    Article  CAS  PubMed  Google Scholar 

  12. Van Waesberghe JH, Kamphorst W, De Groot CJ et al (1999) Axonal loss in MS lesions: MR insight into substrate of disability. Ann Neurol 46:1289–1293

    Google Scholar 

  13. Given CA 2nd, Stevens CS, Lee C (2004) The MRI appearance of tumefactive demyelinating lesions. Am J Radiol 182:195–199

    Google Scholar 

  14. Walner-Blazek M, Rovira A, Filippi M et al (2013) Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis. J Neurol 260:2016–2022

    Article  Google Scholar 

  15. Rossi A (2008) Imaging of acute disseminated encephalomyelitis. Neuroimaging Clin N Am 18:149–161

    Article  PubMed  Google Scholar 

  16. Young NP, Weinshenker BG, Parisi JE et al (2010) Perivenous demyelination: association with clinically defined acute disseminated encephalomyelitis and comparison with pathologically confirmed multiple sclerosis. Brain 133:333–348

    Article  PubMed Central  PubMed  Google Scholar 

  17. Gibbs WN, Kreidie MA, Kim RC et al (2005) Acute hemorrhagic leukoencephalitis neuroimaging features and neuropathologic diagnosis. J Comput Assist Tomogr 29:689–693

    Article  PubMed  Google Scholar 

  18. Xia L, Lin S, Wang ZC et al (2009) Tumefactive demyelinating lesions: nine cases and a review of the literature. Neurosurg Rev 32:171–179

    Article  PubMed  Google Scholar 

  19. Morrissey SP, Stodal H, Zettl U et al (1996) In vivo MRI and its histological correlations in acute adoptive transfer experimental allergic encephalomyelitis. Quantification of inflammation and edema. Brain 119:239–248

    Article  PubMed  Google Scholar 

  20. Schwartz KM, Erickson BJ, Lucchinetti CF (2006) Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology. Neuroradiology 48:143–149

    Article  CAS  PubMed  Google Scholar 

  21. Kirk SL, Karlik SJ (2003) VEGF and vascular changes in chronic neuroinflammation. J Autoimmune 21:353–363

    Article  CAS  Google Scholar 

  22. Su JJ, Osoegawa M, Matsuoka T et al (2006) Upregulation of vascular growth factors in multiple sclerosis: correlation with MRI findings. J Neurol Sci 243:21–30

    Article  CAS  PubMed  Google Scholar 

  23. Proesholdt MA, Jacobson S, Tresser N et al (2002) Vascular endothelial growth factor is expressed in multiple sclerosis plaque and can induce inflammatory lesions in experimental allergic encephalomyelitis rats. J Neuropathol Exp Neurol 61:914–925

    Google Scholar 

  24. Sorensen TL, Ransohoff RM, Strieter RM et al (2004) Chemokine CCL2 and chemokine receptor CCR2 in early active multiple sclerosis. Eur J Neurol 11:445–449

    Article  CAS  PubMed  Google Scholar 

  25. Kobayashi M, Ono Y, Shibata N et al (2009) Correlation between magnetic resonance imaging findings and pathological observations in tumefactive multiple sclerosis. Neuroradiol J 22:155–163

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Drs. T. Maruyama, Y. Muragaki, T. Ochiai, and O. Kubo for biopsy procedures and valuable suggestions. The authors thank Dr. Takahashi (Department of Neurology, Tohoku University) for the analysis of AQP-4 antibodies. A summary of this paper was reported at the 61st meeting of the American Academy of Neurology in 2009. This study was supported by a Health and Labour Sciences Research Grant on Intractable Diseases (Neuroimmunological Diseases) from the Ministry of Health, Labour and Welfare of Japan.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflict of interest.

Ethical standards

The ethics committee at Tokyo Women’s Medical University approved this study. Owing to the retrospective nature of the study, ethics approval was not mandatory.

Author information

Authors and Affiliations

  1. Department of Neurology, School of Medicine, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Masaki Kobayashi, Yuko Shimizu & Shinichiro Uchiyama

  2. Departments of Pathology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Noriyuki Shibata

Authors
  1. Masaki Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuko Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Noriyuki Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shinichiro Uchiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masaki Kobayashi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kobayashi, M., Shimizu, Y., Shibata, N. et al. Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology. J Neurol 261, 1902–1910 (2014). https://doi.org/10.1007/s00415-014-7437-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-014-7437-1

Keywords

Search

Navigation