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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Monophasic, solitary tumefactive demyelinating lesion: neuroimaging features and neuropathological diagnosis
1Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore 168609.
Abstract:
The characteristic clinicoradiological findings of multiple sclerosis and acute disseminated encephalomyelitis (ADEM), demonstrating a recurrent progressive course in the former and monophasicity in the latter associated with multiple discrete white matter lesions with variable enhancement on MRI, are not a diagnostic challenge. On the other hand, the less typical radiological presentation of a solitary tumefactive demyelinating lesion mimics a neoplasm, and often necessitates a biopsy. Nonetheless, histopathological examination is an imperfect gold standard and the recognition of certain imaging features may facilitate the correct diagnosis.
Insights
Multiple sclerosis and acute disseminated encephalomyelitis (ADEM) typically present with distinct MRI findings. Recognizing specific imaging features can help differentiate these conditions and avoid unnecessary biopsies for solitary tumefactive lesions.
Area of Science:
- Neurology
- Radiology
- Pathology
Background:
- Multiple Sclerosis (MS) and Acute Disseminated Encephalomyelitis (ADEM) are demyelinating diseases with characteristic clinicoradiological presentations.
- MS typically shows a relapsing-remitting course with multiple white matter lesions on MRI.
- ADEM usually presents as a monophasic illness with similar MRI findings.
Observation:
- Atypical presentations, particularly solitary tumefactive demyelinating lesions, can mimic neoplasms on MRI.
- These tumefactive lesions often require biopsy for definitive diagnosis.
- Histopathological examination, while considered a gold standard, has limitations.
Findings:
- Characteristic MRI findings aid in differentiating typical MS and ADEM.
- Identifying specific imaging features can help diagnose solitary tumefactive demyelinating lesions.
- Recognizing imaging patterns can potentially reduce the need for invasive procedures.
Implications:
- Accurate radiological diagnosis can prevent misdiagnosis and unnecessary invasive procedures like biopsies.
- Improved understanding of imaging features can lead to earlier and more accurate diagnosis of demyelinating diseases.
- This knowledge can refine diagnostic algorithms for complex neurological presentations.
