Related Experiment Video
Updated: May 6, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Correlation between Magnetic Resonance Imaging Findings and Pathological Observations in Tumefactive Multiple
M Kobayashi1, Y Ono, N Shibata
1Department of Neurology, Tokyo Women's Medical University; Tokyo, Japan - masaki.kob@nifty.ne.jp.
Abstract:
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Tumefactive MS (TMS) is a subtype of MS characterized by solitary or multiple mass lesions with open-ring enhancement on brain magnetic resonance imaging (MRI). Three TMS cases, diagnosed histopathologically by brain biopsy, that were difficult to distinguish from brain tumors or brain abscesses on MRI are presented. On T2-weighted imaging (T2WI) the lesions were high intensity in the center and periphery, with open-ring contrast enhancement at the periphery; iso- to low intensity areas ("T2 low rim") were seen in the surrounding region. Histopathological examination revealed the characteristic features of TMS: severe central demyelination and focal necrosis, peripheral neovascularization and perivascular inflammatory cell infiltration, and perifocal edema. On immunochemistry, both the endothelial cells of the neovasculature and the surrounding macrophages in the periphery expressed vascular endothelial growth factor and monocyte chemoattractant protein-1, which mediate inflammation and angioneogenesis and increase vascular permeability. These findings correspond to the T2 low rim co-localizing with the site of gadolinium enhancement on MRI. Thus, the present study clearly demonstrates the correlation between the radiological features and the pathophysiological aspects of TMS, which may contribute to more precise diagnosis of TMS.
Insights
Tumefactive multiple sclerosis (TMS) lesions show specific MRI features like T2 low rim, correlating with histopathology. This study links imaging findings to inflammation and blood vessel growth, aiding precise TMS diagnosis.
Area of Science:
- Neuroimmunology
- Neuroradiology
- Neuropathology
Background:
- Multiple sclerosis (MS) is a central nervous system inflammatory demyelinating disease.
- Tumefactive MS (TMS) presents as large, distinct lesions on MRI, often mimicking tumors or abscesses.
- Distinguishing TMS from other brain pathologies can be challenging based solely on initial imaging.
Purpose of the Study:
- To present three histopathologically confirmed cases of TMS.
- To correlate specific MRI findings with underlying pathophysiological processes in TMS.
- To improve diagnostic accuracy for TMS by linking radiological and biological features.
Main Methods:
- Case presentation of three patients with histopathologically diagnosed TMS.
- Analysis of MRI characteristics including T2-weighted imaging (T2WI) and contrast enhancement patterns.
- Histopathological examination of brain biopsies, including immunochemistry for specific markers.
Main Results:
- TMS lesions exhibited central high intensity on T2WI with peripheral open-ring enhancement and a surrounding "T2 low rim".
- Histopathology revealed central demyelination/necrosis and peripheral inflammation/neovascularization.
- Immunochemistry showed vascular endothelial growth factor and monocyte chemoattractant protein-1 expression in lesion peripheries, correlating with MRI findings.
Conclusions:
- The "T2 low rim" and gadolinium enhancement in TMS correlate with neovascularization and inflammatory cell infiltration.
- Understanding these correlations enhances the ability to differentiate TMS from other brain lesions.
- This study provides a bridge between radiological presentation and the biological mechanisms of TMS.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:19Multiple Sclerosis l: Introduction
01:27Imaging Studies IV: Magnetic Resonance Imaging