18F-FDG PET/CT in tumefactive multiple sclerosis

Area of Science:

• Neuroimaging
• Neurology
• Immunology

Background:

• Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
• Tumefactive MS (TMS) is a rare, aggressive variant characterized by large demyelinating lesions.
• Accurate and timely diagnosis is crucial for effective management of MS.

Observation:

• A 35-year-old male presented with acute peripheral paresthesia, vision loss, muscle weakness, and gait disturbance.
• Contrast-enhanced MRI revealed multiple periventricular white matter lesions, two with nodular characteristics.
• F-FDG PET/CT demonstrated moderate focal uptake in the nodular lesions (SUVmax 6.9).

Findings:

• Cerebrospinal fluid analysis indicated elevated immunocytes and oligoclonal antibody bands.
• The combination of clinical presentation, MRI, PET/CT findings, and CSF analysis supported the diagnosis.
• The patient was diagnosed with acute onset tumefactive multiple sclerosis.

Implications:

• This case underscores the utility of integrated neuroimaging techniques, including F-FDG PET/CT, in diagnosing challenging MS presentations.
• Early identification of tumefactive MS is essential for initiating appropriate immunosuppressive therapies.
• Further research into the specific imaging biomarkers for TMS could improve diagnostic accuracy and patient outcomes.