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Clinicoradiologic features distinguish tumefactive multiple sclerosis from CNS neoplasms
Xuling Lin1, Wai-Yung Yu1, Lishya Liauw1
1National Neuroscience Institute (XL, W-YY, LL, CRJ, WES, KT); and Tan Tock Seng Hospital (HYL), Singapore.
Neurology. Clinical Practice
|June 1, 2018
Summary
Radiologic features, not symptoms, help differentiate tumefactive multiple sclerosis (TMS) from brain tumors like glioma and CNS lymphoma (CNSL). Key MRI findings aid in diagnosis, potentially avoiding biopsies.
Area of Science:
- Neurology
- Radiology
- Oncology
Background:
- Differentiating tumefactive multiple sclerosis (TMS) from central nervous system (CNS) neoplasms is challenging due to limited data.
- Accurate differentiation is crucial for appropriate patient management and avoiding invasive diagnostic procedures like biopsies.
Purpose of the Study:
- To identify distinct clinical and radiologic features that differentiate TMS from glioma and CNS lymphoma (CNSL) in patients presenting with tumefactive lesions.
Main Methods:
- Retrospective review of 133 patients with tumefactive lesions (1999-2012).
- Two blinded neuroradiologists assessed MRI scans at presentation.
- Correlation of demographic, clinical, laboratory, and radiologic data with final diagnosis (TMS, glioma, or CNSL).
Main Results:
- Younger age and higher female proportion observed in TMS patients.
- TMS lesions were smaller, with less mass effect, and showed contrast enhancement.
- Distinctive radiologic features for TMS included incomplete rim enhancement, peripheral diffusion restriction, and mixed T2 signal/CT hypoattenuation (p < 0.05).
Conclusions:
- Radiologic findings are more effective than presenting symptoms in distinguishing TMS from CNS neoplasms.
- Specific MRI characteristics can aid in the differential diagnosis of tumefactive lesions.
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