MRI Findings in Tumefactive Demyelinating Lesions: A Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Radiology
• Oncology

Background:

• Accurate diagnosis of tumefactive demyelinating lesions (TDLs) is critical to prevent misdiagnosis, unnecessary biopsies, and incorrect treatments.
• Differentiating TDLs from primary brain tumors is a significant clinical challenge.

Purpose of the Study:

• To evaluate conventional and advanced Magnetic Resonance (MR) imaging findings in TDLs.
• To determine the diagnostic performance of MR imaging in distinguishing TDLs from primary brain tumors.

Main Methods:

• A systematic literature search was conducted on Ovid MEDLINE and EMBASE up to December 6, 2017.
• Included original articles describing MR imaging findings in patients with TDLs.
• Pooled incidences of MR imaging findings were calculated using random-effects models; diagnostic performance was assessed using bivariate random-effects models.

Main Results:

• Nineteen studies with 476 patients were analyzed.
• Conventional MR imaging showed a high incidence of T2 hypointense rim (48%), absent/mild mass effect (67%), and absent/mild perilesional edema (57%).
• Advanced MR imaging revealed high apparent diffusion coefficient, peripheral restricted diffusion, and low cerebral blood volume in TDLs. MR imaging demonstrated high pooled sensitivity (89%) and specificity (94%) for differentiating TDLs from brain tumors.

Conclusions:

• Conventional MR imaging findings can aid in differentiating TDLs from primary brain tumors.
• Further research is necessary to establish the added diagnostic value of advanced MR imaging techniques for TDLs.