Tumefactive Primary Central Nervous System Vasculitis: Dynamic Susceptibility Contrast Perfusion-Weighted Magnetic...

Area of Science:

• Neurology
• Radiology
• Oncology

Background:

• Primary central nervous system vasculitis (PCNSV) is a rare inflammatory condition.
• Tumefactive PCNSV (t-PCNSV) can mimic intracranial neoplasms, causing diagnostic challenges.
• Conventional MRI sequences often fail to differentiate t-PCNSV from tumors.

Purpose of the Study:

• To evaluate the utility of dynamic susceptibility contrast (DSC) perfusion-weighted imaging (PWI).
• To differentiate t-PCNSV lesions from intracranial neoplasms like glioblastomas and metastases.
• To assess the significance of DSC-PWI in the diagnostic work-up of t-PCNSV.

Main Methods:

• Retrospective study comparing DSC-PWI in 8 patients with biopsy-proven t-PCNSV.
• Comparison group included 10 patients with glioblastoma and 10 with metastasis.
• Calculation of relative cerebral blood volume ratio (rrCBV) in enhancing solid lesion areas.

Main Results:

• Mean rrCBV in t-PCNSV lesions was significantly lower (0.86±0.7) compared to glioblastoma (5.16±0.79) and metastases (4.27±0.73).
• t-PCNSV lesions showed rrCBV similar to or lower than contralateral normal white matter.
• Glioblastoma and metastasis lesions exhibited markedly elevated rrCBV.

Conclusions:

• DSC-PWI is a valuable tool for diagnosing t-PCNSV.
• A low rrCBV is indicative of t-PCNSV, aiding differentiation from malignant brain tumors.
• This imaging technique can reduce diagnostic confusion in challenging cases.