A tumefactive demyelinating lesion (TDL) is a solitary lesion greater than 2 cm that mimics a neoplasm on imaging 3.
Patients present with symptoms atypical for multiple sclerosis : focal neurologic deficits, seizures, and / or aphasia 5. Most do not progress to multiple sclerosis 6.
The lesions tend to be large but with relatively little mass effect or surrounding oedema. Centrally located dilated veins have also been observed within these lesions 1.
- T1 C+ (Gd) : about half of tumefactive demyelinating lesions demonstrate contrast enhancement 2 ; the enhancement pattern is usually in the form on an open ring and the incomplete portion of the ring is on the gray matter side of the lesion 4.
- perfusion imaging : helps differentiate tumefactive demyelinating lesions from the main differential considerations : high-grade gliomas and lymphomas ; mean relative cerebral blood volume within tumefactive demyelinating lesions have been found to be substantially less than in high-grade gliomas and lymphomas 1.
diffusion imaging (DWI) :
- can be less helpful in differentiating tumefactive demyelinating lesions from tumours, as necrotic neoplasms may display a similar increase in apparent diffusion coefficient (ADC)
- however, diffusion imaging can help differentiate ring-enhancing tumefactive demyelinating lesions from cerebral abscesses
- while the former show mildly increased ADC, the latter demonstrate restricted diffusion. 3
General imaging differential considerations include
- 1. Cha S, Pierce S, Knopp EA et-al. Dynamic contrast-enhanced T2*-weighted MR imaging of tumefactive demyelinating lesions. AJNR Am J Neuroradiol. 22 (6): 1109-16. AJNR Am J Neuroradiol (citation) - Pubmed citation
- 2. Dagher AP, Smirniotopoulos J. Tumefactive demyelinating lesions. Neuroradiology. 1996;38 (6): 560-5. - Pubmed citation
- 3. Given CA, Stevens BS, Lee C. The MRI appearance of tumefactive demyelinating lesions. AJR Am J Roentgenol. 2004;182 (1): 195-9. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Masdeu JC, Moreira J, Trasi S et-al. The open ring. A new imaging sign in demyelinating disease. J Neuroimaging. 1996;6 (2): 104-7. - Pubmed citation
- 5. Paley RJ, Persing JA, Doctor A et-al. Multiple sclerosis and brain tumor: a diagnostic challenge. J Emerg Med. 7 (3): 241-4. - Pubmed citation
- 6. Saindane AM, Cha S, Law M et-al. Proton MR spectroscopy of tumefactive demyelinating lesions. AJNR Am J Neuroradiol. 2002;23 (8): 1378-86. AJNR Am J Neuroradiol (full text) - Pubmed citation
Synonyms & Alternative Spellings
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|Tumefactive demyelinating lesions||✗|
|Tumefactive demyelinating lesion (TDL)||✗|