Differential imaging of atypical demyelinating lesions of the central nervous system

doi:10.1007/s11547-021-01334-y

Review

. 2021 Jun;126(6):827-842.

doi: 10.1007/s11547-021-01334-y. Epub 2021 Jan 24.

Differential imaging of atypical demyelinating lesions of the central nervous system

Matteo Paoletti¹, Shaun Ivan Muzic², Francesca Marchetti², Lisa Maria Farina³, Stefano Bastianello^{3

4}, Anna Pichiecchio^{3

4}

Affiliations

¹ Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy. matteo.paoletti@mondino.it.
² University of Pavia, Pavia, Italy.
³ Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.
⁴ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.

PMID: 33486703
DOI: 10.1007/s11547-021-01334-y

Review

Differential imaging of atypical demyelinating lesions of the central nervous system

Matteo Paoletti et al. Radiol Med. 2021 Jun.

. 2021 Jun;126(6):827-842.

doi: 10.1007/s11547-021-01334-y. Epub 2021 Jan 24.

Authors

Matteo Paoletti¹, Shaun Ivan Muzic², Francesca Marchetti², Lisa Maria Farina³, Stefano Bastianello^{3

4}, Anna Pichiecchio^{3

4}

Affiliations

¹ Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy. matteo.paoletti@mondino.it.
² University of Pavia, Pavia, Italy.
³ Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, PV, Italy.
⁴ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.

PMID: 33486703
DOI: 10.1007/s11547-021-01334-y

Abstract

The detection of atypical and sometimes aggressive or tumefactive demyelinating lesions of the central nervous system often poses difficulties in the differential diagnosis. The clinical presentation is generally aspecific, related to the location and similar to a number of different lesions, including neoplasms and other intracranial lesions with mass effect. CSF analysis may also be inconclusive, especially for lesions presenting as a single mass at onset. As a consequence, a brain biopsy is frequently performed for characterization. Advanced MRI imaging plays an important role in directing the diagnosis, reducing the rate of unnecessary biopsies and allowing a prompt start of therapy that is often crucial, especially in the case of infratentorial lesions. In this review, the main pattern of presentation of atypical inflammatory demyelinating diseases is discussed, with particular attention on the differential diagnosis and how to adequately define the correct etiology.

Keywords: AIIDL; Atypical demyelinating lesions; Multiple sclerosis; TDL; Tumefactive demyelinating lesion.

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References

1. Wallner-Blazek M, Rovira A, Fillipp M et al (2013) Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis. J Neurol 260:2016–2022. https://doi.org/10.1007/s00415-013-6918-y - DOI - PubMed
1. Hardy TA, Reddel SW, Barnett MH et al (2016) Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurol 15:967–981. https://doi.org/10.1016/S1474-4422(16)30043-6 - DOI - PubMed
1. Kobayashi M, Shimizu Y, Shibata N, Uchiyama S (2014) Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology. J Neurol 261:1902–1910. https://doi.org/10.1007/s00415-014-7437-1 - DOI - PubMed
1. Seewann A, Enzinger C, Filippi M et al (2008) MRI characteristics of atypical idiopathic inflammatory demyelinating lesions of the brain: a review of reported findings. J Neurol 255:1–10. https://doi.org/10.1007/s00415-007-0754-x - DOI - PubMed
1. Hardy TA, Miller DH (2014) Baló’s concentric sclerosis. Lancet Neurol 13:740–746. https://doi.org/10.1016/S1474-4422(14)70052-3 - DOI - PubMed

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[1] Wallner-Blazek M, Rovira A, Fillipp M et al (2013) Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis. J Neurol 260:2016–2022. https://doi.org/10.1007/s00415-013-6918-y - DOI - PubMed

[2] Wallner-Blazek M, Rovira A, Fillipp M et al (2013) Atypical idiopathic inflammatory demyelinating lesions: prognostic implications and relation to multiple sclerosis. J Neurol 260:2016–2022. https://doi.org/10.1007/s00415-013-6918-y - DOI - PubMed

[3] Hardy TA, Reddel SW, Barnett MH et al (2016) Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurol 15:967–981. https://doi.org/10.1016/S1474-4422(16)30043-6 - DOI - PubMed

[4] Hardy TA, Reddel SW, Barnett MH et al (2016) Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurol 15:967–981. https://doi.org/10.1016/S1474-4422(16)30043-6 - DOI - PubMed

[5] Kobayashi M, Shimizu Y, Shibata N, Uchiyama S (2014) Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology. J Neurol 261:1902–1910. https://doi.org/10.1007/s00415-014-7437-1 - DOI - PubMed

[6] Kobayashi M, Shimizu Y, Shibata N, Uchiyama S (2014) Gadolinium enhancement patterns of tumefactive demyelinating lesions: correlations with brain biopsy findings and pathophysiology. J Neurol 261:1902–1910. https://doi.org/10.1007/s00415-014-7437-1 - DOI - PubMed

[7] Seewann A, Enzinger C, Filippi M et al (2008) MRI characteristics of atypical idiopathic inflammatory demyelinating lesions of the brain: a review of reported findings. J Neurol 255:1–10. https://doi.org/10.1007/s00415-007-0754-x - DOI - PubMed

[8] Seewann A, Enzinger C, Filippi M et al (2008) MRI characteristics of atypical idiopathic inflammatory demyelinating lesions of the brain: a review of reported findings. J Neurol 255:1–10. https://doi.org/10.1007/s00415-007-0754-x - DOI - PubMed

[9] Hardy TA, Miller DH (2014) Baló’s concentric sclerosis. Lancet Neurol 13:740–746. https://doi.org/10.1016/S1474-4422(14)70052-3 - DOI - PubMed

[10] Hardy TA, Miller DH (2014) Baló’s concentric sclerosis. Lancet Neurol 13:740–746. https://doi.org/10.1016/S1474-4422(14)70052-3 - DOI - PubMed

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Differential imaging of atypical demyelinating lesions of the central nervous system

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Differential imaging of atypical demyelinating lesions of the central nervous system

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