Pseudocystic inflammatory demyelinating lesions in multiple sclerosis: A clinical, radiological, and pathological description

Abstract

Background: Pseudocystic inflammatory demyelinating lesions (PIDLs) are poorly described in MS and might represent a diagnostic challenge.

Objectives: We described the clinical, radiological, pathological, and follow-up characteristics of 13 PIDL in 9 MS patients.

Methods: We constituted a single-center retrospective case series of PIDLs in MS, defined on MRI as expansive cyst-like lesions, with a fluid-signal content, and a diameter of 1 cm or more.

Results: PIDL often occurred at first event (56%), were often asymptomatic (69%), and encircled by a hypo-T2 diffusion-restricted rim and a thin ring-like gadolinium enhancement (100%) on magnetic resonance imaging (MRI). Associated typical MS lesions were constant. Biopsies from two PIDLs displayed classical features of active MS, except for unusual edema.

Conclusion: PIDLs are clinically unremarkable and associated with a good outcome. Their easily recognizable MRI features could help avoid biopsy.

Keywords: MRI; Pseudocystic lesions; atypical inflammatory demyelinating lesions; histopathology; multiple sclerosis; tumefactive demyelinating lesions.