Spinal and cerebral tumefactive MS, clinical and neuroimaging Correlations
Keywords:
intramedullary spinal tumor, MRI, primary CNS lymphoma, tumefactive MSAbstract
The detection of tumefactive multiple sclerosis (TMS) often leads to diagnostic uncertainty, especially if lesions occur in patients without currently known demyelinating disease.
Supratentorial TMS can be differentiated from tumor by some specific imaging features: discrepancy between lesion size and mass effect; specific contrast pattern - open ring directed toward gray matter.
A major challenge is differentiating TMS from primary CNS lymphoma (PCNSL). Suspicion of a brain tumor often necessitates biopsy, which may also show misleading patho-histologic findings.
In the setting of a solitary tumor-like lesion in the myelon, diagnostic efforts are directed at excluding spinal intramedullary tumors.
Two clinical cases suggestive of tumor-like MS in the brain and spinal cord are presented with discussion and suggestions for diagnostic approaches to refine the diagnosis. Tumefactive MS is an uncommon and difficult-to-diagnose form of primary demyelination, making integration of clinical and laboratory data with imaging results and infrequent case follow-up over time extremely important.
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