Article Figures & Data
Figures
- Figure 1
- Magnetic resonance images from a male patient with biopsy-confirmed TDL. A) Axial T2-weighted and (B) axial FLAIR images show a well-defined hyperintense lesion in the left cerebral hemisphere with mild perilesional edema. (C) Contrast-enhanced axial T1WI shows open ring enhancement. (D) Axial DWI and (E) the corresponding ADC map reveal high ADC in the lesion and peripheral restricted diffusion. (F) DSC demonstrates low cerebral blood volume. Adapted from Suh et al.9
- Figure 2
- Three cases of TDLs showing the three different types of morphology on MRI: (a) Axial T2-weighted image showing diffuse, infiltrating lesion with indistinct margins. (b) Sagittal T1-weighted image with contrast highlighting infiltrating lesion heterogeneous enhancement. (c) Sagittal T1-weighted image with contrast showing ring-shaped enhancement. (d) Axial T2-weighted image demonstrating megacystic lesion with distinct margins.5
Tables
- Table 1
- Common differential diagnoses of TDL and their main distinguishing laboratory and imaging features.
Para-clinical feature TDL MS PCNSL HGG MRI T1WI Hypointense Open/closed-ring Gadolinium enhancing and non-enhancing lesions present2 Uniform, contrast-enhancing in 98.9%, often contacting subarachnoid space Solitary in 50-81%3 Heterogeneous enhancement4 Gadolinium enhancement Multiple plaques May have necrotic areas4 Distinct borders1 MRI T2WI FLAIR: hyper-intense, ≥2 cm lesion (round, infiltrative or cystic) ≥1 Ovoid lesion (>3 mm in size), in ≥2 sites of CNS5 Usually hypointense Mostly hyper-intense Hypointense rim Perivenular2 Mass effect, perilesional edema4 Mass effect, edema4 No/mild mass effect and/or edema1 Central vein sign6 Advanced imaging DSC/DWI: heterogeneous ADC values4 Reduced amyloid PET activity in black hole areas in T1-weighted MR images9 DSC/DWI: Homogenous and lower ADC values than TDL4 DSC/DWI: higher ADC and CVB values than PCNSL and TDL4 DSC/ASL perfusion: low CVB1,7 Higher CVB than TDLs4,7 FDG/MET-PET: high uptake10 FDG/MET-PET: high uptake10 FDG/MET-PET: No/low uptake8 CSF OCBs Positive in 30%11 – 80%12 Positive in 90%2 Negative in 90%11 Negative11 Cell count42 + - +++ - (< 50/mL) MBP42 -/+++ -/++ -/+ - CSF biomarkers42 IL-6 -/+ IL-6 - sIL-2R -/+++ sIL-2R - IL-10 -/++ IL-10 - IL-6 -/++ IL-6 - MRI T1WI: Magnetic resonance imaging T1 weighted image, MRI T2WI: Magnetic resonance imaging T2 weighted image, CSF OCBs: Cerebrospinal fluid Oligoclonal bands, TDL: Tumefactive demyelinating lesion, MS: Multiple Sclerosis, PCNSL: Primary Central Nervous system lymphoma, ADC: Apparent diffusion coefficient, CVB: Cerebral blood volume, DSC: Dynamic susceptibility contrast, DWI: Diffusion-weighted imaging, MBP: Myelin basic protein, FLAIR: Fluid attenuated inversion recovery, PET: Positron emission tomography, FDG: Fludeoxyglucose, MET: Metalized Polyethylene Terephthalate, IL: Interleukin
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.