Differential imaging of atypical demyelinating lesions of the central nervous system

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, includ...

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Bibliographic Details
Published in:Radiologia medica 2021-06, Vol.126 (6), p.827-842
Main Authors: Paoletti, Matteo, Muzic, Shaun Ivan, Marchetti, Francesca, Farina, Lisa Maria, Bastianello, Stefano, Pichiecchio, Anna
Format: Article
Language:English
Subjects:
Central nervous system
Diagnosis
Diagnostic Radiology
Etiology
Imaging
Interventional Radiology
Lesions
Magnetic Resonance Imaging
Medical imaging
Medicine
Medicine & Public Health
Neoplasms
Nervous system
Neuroradiology
Radiology
Ultrasound
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Description
Summary: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.
ISSN:0033-8362
1826-6983
DOI:10.1007/s11547-021-01334-y