Diagnosis of demyelinating brain lesion simulating brain tumors on fast imaging employing steady-state acquisition magnetic resonance imaging
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
- Department of Neurosurgery, Kusatsu General Hospital, Shiga, Japan
Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
DOI:10.4103/sni.sni_272_16Copyright: © 2018 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Takeshi Onishi, Naoki Nitta, Tadateru Fukami, Satoshi Nakasu, Kazuhiko Nozaki. Diagnosis of demyelinating brain lesion simulating brain tumors on fast imaging employing steady-state acquisition magnetic resonance imaging. 08-Feb-2018;9:26
How to cite this URL: Takeshi Onishi, Naoki Nitta, Tadateru Fukami, Satoshi Nakasu, Kazuhiko Nozaki. Diagnosis of demyelinating brain lesion simulating brain tumors on fast imaging employing steady-state acquisition magnetic resonance imaging. 08-Feb-2018;9:26. Available from: http://surgicalneurologyint.com/?post_type=surgicalint_articles&p=8757
Background:A single inflammatory demyelinating brain lesion sometimes mimics a brain tumor on conventional magnetic resonance imaging (MRI), and thus poses a considerable diagnostic challenge. We assessed the usefulness of a new MRI technique, fast imaging employing steady-state acquisition (FIESTA), for the diagnosis of inflammatory demyelinating disease (IDD).
Methods:Three patients (2 males, 1 female) with a histopathologically proven inflammatory demyelinating brain lesion which mimicked a brain tumor on MRI were evaluated with a post-contrast three-dimensional FIESTA sequence before biopsy and treatment. Those images were compared with the images of intra-axial brain tumors (n = 147).
Results:Preoperative FIESTA showed an iso- or slightly hyperintense distinct intralesional structure that appeared reticulate or broad-line in patients with IDD. These structures traversed a hyperintense demyelinating lesion in the deep grey matter (DGM) and were connected to the surrounding extralesional area, which appeared to be dense fibers between DGM. Such distinct intralesional structures were not observed in most brain tumors.
Conclusion:Reticulate or broad-line-like intralesional structures on FIESTA may, therefore, be suggestive of IDD rather than indicate a brain tumor.
Keywords: Brain tumor, deep gray matter, FIESTA, inflammatory demyelinating lesion
Acute large or single demyelinating brain lesion distant from the lateral ventricles mimics a neoplasm such as glioma or lymphoma on conventional magnetic resonance imaging (MRI), hence the frequent need for biopsy to confirm the diagnosis.[
In the present study, we report the characteristic findings of inflammatory demyelinating disease (IDD) on FIESTA, which might be helpful for distinguishing IDD from brain tumors.
This retrospective study was approved by the Institutional Review Boards of Shiga University of Medical Science and performed in accordance with the ethical standards laid down in the 1975 Declaration of Helsinki and its later amendments.
The inclusion criteria for this study were: (1) preoperative MRI showing intra-axial tumor-like lesion; (2) pathological evidence of demyelinating lesion or brain tumors; and (3) preoperative post-contrast FIESTA available for review. From January 2009 to December 2015, 3 patients (2 males, 1 female) with IDD and 147 patients with brain tumors were retrospectively evaluated at a single institution.
Imaging was performed using a 3.0-T or 1.5-T MRI system. The three-dimensional (3D) FIESTA sequence used in 3.0-T MRI was as follows: TR, 3.872–4.008; TE, 2.1; flip angle, 45°; field of view, 240 × 240 mm; matrix, 512 × 512; and section thickness, 0.9 mm. The 3-D-FIESTA sequence used in 1.5-T MRI was as follows: TR: 6.656; TE, 3.2; flip angle, 45°; field of view, 240 × 240 mm; matrix, 512 × 512; section thickness, 1.4 mm.
Preoperative FIESTA showed intralesional mildly hyperintense or isointense reticulate [Figure
Our data suggest that FIESTA may be useful for differentiating between IDD and brain tumors when the images show reticulate or broad-line structures in the lesions.
FIESTA provides a high signal in tissues with high T2/T1 ratios, such as cerebrospinal fluid and fat, enables submillimeter spatial resolution, and has been mainly used to evaluate the cerebellopontine angles and inner ear, allowing the precise differentiation between branches of the cranial nerves.[
To our knowledge, the present report is the first to describe the features of IDD on FIESTA and explore its potential usefulness for diagnosing IDD. Because no definite diagnostic imaging modality has been developed for a single inflammatory demyelinating brain lesion mimicking a brain tumor, the intralesional findings on FIESTA might be helpful for diagnosing IDD in combination with other findings on postcontrast T1-weighted images, diffusion-weighted images, MRS, and other modalities.
Although the present study was a retrospective review of a small population, FIESTA may be a useful noninvasive modality for distinguishing IDD from brain tumors in the DGM.
Financial support and sponsorship
Conflicts of interest
The authors declare no conflicts of interest in association with this study.
1. Chávez GD, De Salles AA, Solberg TD, Pedroso A, Espinoza D, Villablanca P. Three-dimensional fast imaging employing steady-state acquisition magnetic resonance imaging for stereotactic radiosurgery of trigeminal neuralgia. Neurosurgery. 2005. 56: E628-
2. Comi G. Multiple sclerosis: Pseudotumoral forms. Neurol Sci. 2004. 25: S374-9
3. Kidd D, Barkhof F, McConnell R, Algra PR, Allen IV, Revesz T. Cortical lesions in multiple sclerosis. Brain. 1999. 122: 17-26
4. Kumar N, Garg RK, Malhotra HS, Gupta RK, Verma R, Sharma PK.editors. Natural course of typical and atypical parenchymal solitary cysticercus granuloma of the brain: A 3-year prospective clinico-radiological study. Neuroradiol J. 2016. 29: 19-29
5. Mont'Alverne Filho FE, Machado Ldos R, Lucato LT, Leite CC. The role of 3D volumetric MR sequences in diagnosing intraventricular neurocysticercosis: Preliminary results. Arq Neuropsiquiatr. 2011. 69: 74-8
6. Roger EM, David SE, Robert DT, Wade LT, Janet MB, Darell DB, Roger EM, Janet MB.editors. Tumors of central neuroepithelial origin. Russell and Rubinstein's Pathology of Tumors of the Nervous System. London: Arnold; 1998. I: 307-572
7. Scherer HJ. Structural development in gliomas. Am J Cancer. 1938. 34: 333-51
8. Widmann G, Henninger B, Kremser C, Jaschke W. MRI Sequences in Head & Neck Radiology-State of the Art. Rofo. 2017. 189: 413-22