Diagnosis of demyelinating brain lesion simulating brain tumors on fast imaging employing steady-state acquisition magnetic resonance imaging

• Published in: Surgical neurology international Vol. 9; no. 1; p. 26
• Main Authors: Onishi, Takeshi, Nitta, Naoki, Fukami, Tadateru, Nakasu, Satoshi, Nozaki, Kazuhiko
• Format: Journal Article
• Language: English
• Published: Pittsford Wolters Kluwer India Pvt. Ltd 01-01-2018; Scientific Scholar; Medknow Publications & Media Pvt Ltd
• Subjects: Brain cancer; Neuro-Oncology: Technical Note; NMR; Nuclear magnetic resonance; Tumors; Brain tumor; inflammatory demyelinating lesion; FIESTA; deep gray matter
• ISSN: 2152-7806; 2229-5097; 2152-7806
• DOI: 10.4103/sni.sni_272_16

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.