Introduction

Demyelinating lesions occasionally present as mass-like lesions on imaging, raising concern for malignancy. The disease course of such tumefactive demyelinating lesions (TDLs) is still being defined.

Methods

We retrospectively analyzed 21 patients with new-onset neurologic symptoms and mass-like lesions on brain magnetic resonance imaging (MRI), which resulted in biopsy-proven diagnoses of demyelination. 18 patients had a median follow-up of 52 months. The clinical, radiologic and histologic features were associated with disease course.

Results

An aggressive disease course (ADC) was noted in 33% of the patients and was associated with an initial largest lesion size ≥35 mm (p = 0.0007), mass effect (p = 0.01) and perilesional edema (p = 0.01) on MRI. Age 30 years and older, at presentation (p = 0.05), as well as the absence of a prior tonsillectomy (p = 0.0128) were also associated with an ADC.

Conclusions

We identified several factors, including initial larger lesion size, mass effect and perilesional edema on MRI, presentation after 30 years of age and the absence of a prior tonsillectomy, that predict an ADC in patients presenting with TDLs. These predictors of disease course can help guide patient follow-up and stratification for intervention.

中文翻译：

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肿瘤性脱髓鞘病变的预后因素：一项回顾性研究

介绍

脱髓鞘病变偶尔在影像学上表现为肿块样病变，引起对恶性肿瘤的关注。这种肿瘤性脱髓鞘病变 (TDL) 的病程仍在定义中。

方法

我们回顾性分析了 21 名在脑磁共振成像 (MRI) 上出现新发神经系统症状和肿块样病变的患者，这些患者导致活检证实的脱髓鞘诊断。18 名患者的中位随访时间为 52 个月。临床、放射学和组织学特征与病程有关。

结果

33% 的患者出现侵袭性病程 (ADC)，并与 MRI 上的初始最大病灶大小 ≥ 35 mm ( p  = 0.0007)、占位效应 ( p  = 0.01) 和病灶周围水肿 ( p  = 0.01) 相关. 年龄 30 岁及以上、就诊时 ( p  = 0.05) 以及之前没有进行过扁桃体切除术 ( p  = 0.0128) 也与 ADC 相关。

结论

我们确定了几个因素，包括最初较大的病灶大小、MRI 上的占位效应和病灶周围水肿、30 岁后的表现以及之前没有进行过扁桃体切除术，这些因素可以预测出现 TDL 的患者的 ADC。这些病程预测因子可以帮助指导患者的随访和干预分层。