On magnetic resonance imaging mri scans, the condition appears as tumorlike lesions larger than two centimeters multiple sclerosis, is a disease of the central nervous system cns, which is comprised of the brain, spinal cord and optic nerve. The demyelinating lesion can mimic infections, vascular lesions, and. Tumefactive multiple sclerosis is a term used to describe patients with established multiple sclerosis who develop large aggressive demyelinating lesions, similaridentical in appearance to those seen in sporadic tumefactive demyelinating lesions tdl. Mr imaging initially revealed parenchymal mass lesions. Tumefactive demyelination is a rare neurological disorder presenting as tumor with demyelinating etiology. Frontal tumefactive demyelinating lesion mimicking. Mass effect and contrast enhancement on neuroimaging make it difficult to distinguish this type of lesion from highgrade gliomas. It is critical that you develop a working knowledge of how each of these techniques provides structural information about organic molecules.
In a chemical context, spectroscopy is used to study energy transitions in atoms and molecules. Spectroscopy is the study of the interaction of electromagnetic radiation with matter. Metabolite findings in tumefactive demyelinating lesions. The patient was treated with highdose steroid and five sessions of plasma exchange with. Multiple sclerosis in 79% and an isolated demyelinating syndrome in 14% lucchinetti cf et al. Electromagnetic spectrum shortwave uhfvhffm radar microwave am radio 10 2 10 4 10 6 10 8 10 10 10 12. Proton mr spectroscopy of tumefactive demyelinating. Illustrate the role of multimodal mri with a focus on spectroscopy, diffusion and perfusion imaging to increase diagnostic confidence. Tumefactive demyelination associated with bilateral optic. We present a clinical scenario of a patient presenting with left homonymous hemianopia with atypical radiological features.
Whether tumefactive demyelination constitutes a disease variant within the broad spectrum of multiple sclerosis or rather depicts a different entity is still matter of debate. A mass spectrum plural spectra is a plot of the ion signal as a function of the masstocharge ratio. Cohort 1 included 6 patients with tdls and 5 with gliomas 3 highgrade, as assessed using a 1. Recognise the difficulties associated with diagnosing tumefactive multiple sclerosis from clinical presentation and conventional imaging. An older age at onset makes distinguishing tumefactive demyelinating lesion tdl from tumors even more challenging. Recently, without biopsy, some tms cases were diagnosed by magnetic resonance spectroscopy mrs, positron emission. Advances in tumefactive cns demyelinating disease and balos. We report a patient with a spaceoccupying lesion in the parietal lobe, which presented a serious diagnostic dilemma, between a rare tumefactive demyelinating disease, such as balo concentric sclerosis and a glioma.
The mri appearance of tumefactive demyelinating lesions. Tumefactive demyelinating lesions pose a diagnostic challenge because they can mimic tumors and abscesses and because they can be caused by a heterogeneous range of disorders. A challenging diagnosis of lateonset tumefactive multiple s. Mr imaging of the brain was obtained in 4 patients who presented clinically with focal neurologic deficits. Tumefactive multiple sclerosis ms is a rare variant of ms that is extremely difficult to diagnose. It is called tumefactive as the lesions are tumorlike and they mimic tumors clinically, radiologically and sometimes pathologically. Tumefactive multiple sclerosis requiring emergent biopsy.
Tumefactive demyelinating lesion radiology reference. Other questions include how best to treat an acute attack as well as the optimal. The ms principle consists of ionizing chemical compounds to generate charge molecules. If youre looking for a free download links of introduction to spectroscopy pdf, epub, docx and torrent then this site is not for you. We present a clinical scenario of a patient presenting with left homonymous hemianopia with atypical radiological. Frequency hertz radio waves infrared visible light ultraviolet x rays gamma rays cosmic rays. Proton mr spectroscopy of tumefactive demyelinating lesions. Balo concentric sclerosis is a rare and severe monophasic demyelinating disease, considered a subtype of multiple sclerosis, appearing as a rounded lesion with alternating layers of high and low signal intensity on mri, giving it a characteristic bullseye or onion bulb appearance 1,9. Singlevoxel proton spectroscopy image obtained using pointresolved sequence press, trte, 1,5005 placed along medial border of lesion at area of enhancement reveals elevated choline cho and suppressed nacetylaspartate naa relative.
These will be considered separately and then followed with a series of example applications. Mri of multiple sclerosis and differential diagnosis. Tumefactive demyelinating lesions in multiple sclerosis. Tumefactive demyelinating lesion tdl is a rare variation of multiple sclerosis ms, 1 which presents as a profound brain edema or mass due to an acute demyelination in the central nervous system. Distinguishing tumefactive lesions from other etiologies of intracranial space occupying lesions is essential to avoid inadvertent surgical or toxic.
It can resemble malignancy and perplex the clinician until all diagnostic tests are exhausted. Choosing when to biopsy a tumefactive lesion to exclude alternative pathology can be difficult. Proton mr spectroscopy has been applied in assessing various intracranial diseases and is increasingly used in diagnosis and clinical management. Analyte atoms in solution are aspirated into the excitation region where they are desolvated, vaporized, and atomized by a flame, discharge, or plasma.
In rare instances, demyelinating disorders manifest as tumefactive lesions that simulate brain tumors. Tumefactive multiple sclerosis requiring emergent biopsy and. Tumefactive multiple sclerosis is a rare form of multiple sclerosis ms with symptoms similar to those of a brain tumor. Tumefactive demyelinating lesions tdls can simulate intracranial neoplasms in clinical presentation and mr imaging appearance, and surgical biopsy is often performed in suspected tumors. Some properties of electromagnetic radiation, such as its refraction when it passes from one medium to another figure \\pageindex1\, are explained best by describing light as a wave. Gliomas and acute ms plaques may have indistinguishable chemical resonance spectra, whereas that of chronic plaque is distinct.
Characterization of tumefactive demyelinating lesions using mr imaging and invivo proton mr spectroscopy hs malhotra, kk jain, a agarwal, mk singh, sk yadav, m husain, n krishnani, and rk gupta multiple sclerosis journal 2008 15. Spectroscopy has many applications in the modern world, ranging from nondestructive examination of materials to medical diagnostic imaging e. Because of its tumorlike features on magnetic resonance imaging mri 1, 2, histological investigation had played an important role for definite diagnosis of tms 3, 4. A brain biopsy is not required to treat for the disease, as it is in cns malignancy. Use of serial proton magnetic resonance spectroscopy to. A large body of published work shows that proton hydrogen 1 1 h magnetic resonance mr spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Tumefactive multiple sclerosis is a condition in which the central nervous system of a person has multiple demyelinating lesions with atypical characteristics for those of standard multiple sclerosis ms. Basic principles and selected applications sridar narayanan, phd magnetic resonance spectroscopy unit mcconnell brain imaging centre dept. Proton magnetic resonance spectroscopy differentiates tumefactive. We report a case of brain tdl as the initial manifestation of lateonset ms associated with cervico.
A challenging diagnosis of lateonset tumefactive multiple. Thus far, no consensus exists about definition and management of tumefactive lesions since the only available evidence comes from small case series and. Clinical senior lecturer, university of sydney may 28th, 2015 disclosures honoraria for talks from novartis, genzyme, merck. We report on the use of serial proton mr spectroscopy 1 h mrs to differentiate between glioma and tumefactive plaque in a known multiple sclerosis ms patient who developed a symptomatic cerebral space occupying lesion. Herein, the authors present a summary of brain disorders in which mr spectroscopy has an impact on patient. Tumefactive multiple sclerosis masquerading as cancer. Electromagnetic radiationlightis a form of energy whose behavior is described by the properties of both waves and particles. Tumefactive demyelinating lesions are rare consequences of central nervous system cns idiopathic inflammatory demyelinating diseases. A 21yearold man presented to eye casualty complaining of altered vision associated with headache and vomiting upon waking.
Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Introduction mass spectrometry ms is an analytical technique that measures the masstocharge particles. Cureus tumefactive multiple sclerosis, a rare variant. Initial evaluations for multiple sclerosis in a university multiple sclerosis center. Although diagnostic challenges without biopsy have been tried by employing radiological studies and cerebrospinal fluid examinations, histological investigation is still necessary for certain diagnosis in some complicated cases. Tumefactive multiple sclerosis tms is a demyelinating disease. Pdf proton mr spectroscopy of tumefactive demyelinating lesions. Pitfalls in the diagnosis of a tumefactive demyelinating. The patient was treated with highdose steroid and five sessions of plasma exchange with significant.
Tumefactive demyelinating lesion is defined as large solitary demyelinating lesion with imaging characteristics mimicking neoplasm. Balo concentric sclerosis radiology reference article. Proton mr spectroscopy of tumefactive demyelinating lesions article pdf available in american journal of neuroradiology 238. Choosing when to biopsy a tumefactive lesion to exclude alternative pathology can be dif. Tumefactive multiple sclerosis radiology reference article. Mass spectrometry is a gas phase technique the sample must be vaporized. Tumefactive demyelinating lesions can present with features similar, clinically and radiologically, to those of brain tumours. Tumefactive lesions are an uncommon manifestation of demyelinating disease and can pose a diagnostic challenge in patients without a preexisting diagnosis of multiple sclerosis. Proton mr spectroscopy has been increasingly used to characterize. Tumefactive demyelinating lesion tdl is defined as a solitary demyelinating lesion greater than 2 cm. It is used for determining masses of particles, for determining the elemental composition of a sample or molecule.
The mri scan of the brain revealed a space occupying lesion within the occipital lobe and mr spectroscopy highlighted this to be inflammatory in nature, most likely a tumefactive. Proton mr spectroscopy has been applied in assessing various intracranial diseases and is increasingly used in diagnosis and clinical. Atomic emission spectroscopy aes or oes uses quantitative measurement of the optical emission from excited atoms to determine analyte concentration. This case report highlights important diagnostic clues in the differential. Advances in tumefactive cns demyelinating disease and balos concentric sclerosis dr todd hardy 1. Mean chonaa ratio was significantly higher in gliomas than in tdls or ms in cohort 1 p 1. Clinical examination was unremarkable except for a rightsided homonymous hemianopia. Systemic lupus erythematosus sle is a chronic inflammatory multisystem disease characterised by varied clinical manifestation and immunological abnormalities. On imaging, they usually present with relatively little mass effect or surrounding edema. Tumefactive demyelinating lesion tdl, also sometimes referred to as monofocal acute inflammatory demyelination maid, is a locally aggressive form of demyelination, usually manifesting as a solitary lesion or sometimes a couple of lesions greater than 2 cm that may mimic a neoplasm on imaging. Tms is characterized by solitary or multiple lesions that are sized 2 cm, withwithout mass effect, edema, and ring enhancement on magnetic resonance imaging mri. These atypical features include size more than 2 cm, mass effect, edema, andor ring enhancement. Cureus tumefactive multiple sclerosis of the cervical.
Previously it was designated as schilders disease or marburgs variant of multiple sclerosis. Tms can mimic clinical and radiological features of a neoplasm, infarction, or abscess and therefore can be diagnostically challenging for clinicians. Advances in tumefactive cns demyelinating disease and. Clinical proton mr spectroscopy in central nervous system. Saindane am, soonmee c, meng l, xiaonan x, knopp ea, zagzag d. We report a case of brain tdl as the initial manifestation of lateonset ms. The mri scan of the brain revealed a space occupying lesion within the occipital lobe and mr spectroscopy highlighted this to be. Increased accumulations of nisopropylp123iiodoamphetamine related to tumefactive multiple sclerosis. In this study, we report a case of cervical ms in a 19yearold patient that was diagnosed based on the mri findings and cerebrospinal fluid analysis. Mass spectroscopy mass spectroscopy is a technique causing the formation of the gaseous ions with or without fragmentation. Singlevoxel proton spectroscopy image obtained using pointresolved sequence press, trte, 1,5005 placed along medial border of lesion at area of enhancement reveals elevated choline cho and suppressed nacetylaspartate naa relative to creatine cr and. Cohort 2 included 6 patients with tdls and 17 patients with gliomas 8 highgrade, as assessed using a 3. Spectroscopy is a technique that uses the interaction of energy with a sample to perform an analysis. Free torrent download introduction to spectroscopy pdf ebook.
Characterization of tumefactive demyelinating lesions. Distinguishing tumefactive demyelinating lesions from glioma. Other questions include how best to treat an acute attack as well as the optimal timing of therapy to prevent relapse. Tumefactive multiple sclerosis tms is a rare entity which can be difficult to diagnose unless definitive diagnostic measures are taken. Proton magnetic resonance spectroscopy differentiates. Spectroscopy nmr, ir, ms, uvvis main points of the chapter 1. To use mr spectroscopy to aid in the diagnosis of demyelinating disease and to help differentiate tumefactive demyelinating lesions from neoplastic processes. Tumorlike demyelination in tumefactive ms is rare and estimated at 1 to 2 per cases of ms or 3 cases per million per year in the general population. The ionized molecule often fragments into smaller ionsradicals. Pdf proton mr spectroscopy of tumefactive demyelinating. Tumefactive multiple sclerosis tms is a rare variant of multiple sclerosis ms with atypical features that pose a diagnostic challenge. Mass spectrometry ms is an analytical chemistry technique that helps identify the amount and type of chemicals present in a sample by measuring the masstocharge ratio and abundance of gasphase ions. Tumefactive multiple sclerosis is a demyelinating disease that demonstrates tumorlike features on magnetic resonance imaging.
The clinical presentation of the disorder has wide spectra, from an asymptomatic presentation to a severe lifethreatening disease affecting several organs. Multiple sclerosis ms is an inflammatory, demyelinating disease of the central nervous system cns that affects approximately 400,000 people in the united states and 2. Introduction to spectroscopy pdf kindle free download. Nowadays several variants of ms have been described. Spectroscopic magnetic resonance imaging of a tumefactive. Multiple large tumefactive ms plaques in a young man.
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