| Objective:On the base of the previous of research,we made up the shortfall and improved research methods to further explore the dynamic evolution rules of tumefactive demyelinating lesions(TDLs)on contrast-enhanced magnetic resonance imaging(MRI)with the different clinical stages.Methods:35 patients with TDLs proven by using pathological studies and met the grouping criteria were recruited with prospective cohort studies from the Department of Neurology in Navy General Hospital from January 2015 to January 2017.Brain enhanced magnetic resonance imaging(MRI)scan of different clinical stages(acute phase,subacute phase and chronic phase)were completed after enrollment.The characteristics of patients with TDLs on contrast-enhanced MRI in different clinical stages were compared and the evolutional characteristics were summarized.Results:1.General clinical data:35 patients included 15 males and 20 females.Male to female ratio was 3 to 4.The average onset age was 36.3±12.7 years.The initial clinical symptoms included mainly headache(n=8),limb weakness(n=6),numbness of the limbs(n=5),speech deficits(n=4),visual loss(n=4).The clinical symptoms during the course of the disease were mainly limb weakness(n=18),numbness of the limbs(n=12),headache(n=8),cognitive impairment(n=7),speech deficits(n=7),visual loss(n=4).2.Imaging characteristic:(1)Number of lesions:71.4%(25/35)were multiple,and 54.3%(19/35)involved both sides.(2)The mainly location of involvement were frontal lobe(51.4%,n=18),parietal lobe(42.9%,n=15),periventricular areas(40.0%,n=14),basal ganglia(31.4%,n=11),corpus callosum(22.9%,n=8),temporal lobe(20.0%,n=7)and thalamus(17.1%,n=6).(3)All of 35 patients were of low density on brain CT.(4)The shapes of the lesions were diffusely infiltrating(51.4%,n=18)and ring shaped(37.1%,n=13).(5)Brain MRI showed that all of the lesions displayed long T1 and long T2 signals,and border of the lesions were clear(60.0%).Homogeneous and relative heterogeneous lesions were in 62.9%and 37.1%,respectively.All of the lesions both became small in chronic phase(100%).There were lesions presenting with low T2 signals edge in 12 cases(34.3%).The peripheral edema could be found in 91.4%cases(32/35),in which 56.3%(18/32)showed mild edema.Mild space occupying effect of the lesions were found in 62,9%(n=22),and 37.1%(n=13)were moderate.3 cases showed midline shift.(6)On diffusion weighted MR imaging(DWI):? In acute phase(? 21 days):68.6%with hyperintense signals and 31.4%with slightly hyperintense signals were found.?In subacute phase(22?42 days):42.9%with hyperintense signals and 57.1%with slightly hyperintense signals were detected.? In chronic phase(? 43 days):37.1%with hyperintense signals,48.6%with slightly hyperintense signals and 14.3%with iso-signals were found.(7)The characteristics of typital lesions on contrast-enhanced MRI in different clinical stages are as follows:? Acute phase(all of the patients showed enhancement):the patterns of enhancement were mainly patchy(74.3%,n=26),nodule(34.3%,n=12),closed ring(14.3%,n=5)and open ring(11.4%,n=4).? Subacute phase(32 cases showed different degrees of enhancement):the patterns of enhancement were mainly open ring(40.6%,n=13),closed ring(31.3%,n=10),patchy(25.0%,n=8)and irregular edge of enhancement(21.9%,n=7).? Chronic phase(15 cases still showed enhancement):the patterns of enhancement were mainly pale patchy(66.7%,n=10),open ring(33.3%,n=5),patchy(13.3%,n=2)and closed ring(13.3%,n=2).Statistical analysis showed that the more common patterns of enhancement in acute phase were patchy and nodule,edge of enhancement including closed ring,open ring and irregular edge of enhancement were found mostly in subacute phase,and pale patchy were found mostly in chronic phase.Conclusions:1.The manifestation of the lesions on contrast-enhanced MRI may have some characteristic dynamics of evolution with different clinical stages.In acute phase,the patterns of enhancement were mainly patchy and nodular,and a few were combined with open-ring and closed-ring enhancement.In subacute phase,the patterns of enhancement gradually evolved into edge of enhancement of the lesions such as closed-ring,open-ring and irregular enhancement,and a few appeared patchy enhancement.In chronic phase,the degree of enhancement evidently faded which were mainly pale patchy.The open ring enhancement still could be seen in some cases,with the original enhancement even being already disappeared.2.We summarized the regularity and found three kinds of evolutionary process of typital lesions on contrast-enhanced MRI in different clinical stages are as follows:? The enhancement could be seen in center of lesions in acute phase,the enhancement were on the edge of the lesion in subacute phase,and the enhancement faded even disappeared in chronic phase.? The enhancement could be seen in center of lesions in acute phase,the enhancement became faded in subacute phase,and the enhancement became more faded even disappeared in chronic phase.? The enhancement could be seen on the edge of the lesion in acute phase,the enhancement of margin of lesions faded or showed patchy in subacute phase,and the enhancement of margin of lesions became more faded even disappeared in chronic phase.3.The manifestation of the lesions on contrast-enhanced MRI in patients with TDLs may have obvious characteristic dynamic evolution with different clinical stages,which may have a role to improve the diagnosis of TDLs and the differential diagnosis with other lesions. |
PDF Full Text Request