The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions
Yıl: 2021 Cilt: 27 Sayı: 2 Sayfa Aralığı: 164 - 170 Metin Dili: İngilizce DOI: 10.4274/tnd.2021.00907 İndeks Tarihi: 19-01-2022
The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions
Öz: Objective: The diagnosis of patients with atypical demiyelinating lesions has always been challenging, sometimes leading to a biopsy. Recent literature has radiologically classified atypical inflammatory demyelinating lesions as ring-like, Balo-like, infiltrative, megacystic, and unclassified lesions. In this study, we aimed to assess the demographics and clinical and radiologic findings in patients with atypical lesions. Materials and Methods: The records of 320 patients with demyelinating disorders were retrospectively assessed using iMed database. Patients with atypical lesions and whose magnetic resonance imaging evaluations were included. Clinical and radiologic findings were evaluated and lesions were classified according to the recommended criteria. Results: Twenty-seven patients (16 females) were included and the mean age was 34.26±6.12 (range: 26-49) years. Fourteeen patients had ring-like, three had Balo-like, three had megacystic, five had infiltrative, and two patients had unclassified lesions. Diffusion restriction was observed in contrast-enhancing sites in ring-like lesions, heterogeneously in infiltrative lesions and also peripherally in Balo-like lesions. Two patients with infiltrative lesions had additional lesions on follow-up and had to undergo biopsy. Two patients died despite aggressive treatment. Two patients with Balo-like lesions were evaluated as having acute disseminated encephalomyelitis and did not have further relapses. Seventeen patients from the study group converted to multiple sclerosis (MS) on follow-up. Conclusion: Differential diagnosis of atypical inflammatory demyelinating lesions is not always easy, the prognosis is not different from MS lesions. Mostly, ringlike lesions seem to convert to MS with recurrent relapses; however, infiltrative lesions seem to have poorer outcomes, especially if patients have additional relapses.
Anahtar Kelime: Atipik Enflamatuvar Demiyelinizan Lezyonların Değerlendirilmesinde Manyetik Rezonans Görüntülemenin Diagnostik ve Prognostik Önemi
Öz: Amaç: Tipik olmayan demiyelinizan lezyonlar ile prezente olan hastaların tanısı zaman zaman biyopsi gerektirecek kadar zor olabilmektedir. Son yayınlarda atipik enflamatuvar demiyelinizan lezyonlar radyolojik olarak 5 ana sınıfta tanımlanmıştır: Halka benzeri, balo benzeri, infiltratif, megakistik ve sınıflandırılamayandır. Bu çalışmada atipik lezyonlara sahip hastaları demografik, klinik ve radyolojik olarak değerlendirmeyi amaçladık. Gereç ve Yöntem: iMed veritabanı kullanılarak demiyelinizan hastalık tanısı ile izlenmekte olan 320 hasta retrospektif olarak değerlendirildi. Çalışmaya manyetik rezonans görüntülemesi olan ve atipik demiyelinizan lezyona sahip olan hastalar dahil edildi. Klinik ve radyolojik bulgular değerlendirildi ve lezyonlar önerilen kriterlere göre sınıflandırıldı. Bulgular: Çalışmaya yaş ortalaması 34,26±6,12 (26-49) olan 27 (16 kadın) hasta dahil edildi. Lezyonlar sınıflandırıldığında 14 hasta halka benzeri, 3 hasta Balo benzeri, 3 hasta megakistik, 5 hasta infiltratif, 2 hasta sınıflandırılamayan atipik demiyelinizan lezyonlara sahipti. Difüzyon ağırlıklı serileri bulunan görüntüler değerlendirildiğinde, Balo benzeri lezyonların etrafında, infiltratif lezyonlarda heterojen şekilde ve halka benzeri lezyonların kontrast tutulumu olan bölgelerinde aynı zamanda difüzyon kısıtlılığı da gözlendi. Prognostik faktörler değerlendirildiğinde, infiltratif lezyonları olan 2 hastanın takiplerinde lezyonları arttı ve hastalara biyopsi yapılmak zorunda kalınıldı. İki hasta agresif tedaviye rağmen kaybedildi. Balo benzeri lezyonu olan hastaların 2 tanesinin relapsı olmadı ve kliniği akut disemine ensefalomiyelit olarak değerlendirildi. Çalışma grubundaki 17 hasta takiplerinde klinik olarak multipl skleroz (MS) tanısı ile halen takip edilmektedir. Sonuç: Her ne kadar atipik enflamatuvar demiyelinizan lezyonların ayırıcı tanısı her zaman kolay olmasa da, prognozları MS lezyonlarından çok farklı değildir. Genellikle halka benzeri lezyonlar rekürren relapsları olan MS’ye dönüşmekteyken, özellikle relapsları olan infiltratif lezyonlu hastaların prognozu kötü olmaktadır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | Ozdemir Z, Acar E, Soysal A (2021). The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. , 164 - 170. 10.4274/tnd.2021.00907 |
| Chicago | Ozdemir Zeynep,Acar Erkan,Soysal Aysun The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. (2021): 164 - 170. 10.4274/tnd.2021.00907 |
| MLA | Ozdemir Zeynep,Acar Erkan,Soysal Aysun The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. , 2021, ss.164 - 170. 10.4274/tnd.2021.00907 |
| AMA | Ozdemir Z,Acar E,Soysal A The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. . 2021; 164 - 170. 10.4274/tnd.2021.00907 |
| Vancouver | Ozdemir Z,Acar E,Soysal A The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. . 2021; 164 - 170. 10.4274/tnd.2021.00907 |
| IEEE | Ozdemir Z,Acar E,Soysal A "The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions." , ss.164 - 170, 2021. 10.4274/tnd.2021.00907 |
| ISNAD | Ozdemir, Zeynep vd. "The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions". (2021), 164-170. https://doi.org/10.4274/tnd.2021.00907 |
| APA | Ozdemir Z, Acar E, Soysal A (2021). The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. Türk Nöroloji Dergisi, 27(2), 164 - 170. 10.4274/tnd.2021.00907 |
| Chicago | Ozdemir Zeynep,Acar Erkan,Soysal Aysun The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. Türk Nöroloji Dergisi 27, no.2 (2021): 164 - 170. 10.4274/tnd.2021.00907 |
| MLA | Ozdemir Zeynep,Acar Erkan,Soysal Aysun The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. Türk Nöroloji Dergisi, vol.27, no.2, 2021, ss.164 - 170. 10.4274/tnd.2021.00907 |
| AMA | Ozdemir Z,Acar E,Soysal A The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. Türk Nöroloji Dergisi. 2021; 27(2): 164 - 170. 10.4274/tnd.2021.00907 |
| Vancouver | Ozdemir Z,Acar E,Soysal A The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions. Türk Nöroloji Dergisi. 2021; 27(2): 164 - 170. 10.4274/tnd.2021.00907 |
| IEEE | Ozdemir Z,Acar E,Soysal A "The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions." Türk Nöroloji Dergisi, 27, ss.164 - 170, 2021. 10.4274/tnd.2021.00907 |
| ISNAD | Ozdemir, Zeynep vd. "The Diagnostic and Prognostic Value of Magnetic Resonance Imaging for Evaluating Atypical Inflammatory Demyelinating Lesions". Türk Nöroloji Dergisi 27/2 (2021), 164-170. https://doi.org/10.4274/tnd.2021.00907 |
