Diffusion-weighted imaging characteristics of biopsy-proven demyelinating brain lesions

N. Abou Zeid, I. Pirko, Bradley J Erickson, S. D. Weigand, K. M. Thomsen, B. Scheithauer, Joseph E Parisi, Caterina Giannini, L. Linbo, Claudia F Lucchinetti

Research output: Contribution to journalArticle

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Abstract

Objectives: To describe lesional diffusion-weighted imaging characteristics in a cohort of patients with biopsy-proven CNS inflammatory demyelinating disease (IDD) and compare diffusion characteristics of ring-enhancing CNS IDD lesions vs abscesses and tumors. Methods: Forty prebiopsy apparent diffusion coefficient (ADC) maps were reviewed from 30 patients with CNS IDD. Lesions were analyzed for size, T2-weighted (T2W) hypointense rim, enhancement, and ADC pattern. ADC patterns of CNS IDD ring-enhancing lesions were compared with a published cohort of 35 patients with ring-enhancing tumors and abscesses. Results: IDD lesions displayed a spectrum of peripheral ADC patterns at the lesion edge: restricted diffusion (low ADC), 33%; increased diffusion (high ADC), 60%; and normal diffusion (homogeneously isointense), 7%. Of biopsied lesions, 93% enhanced (ring, 52%; heterogeneous, 34%; homogeneous, 7%). A hypointense T2W rim was observed in 53%. A ring pattern on ADC (isointense or dark) was associated with T2W hypointense rims (p = 0.02) but not with ring enhancement. On serial imaging, 4 of 7 (57%) patients demonstrated changes in ADC patterns. Peripheral restriction was more common in IDD (p = 0.006) than in tumors or abscesses, whereas central restriction was only observed in abscesses. Restricted lesions in the same stage were more common in the non-IDD cohort (42% vs 20%), with a uniform restricted pattern seen only in abscesses. Conclusions: In ring-enhancing lesions, peripheral diffusion restriction is more common in IDD than in tumors/abscesses, whereas central restriction is more common among abscesses. Rapid ADC pattern changes in IDD probably reflect dynamic lesion evolution and may distinguish IDD from tumors.

Original languageEnglish (US)
Pages (from-to)1655-1662
Number of pages8
JournalNeurology
Volume78
Issue number21
DOIs
StatePublished - May 22 2012

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Demyelinating Diseases
Biopsy
Brain
Abscess
Brain Lesion
Imaging
Neoplasms
Lesion
Ring
Central Nervous System

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Diffusion-weighted imaging characteristics of biopsy-proven demyelinating brain lesions. / Abou Zeid, N.; Pirko, I.; Erickson, Bradley J; Weigand, S. D.; Thomsen, K. M.; Scheithauer, B.; Parisi, Joseph E; Giannini, Caterina; Linbo, L.; Lucchinetti, Claudia F.

In: Neurology, Vol. 78, No. 21, 22.05.2012, p. 1655-1662.

Research output: Contribution to journalArticle

Abou Zeid, N, Pirko, I, Erickson, BJ, Weigand, SD, Thomsen, KM, Scheithauer, B, Parisi, JE, Giannini, C, Linbo, L & Lucchinetti, CF 2012, 'Diffusion-weighted imaging characteristics of biopsy-proven demyelinating brain lesions', Neurology, vol. 78, no. 21, pp. 1655-1662. https://doi.org/10.1212/WNL.0b013e3182574f66
Abou Zeid, N. ; Pirko, I. ; Erickson, Bradley J ; Weigand, S. D. ; Thomsen, K. M. ; Scheithauer, B. ; Parisi, Joseph E ; Giannini, Caterina ; Linbo, L. ; Lucchinetti, Claudia F. / Diffusion-weighted imaging characteristics of biopsy-proven demyelinating brain lesions. In: Neurology. 2012 ; Vol. 78, No. 21. pp. 1655-1662.
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abstract = "Objectives: To describe lesional diffusion-weighted imaging characteristics in a cohort of patients with biopsy-proven CNS inflammatory demyelinating disease (IDD) and compare diffusion characteristics of ring-enhancing CNS IDD lesions vs abscesses and tumors. Methods: Forty prebiopsy apparent diffusion coefficient (ADC) maps were reviewed from 30 patients with CNS IDD. Lesions were analyzed for size, T2-weighted (T2W) hypointense rim, enhancement, and ADC pattern. ADC patterns of CNS IDD ring-enhancing lesions were compared with a published cohort of 35 patients with ring-enhancing tumors and abscesses. Results: IDD lesions displayed a spectrum of peripheral ADC patterns at the lesion edge: restricted diffusion (low ADC), 33{\%}; increased diffusion (high ADC), 60{\%}; and normal diffusion (homogeneously isointense), 7{\%}. Of biopsied lesions, 93{\%} enhanced (ring, 52{\%}; heterogeneous, 34{\%}; homogeneous, 7{\%}). A hypointense T2W rim was observed in 53{\%}. A ring pattern on ADC (isointense or dark) was associated with T2W hypointense rims (p = 0.02) but not with ring enhancement. On serial imaging, 4 of 7 (57{\%}) patients demonstrated changes in ADC patterns. Peripheral restriction was more common in IDD (p = 0.006) than in tumors or abscesses, whereas central restriction was only observed in abscesses. Restricted lesions in the same stage were more common in the non-IDD cohort (42{\%} vs 20{\%}), with a uniform restricted pattern seen only in abscesses. Conclusions: In ring-enhancing lesions, peripheral diffusion restriction is more common in IDD than in tumors/abscesses, whereas central restriction is more common among abscesses. Rapid ADC pattern changes in IDD probably reflect dynamic lesion evolution and may distinguish IDD from tumors.",
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T1 - Diffusion-weighted imaging characteristics of biopsy-proven demyelinating brain lesions

AU - Abou Zeid, N.

AU - Pirko, I.

AU - Erickson, Bradley J

AU - Weigand, S. D.

AU - Thomsen, K. M.

AU - Scheithauer, B.

AU - Parisi, Joseph E

AU - Giannini, Caterina

AU - Linbo, L.

AU - Lucchinetti, Claudia F

PY - 2012/5/22

Y1 - 2012/5/22

N2 - Objectives: To describe lesional diffusion-weighted imaging characteristics in a cohort of patients with biopsy-proven CNS inflammatory demyelinating disease (IDD) and compare diffusion characteristics of ring-enhancing CNS IDD lesions vs abscesses and tumors. Methods: Forty prebiopsy apparent diffusion coefficient (ADC) maps were reviewed from 30 patients with CNS IDD. Lesions were analyzed for size, T2-weighted (T2W) hypointense rim, enhancement, and ADC pattern. ADC patterns of CNS IDD ring-enhancing lesions were compared with a published cohort of 35 patients with ring-enhancing tumors and abscesses. Results: IDD lesions displayed a spectrum of peripheral ADC patterns at the lesion edge: restricted diffusion (low ADC), 33%; increased diffusion (high ADC), 60%; and normal diffusion (homogeneously isointense), 7%. Of biopsied lesions, 93% enhanced (ring, 52%; heterogeneous, 34%; homogeneous, 7%). A hypointense T2W rim was observed in 53%. A ring pattern on ADC (isointense or dark) was associated with T2W hypointense rims (p = 0.02) but not with ring enhancement. On serial imaging, 4 of 7 (57%) patients demonstrated changes in ADC patterns. Peripheral restriction was more common in IDD (p = 0.006) than in tumors or abscesses, whereas central restriction was only observed in abscesses. Restricted lesions in the same stage were more common in the non-IDD cohort (42% vs 20%), with a uniform restricted pattern seen only in abscesses. Conclusions: In ring-enhancing lesions, peripheral diffusion restriction is more common in IDD than in tumors/abscesses, whereas central restriction is more common among abscesses. Rapid ADC pattern changes in IDD probably reflect dynamic lesion evolution and may distinguish IDD from tumors.

AB - Objectives: To describe lesional diffusion-weighted imaging characteristics in a cohort of patients with biopsy-proven CNS inflammatory demyelinating disease (IDD) and compare diffusion characteristics of ring-enhancing CNS IDD lesions vs abscesses and tumors. Methods: Forty prebiopsy apparent diffusion coefficient (ADC) maps were reviewed from 30 patients with CNS IDD. Lesions were analyzed for size, T2-weighted (T2W) hypointense rim, enhancement, and ADC pattern. ADC patterns of CNS IDD ring-enhancing lesions were compared with a published cohort of 35 patients with ring-enhancing tumors and abscesses. Results: IDD lesions displayed a spectrum of peripheral ADC patterns at the lesion edge: restricted diffusion (low ADC), 33%; increased diffusion (high ADC), 60%; and normal diffusion (homogeneously isointense), 7%. Of biopsied lesions, 93% enhanced (ring, 52%; heterogeneous, 34%; homogeneous, 7%). A hypointense T2W rim was observed in 53%. A ring pattern on ADC (isointense or dark) was associated with T2W hypointense rims (p = 0.02) but not with ring enhancement. On serial imaging, 4 of 7 (57%) patients demonstrated changes in ADC patterns. Peripheral restriction was more common in IDD (p = 0.006) than in tumors or abscesses, whereas central restriction was only observed in abscesses. Restricted lesions in the same stage were more common in the non-IDD cohort (42% vs 20%), with a uniform restricted pattern seen only in abscesses. Conclusions: In ring-enhancing lesions, peripheral diffusion restriction is more common in IDD than in tumors/abscesses, whereas central restriction is more common among abscesses. Rapid ADC pattern changes in IDD probably reflect dynamic lesion evolution and may distinguish IDD from tumors.

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