MRI characteristics of atypical idiopathic inflammatory demyelinating lesions of the brain - A review of reported findings
MRI characteristics of atypical idiopathic inflammatory demyelinating lesions of the brain - A review of reported findings
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DOI：
10.1007/s00415-007-0754-x
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发表时间：
2008-01-01
影响因子：
6
通讯作者：
Fazekas, F.
中科院分区：
文献类型：
--
作者：
Seewann, A.;Enzinger, C.;Fazekas, F.
背景 大脑特发性炎症性脱髓鞘病变 (IIDL) 通常表现为多发性硬化症 (MS) 的形态学特征。然而，IIDL 的非典型表现也存在，并且可能带来严重的诊断问题以及预后和适当治疗的不确定性。我们试图通过查阅文献来改善这种情况。方法 我们从 1984 年 1 月到 2004 年 12 月进行了 PubMed 检索，寻找报道 IIDL 的英文文章，这些文章被认为是形态非典型的（66 篇文章；报告了 270 例病例）。从这些出版物中，69 份患者报告可以提取有关磁共振成像 (MRI) 和相关疾病特征的充分信息。结果 报告的非典型 IIDL 最常表现为大的环状病变 (n = 27)，现在认为这非常提示抗体介导的 MS 形式。真正的非典型 IIDL 不太常见，并表现出我们称为巨囊性 (n = 8)、Balo 样 (n = 11) 和弥漫性浸润 (n = 11) 的外观。尽管由于缺乏原始数据而受到限制，但评估者之间在定义非典型 IIDL 亚型时的一致性为中等至显着（kappa 0.48-0.68），并且我们注意到它们与某些人口统计、临床和临床旁变量相关的趋势。解释 我们建议，文献中报道为非典型的 IIDL 可以根据其 MRI 表现分为几种不同的亚型。这些模式的识别可能有助于鉴别诊断和未来的分类。由于我们的审查固有的局限性，这必须由未来的注册机构确认。
Background Idiopathic inflammatory demyelinating lesions (IIDL) of the brain usually present with a morphologic pattern characteristic of multiple sclerosis (MS). Atypical appearances of IIDLs also exist, however, and can pose significant diagnostic problems and uncertainty regarding prognosis and adequate therapy. We attempted to improve upon this situation by reviewing the literature. Methods We performed a PubMed search from January 1984 through December 2004 for articles in English reporting on IIDLs which had been considered as morphologically atypical ( 66 articles; 270 cases reported). From these publications 69 individual patient reports allowed the extraction of adequate information on magnetic resonance imaging (MRI) and associated disease characteristics. Results Reported atypical IIDLs most frequently manifested as large ring-like lesions (n=27) which are now considered quite suggestive of an antibody-mediated form of MS. Truly atypical IIDLs were less common and exhibited appearances which we termed megacystic (n=8), Balo-like (n=11) and diffusely infiltrating (n=11). Despite limitations imposed by the absence of original data the inter-rater agreement in defining these subtypes of atypical IIDLs was moderate to substantial ( kappa 0.48-0.68) and we noted trends for their association with certain demographic, clinical and paraclinical variables. Interpretation We suggest that IIDLs reported as atypical in the literature can be segregated into several distinct subtypes based on their MRI appearance. The recognition of these patterns may be useful for the differential diagnosis and for a future classification. Because of the limitations inherent in our review this will have to be confirmed by a prospective registry.