Objective: To explore the dynamic features of tumefactive demyelinating lesions (TDLs) in different clinical stages by contrast-enhanced magnetic resonance imaging (MRI). Methods: Thirty-five patients with TDLs proven by pathological studies were prospectively recruited from January 2015 to January 2017.Brain contrast-enhanced MRI of the patients in different clinical stages including acute phase, subacute phase and chronic phase were completed after enrollment.The characteristics of contrast-enhanced MRI in different clinical stages were compared and the evolutional characteristics were summarized. Results: (1) Acute phase (35/35): the patterns of enhancement were patchy (74.3%, n=26), nodule (34.3%, n=12), closed ring (14.3%, n=5) and open ring (11.4%, n=4). (2) Subacute phase (32/35): the patterns of enhancement were 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). (3) Chronic phase (15/35): the patterns of enhancement were pale patchy (10/15), open ring (5/15) and closed ring (2/15). (4) The proportions of enhancement patterns including patchy, nodule, edge enhancement and pale patchy were significantly different among different clinical stages: ① The patchy and nodule were the more common enhancement patterns in acute phase. ② The edge enhancement was found mostly in subacute phase. ③ The pale patchy was found mostly in chronic phase. Conclusions: The manifestation of the lesions on contrast-enhanced MRI may have some characteristics of dynamic evolution according to different clinical stages.The dynamic observation may be helpful for the diagnosis and differential diagnosis of TDLs.
目的： 探索瘤样脱髓鞘病变(TDLs)增强磁共振(MRI)随不同临床分期的动态演变特点规律。 方法： 采用前瞻性研究方法，收集2015年1月至2017年1月经病理证实的TDLs患者35例。入组后，进一步完善不同临床分期(急性期、亚急性期、慢性期)的头颅MRI增强检查。比较不同临床分期TDLs头颅MRI增强扫描特点差异，归纳其演变特点。 结果： (1)急性期(35/35)：斑片状26例(74.3%)、结节样12例(34.3%)、闭合环形5例(14.3%)、开环样4例(11.4%)；(2)亚急性期(32/35)：开环样13例(40.6%)、闭合环形10例(31.3%)、斑片样8例(25.0%)、不规则边缘强化7例(21.9%)；(3)慢性期(15/35)：浅淡斑片状10例(10/15)、开环样5例(5/15)、闭合环形2例(2/15)；(4)不同临床分期中，斑片状、结节样、病灶边缘强化及浅淡斑片状强化所占比例不同，具有统计学意义：①急性期以斑片状和结节样强化更常见；②亚急性期以病灶边缘强化方式更多见；③慢性期以浅淡斑片状强化更常见。 结论： 不同临床分期TDLs头颅增强MRI具有一定演变特征，动态观察有助于TDLs的诊断和鉴别。.
Keywords: Central nervous system; Enhancement; Magnetic resonance imaging; Tumefactive demyelinating lesions.