Tumefactive demyelination (TD) may show a number of features on magnetic resonance imaging (MRI) that can aid in its diagnosis. It is important to distinguish it from brain tumors and cerebral infection, since the therapies are so different.


MRI findings suggestive of tumefactive demyelinaitng lesions (TDL):

(1) one or more white matter lesions > 2 cm in diameter that are hyperintense on T2-weighted images

(2) low mass effect relative to size

(3) little vasogenic edema

(4) incomplete (open-ring) enhancement, often more pronounced on the medial aspect

(5) vessel-like structures running through the center of the lesion(s) on T2-weighted images

(6) low relative cerebral blood flow volume


A highly specific finding (Kim et al) was CT hypoattenuation of an MRI-enhancing lesion.


MRI findings that are nonspecific and shared with other CNS lesions such as gliomas:

(1) ill-defined or irregular border

(2) some mass effect

(3) perilesional edema

(4) central necrosis

(5) variable enhancement

(6) variable signal intensity on T2-weighted images

(7) involvement of gray matter


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