Imaging and clinical properties of inflammatory demyelinating pseudotumor in the spinal cord

Ying Wang; Min Wang; Hui Liang; Quntao Yu; Zhihui Yan; Min Kong

doi:10.3969/j.issn.1673-5374.2013.26.010

摘要：Inflammatory demyelinating pseudotumor usual y occurs in the brain and rarely occurs in the spinal cord. On imaging, inflammatory demyelinating pseudotumor appears very similar to intramedul ary tumors such as gliomas. It is often misdiagnosed as intramedul ary tumor and surgical y resected. In view of this, the clinical and magnetic resonance imaging manifestations and the pathological fea-tures of 36 cases of inflammatory demyelinating pseudotumor in the spinal cord were retrospec-tively analyzed and summarized. Most of these cases suffered from acute or subacute onset and exhibited a sensorimotor disorder. Among them, six cases were misdiagnosed as having intrame-dul ary gliomas, and inflammatory demyelinating pseudotumor was only identified and pathologi-cal y confirmed after surgical resection. Lesions in the cervical and thoracic spinal cord were com-mon. Magnetic resonance imaging revealed edema and space-occupying lesions to varying de-grees at the cervical-thoracic junction, with a predominant feature of non-closed rosette-like rein-forcement (open-loop sign). Pathological examination showed perivascular cuffing of predominantly dense lymphocytes, and demyelination was observed in six of the misdiagnosed cases. These re-sults suggest that tumor-like inflammatory demyelinating disease in the spinal cord is a kind of special demyelinating disease that can be categorized as inflammatory pseudotumor. These solitary lesions are easily confused with intramedul ary neoplasms. Patchy or non-closed reinforcement (open-ring sign) on magnetic resonance imaging is the predominant property of inflammatory de-myelinating pseudotumor, and inflammatory cel infiltration and demyelination are additional patho-logical properties.