MRI Patterns of Isolated Lesions in the Medulla Oblongata
| Autor: | Otto Rapalino, Gilberto Gonzalez, Supada Prakkamakul, Pamela W. Schaefer |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Pathology medicine.diagnostic_test Medullary cavity business.industry Magnetic resonance imaging 030218 nuclear medicine & medical imaging Lesion 03 medical and health sciences 0302 clinical medicine Biopsy Medulla oblongata Etiology Medicine Radiology Nuclear Medicine and imaging Neurology (clinical) Radiology Differential diagnosis medicine.symptom Medical diagnosis business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Neuroimaging. 27:135-143 |
| ISSN: | 1051-2284 |
| DOI: | 10.1111/jon.12361 |
| Popis: | BACKGROUND AND PURPOSE Isolated lesions of the medulla oblongata are difficult to diagnose due to their rarity and high biopsy risk. Several individual case reports have been published, but a systematic descriptive study is lacking. Our study has three objectives that 1) provide a differential diagnosis, 2) describe magnetic resonance imaging (MRI) findings, and 3) propose a stepwise MRI-based approach to the isolated lesions of the medulla oblongata in nonstroke patients. METHODS We performed an institutional Review Board–approved retrospective analysis of 34 consecutive cases of isolated medullary lesions from nonstroke causes identified from our imaging database between January 2000 and May 2015. Eleven were excluded due to lack of pretreatment or follow-up MRI. MR studies were reviewed by two blinded neuroradiologists. The diagnosis, demographic data, and MR findings were reported using frequencies and proportions. An MRI-based diagnostic algorithm was proposed. RESULTS Most lesions were neoplasms (47%), followed by vascular malformations (15%), demyelinating/inflammatory lesions (15%), others (12%), unknown (8%), and infection (3%). Five MRI patterns were identified: 1) cystic lesion, 2) exophytic noncystic lesion, 3) intrinsic lesion with T2 hypointensity, 4) enhancing intrinsic lesion, and 5) nonenhancing intrinsic lesion. All showing patterns 1 and 2 were neoplasms or cysts. All showing pattern 3 were vascular malformations. Patterns 4 and 5 comprised of multiple etiologies. CONCLUSIONS Neoplasms are the most common cause of isolated medullary lesions in nonstroke patients. Other differential diagnoses include vascular malformations, demyelinating/inflammatory lesions, and infections. A stepwise MRI-based approach can help differentiate between various etiologies. |
| Databáze: | OpenAIRE |
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