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

摘要

Inflammatory demyelinating pseudotumor usually occurs in the brain and rarely occurs in the spinal cord.On imaging,inflammatory demyelinating pseudotumor appears very similar to intramedullary tumors such as gliomas.It is often misdiagnosed as intramedullary tumor and surgically resected.In view of this,the clinical and magnetic resonance imaging manifestations and the pathological features of 36 cases of inflammatory demyelinating pseudotumor in the spinal cord were retrospectively 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 intramedullary gliomas,and inflammatory demyelinating pseudotumor was only identified and pathologically confirmed after surgical resection.Lesions in the cervical and thoracic spinal cord were common.Magnetic resonance imaging revealed edema and space-occupying lesions to varying degrees at the cervical-thoracic junction,with a predominant feature of non-closed rosette-like reinforcement(open-loop sign).Pathological examination showed perivascular cuffing of predominantly dense lymphocytes,and demyelination was observed in six of the misdiagnosed cases.These results 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 intramedullary neoplasms.Patchy or non-closed reinforcement(open-ring sign)on magnetic resonance imaging is the predominant property of inflammatory demyelinating pseudotumor,and inflammatory cell infiltration and demyelination are additional pathological properties.