Deep Learning With Data Enhancement for the Differentiation of Solitary and Multiple Cerebral Glioblastoma, Lymphoma, and Tumefactive Demyelinating Lesion

ObjectivesTo explore the MRI-based differential diagnosis of deep learning with data enhancement for cerebral glioblastoma (GBM), primary central nervous system lymphoma (PCNSL), and tumefactive demyelinating lesion (TDL).Materials and MethodsThis retrospective study analyzed the MRI data of 261 patients with pathologically diagnosed solitary and multiple cerebral GBM (n = 97), PCNSL (n = 92), and TDL (n = 72). The 3D segmentation model was trained to capture the lesion. Different enhancement data were generated by changing the pixel ratio of the lesion and non-lesion areas. The 3D classification network was trained by using the enhancement data. The accuracy, sensitivity, specificity, and area under the curve (AUC) were used to assess the value of different enhancement data on the discrimination performance. These results were then compared with the neuroradiologists’ diagnoses.ResultsThe diagnostic performance fluctuated with the ratio of lesion to non-lesion area changed. The diagnostic performance was best when the ratio was 1.5. The AUCs of GBM, PCNSL, and TDL were 1.00 (95% confidence interval [CI]: 1.000–1.000), 0.96 (95% CI: 0.923–1.000), and 0.954 (95% CI: 0.904–1.000), respectively.ConclusionsDeep learning with data enhancement is useful for the accurate identification of GBM, PCNSL, and TDL, and its diagnostic performance is better than that of the neuroradiologists.

A 25-Year-Old Clinically Isolated Syndrome Patient with Tumefactive Demyelinating Lesion in Cervical Cord: A Case Report and a Mini Review

: This study aimed to present a case of a clinically isolated syndrome (CIS) with a reported tumefactive demyelinating lesion (TDLs) in the cord. The patient was a 25-year-old woman who referred to MS Clinic complaining of walking impairment and a blurred vision in the right eye. In the magnetic resonance imaging (MRI) of the brain, there were several periventricular plaques, a significant portion of which had enhanced, but none of the lesions was tumefactive. In the cervical MRI, however, several tumefactive plaques appeared with a clear enhancement and expansion, which was central-based in the axial view. Concerning the involvement of the cervical cord, further examinations were conducted of anti-aquaporin and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies, which were negative. The patient was treated with 1g methylprednisolone daily injection for five days; her symptoms recovered completely. Then, due to the extent of the involvement, rituximab was prescribed for her. Unlike the TDLs of the brain, little attention has been paid to these lesions in the cord. Here, firstly a case of CIS with a tumefactive lesion reported in the cord is investigated, and then, by examining similar cases, we try to find a definition for cord TDLs.

Tumefactive Demyelinating Lesions in Children: A Rare Case of Conus Medullaris Involvement and Systematic Review of the Literature

Tumefactive demyelinating lesions are an uncommon manifestation of demyelinating disease that mimic primary central nervous system neoplasms and can pose a diagnostic challenge in patients without a pre-existing diagnosis of multiple sclerosis. Although a biopsy may be required to distinguish TDL from neoplasms or infection, certain ancillary and radiographic findings may preclude the need for invasive diagnostic procedures. We describe the case of a 15-year-old boy with a tumefactive demyelinating lesion involving the conus medullaris. An exhaustive systematic literature search of pediatric cases of TDL yielded an additional 78 cases. This review summarizes the current knowledge and recommendations for the diagnosis and management of this condition, highlighting the clinical, demographic, and radiologic features of 79 reported cases, including our own. Furthermore, it underscores areas of the literature where evidence is still lacking. Further research is needed to optimize clinical detection and medical management of this condition.