Journal of Neurology and Neuroscience

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Tumefactive Demyelinating Lesions in Multiple Sclerosis: Role of Magnetic Resonance Spectroscopy (MRS)

Shaista Anwar Siddiqi, Naseeb Ullah Khan Kakkar, Carolina Maria Pires, AbuBaker AlMadani AlShaffi, Sayeed Iqbal, Ayoub Abidzada and Jihad Said Salim Inshasi

Tumefactive Demyelinating Lesions (TDL) is characterized by large demyelinating lesions that frequently mimic intracranial neoplasm or abscess. Proton Magnetic Resonance Spectroscopy (MRS) imaging is a potentially exciting tool to help in the diagnosis. Literature reports, studying the potential utility of MRS in differentiating TDLs from neoplasms, have focused on the quantification of biochemical metabolites such as N-acetyl aspartate (NAA), Choline (Cho), Creatine (Cr), Lactate (Lac), mobile Lipids (Lip) and Glutamate (Glx). We hereby report MRS findings of three patients with tumefactive lesions, i.e. elevated Choline and Lactate (except patient 3) peaks with reduced NAA peaks, consistent with demyelination. Based on the improvements in clinical and imaging outcomes during subsequent follow ups confirming Multiple Sclerosis (MS), we propose that elevation of Lactate and Choline peaks together with reduction of NAA peak on MRS study together with clinical picture may serve as an important non-invasive tool to differentiate TDL from other radiological correlates.