Imaging Mimics of Brain Tumors

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Key points

  • Tumor mimics may account for 4% to 13% of referrals to a neuro-oncology service, so consideration of nonneoplastic processes is critical during initial evaluation of CNS neoplasia.

  • Leveraging specific imaging signs and advanced imaging techniques detailed herein may add diagnostic confidence when considering various autoimmune, infectious, and vascular tumor mimics.

  • Variability in ancillary laboratory diagnostics, including serologic and various immunohistochemical tests, may confer sufficiently

Demyelinating and Inflammatory Disorders

Although multiple sclerosis typically displays small multifocal perivenular demyelinating plaques with a propensity for the callososeptal interface that disseminate in space and time, larger tumefactive lesions may occasionally constitute the imaging presentation. In such cases, almost one-third of the larger tumefactive lesions can be the only lesion, potentially leading to misdiagnosis as neoplasia. Solitary and/or tumefactive lesions are more likely to occur in the uncommon multiple

Laboratory test pearls and pitfalls

When confronted by imaging with a brain tumor mimic, the clinical history is crucial to guide the need for laboratory studies that may help in the diagnosis. For instance, imaging characteristics in the context of a history of immunosuppression or epidemiologic exposure raises the suspicion of an infectious cause. Thus, a detailed medical history increases the utility of ordering serologic and CSF tests. Unfortunately, for most circumstances there are no studies that determine the sensitivity

Summary

Prospective identification of brain tumor mimics is an opportunity for the interpreting radiologist to add value to patient care by decreasing time to diagnosis and avoiding unnecessary surgical procedures and medical therapies, but requires familiarity with mimic entities and an appropriately high degree of suspicion.

Clinics care points

  • Tumor mimics may account for 4% to 13% of referrals to a neuro-oncology service, so consideration of nonneoplastic processes is critical during initial evaluation of CNS neoplasia.

  • Leveraging specific imaging signs and advanced imaging techniques detailed herein may add diagnostic confidence when considering various autoimmune, infectious, and vascular tumor mimics.

  • Variability in ancillary laboratory diagnostics, including serologic and various immunohistochemical tests, may confer sufficiently

Disclosure

The authors have nothing to disclose.

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