Dados do Trabalho

Título

Practical Approach in the Differential Diagnosis of Cortical Lesions

Introdução e objetivo(s)

Brain cortical lesions constitute a broad and heterogeneous group of pathologies and represent, in many cases, a diagnostic challenge for general radiologists and neuroradiologists. A cortical imaging can be a manifestation of an inflammatory disease such as multiple sclerosis (MS), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) or autoimmune encephalitis. We can also find them in infectious disorders like tuberculosis, syphilis, among others. There are a several neoplastic disorders that can affect the brain cortex, suchas the dysembryoplastic neuroepithelial tumor (DNET) and the multinodular and vacuolating neuronal tumor (MVNT) that are differential diagnosis in this group and are frequently described. It is important to remember other causes such as toxic and metabolic disorders, like osmotic demyelination syndrome, vascular causes such as ischemic events, development disorders like cortical focal dysplasia, phakomatosis such as tuberous sclerosis and others. This study aims to review the principal imaging patterns of cortical lesions and define a practical approach of them, focusing on MRI findings, to help general radiologists and neuroradiologists in the diagnosis of cortical lesions.

Método(s)

This study consists in a pictorial essay based in a serial of selected anonymized cases from our database imaging system, which were collected and analyzed. The including criteria were the presence of cortical lesions isolated or multiple, associated or not to white matter alterations which were ≤ 3,0 cm. We selected MRI basic sequences and also advanced sequences in order to identify and categorize imaging patterns through major pathology groups.

Discussão

The approach of a cortical imaging should englobe general features such as localization, associated lesions, multiple or not, white matter involvement, enhancement pattern, in particular, leptomeningeal enhancement, diffusion restriction and others. Radiologists can use advanced sequences in order to help their diagnosis, such as spectroscopy (specially in toxic metabolic disorders), T1 perfusion, or basic sequences like post-contrasted FLAIR in MS cortical lesions, for example.

Conclusões

In conclusion, cortical lesions remain a challenge for neuroradiologists and general radiologists. The cortex involvement englobes a heterogeneous group of disorders. Our goal is to minimize these possibilities in our report with the help of imaging patterns.

Palavras Chave

Cortical lesions

Arquivos