# Identifying Tumefactive Demyelination on Synthetic MRI Myelin Maps

## TL;DR

This paper presents a case where synthetic MRI helped distinguish a demyelinating lesion from a brain tumor in a young patient.

## Contribution

The study introduces the use of synthetic MRI myelin maps in pediatric cases to differentiate tumefactive demyelination from gliomas.

## Key findings

- SyMRI revealed a 'rim of decreased myelination' in a pediatric patient, supporting a demyelinating diagnosis.
- The patient's symptoms resolved without recurrence, and immunotherapy confirmed the demyelination diagnosis.
- The case highlights SyMRI's potential in pediatric neuroradiology for diagnostic differentiation.

## Abstract

Tumefactive demyelinating lesions and brain neoplasms often present as a diagnostic challenge due to overlapping radiographic features among conventional imaging modalities ultimately resulting in uncertainty if a biopsy is warranted to establish a definitive diagnosis. Synthetic MRI (SyMRI) is a novel imaging technique providing myelin maps to aid with diagnosis, yet its use in pediatric patients remains largely unexplored. Therein, we report a pediatric case utilizing SyMRI to assist in differentiating tumefactive demyelination from a recurrent glioma. This 16-year-old female with a history of ganglioglioma, presented with sudden left-sided weakness. The initial MRI suggested either a glial neoplasm or a demyelinating lesion, prompting consideration of a biopsy. SyMRI revealed a unique “rim of decreased myelination,” challenging the initial diagnosis. Within 1 week from admission, the patient's symptoms resolved without recurrence. Immunotherapy resolved the demyelinating lesion, supporting the initial SyMRI finding. The case demonstrates the potential of SyMRI in pediatric neuroradiology, highlighting a distinct “rim of demyelination” and its comparison to gliomas aiding in the diagnostic process.