ABSTRACT
OBJECTIVES: To describe lesional diffusion-weighted imaging characteristics in a cohort of patients with biopsy-proven CNS inflammatory demyelinating disease (IDD) and compare diffusion characteristics of ring-enhancing CNS IDD lesions vs abscesses and tumors. METHODS: Forty prebiopsy apparent diffusion coefficient (ADC) maps were reviewed from 30 patients with CNS IDD. Lesions were analyzed for size, T2-weighted (T2W) hypointense rim, enhancement, and ADC pattern. ADC patterns of CNS IDD ring-enhancing lesions were compared with a published cohort of 35 patients with ring-enhancing tumors and abscesses. RESULTS: IDD lesions displayed a spectrum of peripheral ADC patterns at the lesion edge: restricted diffusion (low ADC), 33%; increased diffusion (high ADC), 60%; and normal diffusion (homogeneously isointense), 7%. Of biopsied lesions, 93% enhanced (ring, 52%; heterogeneous, 34%; homogeneous, 7%). A hypointense T2W rim was observed in 53%. A ring pattern on ADC (isointense or dark) was associated with T2W hypointense rims (p = 0.02) but not with ring enhancement. On serial imaging, 4 of 7 (57%) patients demonstrated changes in ADC patterns. Peripheral restriction was more common in IDD (p = 0.006) than in tumors or abscesses, whereas central restriction was only observed in abscesses. Restricted lesions in the same stage were more common in the non-IDD cohort (42% vs 20%), with a uniform restricted pattern seen only in abscesses. CONCLUSIONS: In ring-enhancing lesions, peripheral diffusion restriction is more common in IDD than in tumors/abscesses, whereas central restriction is more common among abscesses. Rapid ADC pattern changes in IDD probably reflect dynamic lesion evolution and may distinguish IDD from tumors.
Subject(s)
Demyelinating Diseases/diagnosis , Diffusion Magnetic Resonance Imaging/methods , Abscess/diagnosis , Abscess/pathology , Adolescent , Adult , Aged , Cohort Studies , Demyelinating Diseases/immunology , Demyelinating Diseases/pathology , Female , Humans , Inflammation/classification , Inflammation/diagnosis , Inflammation/pathology , Male , Middle Aged , Neoplasms/diagnosis , Neoplasms/pathology , Retrospective Studies , Single-Blind Method , Young AdultABSTRACT
This paper describes the Primary Care Fellowship in Women's Health based in the Family Medicine Department at UMDNJ-Robert Wood Johnson Medical School. The major components of the program are detailed and include the clinical, teaching, research, masters in public health, community involvement, and leadership aspects. In addition, the paper discusses how the approach of family medicine lends itself to the study and practice of the women's health concepts of totality, centrality, and diversity.
