Multiple sclerosis MRI

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Fahimeh Shojaei, M.D.

## Overview

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On MRI, multiple sclerosis is characterized by cerebral plaques disseminating in space and time which are characteristic of demyelinating areas. These lesions are commonly void, and located in periventricular white matter, cerebellum, and the brain stem. These lesions are hyperintense on T2 sections of a MRI.

## MRI

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MRI may be helpful in the diagnosis of multiple sclerosis. Findings on MRI diagnostic of multiple sclerosis include:

* Disseminating lesions in space and time.

* cerebral plaques which are demyelinating areas.[1] These lesions are commonly ovoid, and located in periventricular white matter, cerebellum and brain stem.[2] These lesions are hyperintense on T2 sections of MRI. There are also gray matter lesions, presents as hypointensity in T2-weighted and are correlated with patients physical disability and brain atrophy.[3][4]

* Spinal cords lesions are common in MS disease and are often symptomatic. These lesions are focal or diffuse, small land located mostly in the cervical spinal cord. spinal cord findings can be very helpful for diagnosing MS rather than brain MRI only.[5][6][7]
* On T1-weighted MRI, MS lesions are isointens to white matter, but sometimes we see these lesions as a hypointens lesions called “black holes” mostly seen in supratentorial region . These black holes can disappear after several months due to remyelination but persistent black hole lesion can be a marker of active disease and demyelination injury.[8][9][10]
* We can see brain atrophy in MS patient especially in the thalamus areas. some studies show that thalamus atrophy can be an indicator of disease progression.[11][12]

NOTE: To differentiate acute and chronic lesion from each other, we most know that acute lesions tends to be larger in size with poor defined border, but chronic lesion are smaller due to reduction of inflammation and edema and have sharp borders in imaging.[13]

Case courtesy of <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/11646">rID: 11646</a> Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8662">rID: 8662</a>

## References

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1. ↑ Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mörk S, Bö L (January 1998). "Axonal transection in the lesions of multiple sclerosis". N. Engl. J. Med. 338 (5): 278–85. doi:10.1056/NEJM199801293380502. PMID 9445407.
2. ↑ Fazekas F, Barkhof F, Filippi M, Grossman RI, Li DK, McDonald WI, McFarland HF, Paty DW, Simon JH, Wolinsky JS, Miller DH (August 1999). "The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis". Neurology. 53 (3): 448–56. PMID 10449103.
3. ↑ Bakshi R, Shaikh ZA, Janardhan V (January 2000). "MRI T2 shortening ('black T2') in multiple sclerosis: frequency, location, and clinical correlation". Neuroreport. 11 (1): 15–21. PMID 10683822.
4. ↑ Bakshi R, Dmochowski J, Shaikh ZA, Jacobs L (March 2001). "Gray matter T2 hypointensity is related to plaques and atrophy in the brains of multiple sclerosis patients". J. Neurol. Sci. 185 (1): 19–26. PMID 11266686.
5. ↑ Lukas C, Sombekke MH, Bellenberg B, Hahn HK, Popescu V, Bendfeldt K, Radue EW, Gass A, Borgwardt SJ, Kappos L, Naegelin Y, Knol DL, Polman CH, Geurts JJ, Barkhof F, Vrenken H (November 2013). "Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: MR imaging findings in a large cohort of patients". Radiology. 269 (2): 542–52. doi:10.1148/radiol.13122566. PMID 23737540.
6. ↑ Nijeholt GJ, van Walderveen MA, Castelijns JA, van Waesberghe JH, Polman C, Scheltens P, Rosier PF, Jongen PJ, Barkhof F (April 1998). "Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms". Brain. 121 ( Pt 4): 687–97. PMID 9577394.
7. ↑ McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg-Wollheim M, Sibley W, Thompson A, van den Noort S, Weinshenker BY, Wolinsky JS (July 2001). "Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis". Ann. Neurol. 50 (1): 121–7. PMID 11456302.
8. ↑ van Walderveen MA, Kamphorst W, Scheltens P, van Waesberghe JH, Ravid R, Valk J, Polman CH, Barkhof F (May 1998). "Histopathologic correlate of hypointense lesions on T1-weighted spin-echo MRI in multiple sclerosis". Neurology. 50 (5): 1282–8. PMID 9595975.
9. ↑ Simon JH, Lull J, Jacobs LD, Rudick RA, Cookfair DL, Herndon RM, Richert JR, Salazar AM, Sheeder J, Miller D, McCabe K, Serra A, Campion MK, Fischer JS, Goodkin DE, Simonian N, Lajaunie M, Wende K, Martens-Davidson A, Kinkel RP, Munschauer FE (July 2000). "A longitudinal study of T1 hypointense lesions in relapsing MS: MSCRG trial of interferon beta-1a. Multiple Sclerosis Collaborative Research Group". Neurology. 55 (2): 185–92. PMID 10908888.
10. ↑ Bitsch A, Kuhlmann T, Stadelmann C, Lassmann H, Lucchinetti C, Brück W (June 2001). "A longitudinal MRI study of histopathologically defined hypointense multiple sclerosis lesions". Ann. Neurol. 49 (6): 793–6. PMID 11409432.
11. ↑ Chard DT, Griffin CM, Parker GJ, Kapoor R, Thompson AJ, Miller DH (February 2002). "Brain atrophy in clinically early relapsing-remitting multiple sclerosis". Brain. 125 (Pt 2): 327–37. PMID 11844733.
12. ↑ Zivadinov R, Havrdová E, Bergsland N, Tyblova M, Hagemeier J, Seidl Z, Dwyer MG, Vaneckova M, Krasensky J, Carl E, Kalincik T, Horáková D (September 2013). "Thalamic atrophy is associated with development of clinically definite multiple sclerosis". Radiology. 268 (3): 831–41. doi:10.1148/radiol.13122424. PMID 23613615.
13. ↑ Ingle GT, Thompson AJ, Miller DH (2002). "Magnetic resonance imaging in primary progressive multiple sclerosis". J Rehabil Res Dev. 39 (2): 261–71. PMID 12051469.

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