Multiple sclerosis MRI: Difference between revisions
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==Overview== | ==Overview== | ||
On [[MRI]], multiple sclerosis is characterized by [[cerebral]] plaques which are [[demyelinating]] areas. | On [[MRI]], multiple sclerosis is characterized by [[cerebral]] plaques disseminating in space and time which are characteristic of [[demyelinating]] areas. These [[Lesion|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== | ==MRI== | ||
[[MRI]] may be helpful in the diagnosis of multiple sclerosis. Findings on MRI diagnostic of multiple sclerosis include: | [[MRI]] may be helpful in the [[diagnosis]] of multiple sclerosis. Findings on MRI diagnostic of multiple sclerosis include: | ||
* Disseminating [[lesions]] in space and time. | * Disseminating [[lesions]] in space and time. | ||
* [[cerebral]] plaques which are [[demyelinating]] areas.<ref name="pmid9445407">{{cite journal |vauthors=Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mörk S, Bö L |title=Axonal transection in the lesions of multiple sclerosis |journal=N. Engl. J. Med. |volume=338 |issue=5 |pages=278–85 |date=January 1998 |pmid=9445407 |doi=10.1056/NEJM199801293380502 |url=}}</ref> These [[Lesion|lesions]] are commonly ovoid, and located in periventricular [[white matter]], [[cerebellum]] and [[brain stem]].<ref name="pmid10449103">{{cite journal |vauthors=Fazekas F, Barkhof F, Filippi M, Grossman RI, Li DK, McDonald WI, McFarland HF, Paty DW, Simon JH, Wolinsky JS, Miller DH |title=The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis |journal=Neurology |volume=53 |issue=3 |pages=448–56 |date=August 1999 |pmid=10449103 |doi= |url=}}</ref> 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]].<ref name="pmid10683822">{{cite journal |vauthors=Bakshi R, Shaikh ZA, Janardhan V |title=MRI T2 shortening ('black T2') in multiple sclerosis: frequency, location, and clinical correlation |journal=Neuroreport |volume=11 |issue=1 |pages=15–21 |date=January 2000 |pmid=10683822 |doi= |url=}}</ref><ref name="pmid11266686">{{cite journal |vauthors=Bakshi R, Dmochowski J, Shaikh ZA, Jacobs L |title=Gray matter T2 hypointensity is related to plaques and atrophy in the brains of multiple sclerosis patients |journal=J. Neurol. Sci. |volume=185 |issue=1 |pages=19–26 |date=March 2001 |pmid=11266686 |doi= |url=}}</ref> | * [[cerebral]] plaques which are [[demyelinating]] areas.<ref name="pmid9445407">{{cite journal |vauthors=Trapp BD, Peterson J, Ransohoff RM, Rudick R, Mörk S, Bö L |title=Axonal transection in the lesions of multiple sclerosis |journal=N. Engl. J. Med. |volume=338 |issue=5 |pages=278–85 |date=January 1998 |pmid=9445407 |doi=10.1056/NEJM199801293380502 |url=}}</ref> These [[Lesion|lesions]] are commonly ovoid, and located in periventricular [[white matter]], [[cerebellum]] and [[brain stem]].<ref name="pmid10449103">{{cite journal |vauthors=Fazekas F, Barkhof F, Filippi M, Grossman RI, Li DK, McDonald WI, McFarland HF, Paty DW, Simon JH, Wolinsky JS, Miller DH |title=The contribution of magnetic resonance imaging to the diagnosis of multiple sclerosis |journal=Neurology |volume=53 |issue=3 |pages=448–56 |date=August 1999 |pmid=10449103 |doi= |url=}}</ref> 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]].<ref name="pmid10683822">{{cite journal |vauthors=Bakshi R, Shaikh ZA, Janardhan V |title=MRI T2 shortening ('black T2') in multiple sclerosis: frequency, location, and clinical correlation |journal=Neuroreport |volume=11 |issue=1 |pages=15–21 |date=January 2000 |pmid=10683822 |doi= |url=}}</ref><ref name="pmid11266686">{{cite journal |vauthors=Bakshi R, Dmochowski J, Shaikh ZA, Jacobs L |title=Gray matter T2 hypointensity is related to plaques and atrophy in the brains of multiple sclerosis patients |journal=J. Neurol. Sci. |volume=185 |issue=1 |pages=19–26 |date=March 2001 |pmid=11266686 |doi= |url=}}</ref> | ||
* [[Spinal cord]]<nowiki/>s 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 [[Diagnosis|diagnosing]] [[MS]] rather than brain [[MRI]] only.<ref name="pmid23737540">{{cite journal |vauthors=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 |title=Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: MR imaging findings in a large cohort of patients |journal=Radiology |volume=269 |issue=2 |pages=542–52 |date=November 2013 |pmid=23737540 |doi=10.1148/radiol.13122566 |url=}}</ref><ref name="pmid9577394">{{cite journal |vauthors=Nijeholt GJ, van Walderveen MA, Castelijns JA, van Waesberghe JH, Polman C, Scheltens P, Rosier PF, Jongen PJ, Barkhof F |title=Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms |journal=Brain |volume=121 ( Pt 4) |issue= |pages=687–97 |date=April 1998 |pmid=9577394 |doi= |url=}}</ref><ref name="pmid11456302">{{cite journal |vauthors=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 |title=Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis |journal=Ann. Neurol. |volume=50 |issue=1 |pages=121–7 |date=July 2001 |pmid=11456302 |doi= |url=}}</ref> | * [[Spinal cord]]<nowiki/>s [[lesions]] are common in [[MS]] disease and are often [[symptomatic]]. These [[lesions]] are focal or diffuse, small land located mostly in the [[Cervical nerves|cervical spinal cord]]. [[spinal cord]] findings can be very helpful for [[Diagnosis|diagnosing]] [[MS]] rather than brain [[MRI]] only.<ref name="pmid23737540">{{cite journal |vauthors=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 |title=Relevance of spinal cord abnormalities to clinical disability in multiple sclerosis: MR imaging findings in a large cohort of patients |journal=Radiology |volume=269 |issue=2 |pages=542–52 |date=November 2013 |pmid=23737540 |doi=10.1148/radiol.13122566 |url=}}</ref><ref name="pmid9577394">{{cite journal |vauthors=Nijeholt GJ, van Walderveen MA, Castelijns JA, van Waesberghe JH, Polman C, Scheltens P, Rosier PF, Jongen PJ, Barkhof F |title=Brain and spinal cord abnormalities in multiple sclerosis. Correlation between MRI parameters, clinical subtypes and symptoms |journal=Brain |volume=121 ( Pt 4) |issue= |pages=687–97 |date=April 1998 |pmid=9577394 |doi= |url=}}</ref><ref name="pmid11456302">{{cite journal |vauthors=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 |title=Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis |journal=Ann. Neurol. |volume=50 |issue=1 |pages=121–7 |date=July 2001 |pmid=11456302 |doi= |url=}}</ref> | ||
* On T1-weigh<nowiki/>ted 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.<ref name="pmid9595975">{{cite journal |vauthors=van Walderveen MA, Kamphorst W, Scheltens P, van Waesberghe JH, Ravid R, Valk J, Polman CH, Barkhof F |title=Histopathologic correlate of hypointense lesions on T1-weighted spin-echo MRI in multiple sclerosis |journal=Neurology |volume=50 |issue=5 |pages=1282–8 |date=May 1998 |pmid=9595975 |doi= |url=}}</ref><ref name="pmid10908888">{{cite journal |vauthors=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 |title=A longitudinal study of T1 hypointense lesions in relapsing MS: MSCRG trial of interferon beta-1a. Multiple Sclerosis Collaborative Research Group |journal=Neurology |volume=55 |issue=2 |pages=185–92 |date=July 2000 |pmid=10908888 |doi= |url=}}</ref><ref name="pmid11409432">{{cite journal |vauthors=Bitsch A, Kuhlmann T, Stadelmann C, Lassmann H, Lucchinetti C, Brück W |title=A longitudinal MRI study of histopathologically defined hypointense multiple sclerosis lesions |journal=Ann. Neurol. |volume=49 |issue=6 |pages=793–6 |date=June 2001 |pmid=11409432 |doi= |url=}}</ref> | * On T1-weigh<nowiki/>ted MRI, MS lesions are isointens to [[white matter]], but sometimes we see these [[Cerebellum|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.<ref name="pmid9595975">{{cite journal |vauthors=van Walderveen MA, Kamphorst W, Scheltens P, van Waesberghe JH, Ravid R, Valk J, Polman CH, Barkhof F |title=Histopathologic correlate of hypointense lesions on T1-weighted spin-echo MRI in multiple sclerosis |journal=Neurology |volume=50 |issue=5 |pages=1282–8 |date=May 1998 |pmid=9595975 |doi= |url=}}</ref><ref name="pmid10908888">{{cite journal |vauthors=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 |title=A longitudinal study of T1 hypointense lesions in relapsing MS: MSCRG trial of interferon beta-1a. Multiple Sclerosis Collaborative Research Group |journal=Neurology |volume=55 |issue=2 |pages=185–92 |date=July 2000 |pmid=10908888 |doi= |url=}}</ref><ref name="pmid11409432">{{cite journal |vauthors=Bitsch A, Kuhlmann T, Stadelmann C, Lassmann H, Lucchinetti C, Brück W |title=A longitudinal MRI study of histopathologically defined hypointense multiple sclerosis lesions |journal=Ann. Neurol. |volume=49 |issue=6 |pages=793–6 |date=June 2001 |pmid=11409432 |doi= |url=}}</ref> | ||
* We can see <nowiki/>brain atrophy in MS patient especially in the thalamus areas. some studies show that thalamus atrophy can be an indicator of disease progression.<ref name="pmid11844733">{{cite journal |vauthors=Chard DT, Griffin CM, Parker GJ, Kapoor R, Thompson AJ, Miller DH |title=Brain atrophy in clinically early relapsing-remitting multiple sclerosis |journal=Brain |volume=125 |issue=Pt 2 |pages=327–37 |date=February 2002 |pmid=11844733 |doi= |url=}}</ref><ref name="pmid23613615">{{cite journal |vauthors=Zivadinov R, Havrdová E, Bergsland N, Tyblova M, Hagemeier J, Seidl Z, Dwyer MG, Vaneckova M, Krasensky J, Carl E, Kalincik T, Horáková D |title=Thalamic atrophy is associated with development of clinically definite multiple sclerosis |journal=Radiology |volume=268 |issue=3 |pages=831–41 |date=September 2013 |pmid=23613615 |doi=10.1148/radiol.13122424 |url=}}</ref> | * We can see <nowiki/>[[brain atrophy]] in MS patient especially in the [[thalamus]] areas. some studies show that [[thalamus]] [[atrophy]] can be an indicator of disease progression.<ref name="pmid11844733">{{cite journal |vauthors=Chard DT, Griffin CM, Parker GJ, Kapoor R, Thompson AJ, Miller DH |title=Brain atrophy in clinically early relapsing-remitting multiple sclerosis |journal=Brain |volume=125 |issue=Pt 2 |pages=327–37 |date=February 2002 |pmid=11844733 |doi= |url=}}</ref><ref name="pmid23613615">{{cite journal |vauthors=Zivadinov R, Havrdová E, Bergsland N, Tyblova M, Hagemeier J, Seidl Z, Dwyer MG, Vaneckova M, Krasensky J, Carl E, Kalincik T, Horáková D |title=Thalamic atrophy is associated with development of clinically definite multiple sclerosis |journal=Radiology |volume=268 |issue=3 |pages=831–41 |date=September 2013 |pmid=23613615 |doi=10.1148/radiol.13122424 |url=}}</ref> | ||
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.<ref name="pmid12051469">{{cite journal |vauthors=Ingle GT, Thompson AJ, Miller DH |title=Magnetic resonance imaging in primary progressive multiple sclerosis |journal=J Rehabil Res Dev |volume=39 |issue=2 |pages=261–71 |date=2002 |pmid=12051469 |doi= |url=}}</ref> | NOTE: To differentiate [[acute]] and [[chronic]] [[lesion]] from each other, we most know that [[Acute (medicine)|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.<ref name="pmid12051469">{{cite journal |vauthors=Ingle GT, Thompson AJ, Miller DH |title=Magnetic resonance imaging in primary progressive multiple sclerosis |journal=J Rehabil Res Dev |volume=39 |issue=2 |pages=261–71 |date=2002 |pmid=12051469 |doi= |url=}}</ref> | ||
[[File:Multiple-sclerosis-6.jpg|500px|none|thumb|Case courtesy of <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/11646">rID: 11646</a>]] | |||
[[File:Multiple-sclerosis-45.jpg|500px|none|thumb|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== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
Latest revision as of 22:47, 29 July 2020
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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
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
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]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.