Case 26

Multiple sclerosis
• CT:
• Areas of periventricular hypointensities, particularly in the left frontal region

• MR:
• Patchy plaque-like hyperintensities on T2 and FLAIR in the periventricular and
subcortical WM of the cerebral hemispheres
• Lesions are hypointense on T1 images
• Ring enhancement of some of the plaque-like lesions in the frontal lobes
(acute plaque)
Multiple sclerosis
• Dawson’s fingers: represent lymphocytic infiltration along periventricular
medullary veins
• Ovoid hyperintense plaques classically seen perpendicular to the axis of the lateral ventricles
on fluid sensitive sequences (T2 and FLAIR)

• Acute lesion: may have a "target" appearance

• Hyperintense center representing demyelination with a slightly less hyperintense periphery
representing vasogenic edema
• Rim of hypointensity separates these two regions
• Contrast enhancing lesions may be acute lesions
 Case directory

Multifocal white matter lesions

• Multiple sclerosis
• Acute disseminated encephalomyelitis (ADEM)
• Lyme disease
• AIDS
• Progressive multifocal leukoencephalopathy (PML)
• Neurosarcoidosis
• Vasculitides
• Small vessel ischemic disease