Magnetic Resonance Imaging in

Multiple Sclerosis
Magnetic Resonance Imaging
MRI is the most sensitive indicator in the
detection of MS plaques, but imaging findings
alone should never be considered diagnostic.
More than 90% of the lesions visualized by
MRI are asymptomatic.
Brant, W. and Helms, C. Fundamentals of Diagnostic Radiology. 4
th
ed. Lippincott Williams & Wilkins. 2012.
Longo, D. Harrisons Principles of Internal Medicine. 18
th
ed. McGraw-Hill Companies, Inc. 2012.
Magnetic Resonance Imaging
It is the most helpful ancillary examination in
the diagnosis of MS, by virtue of its ability to
reveal asymptomatic plaques in the
cerebrum, brainstem, optic nerves and spinal
cord.
Ropper, H. et. al., Adams and Victors Principles of Neurology, 10
th
ed. McGraw-Hill Education. 2014.
Magnetic Resonance Imaging
In clinically confirmed cases of MS, MRI
typically demonstrates lesions in more than
90% of cases as opposed to <50% in CT scan.
Brant, W. and Helms, C. Fundamentals of Diagnostic Radiology. 4
th
ed. Lippincott Williams & Wilkins. 2012.
T2WI demonstrates
multiple bright signal
abnormalities in white
matter, typical for MS
MS plaques are:
round or ovoid, with a
periventricular or
juxtacortical location
bright on T2WIs, reflecting
active inflammation or
chronic scarring

Brant, W. and Helms, C. Fundamentals of Diagnostic Radiology. 4
th
ed. Lippincott Williams & Wilkins. 2012.
Lesions are multifocal
within the brain,
brainstem, and spinal cord.
Lesions larger than 6 mm
are particularly helpful
diagnostically, especially if
located in the:
corpus callosum
periventricular white matter
brainstem
cerebellum
spinal cord
Longo, D. Harrisons Principles of Internal Medicine. 18
th
ed. McGraw-Hill Companies, Inc. 2012.





Many lesions are seen perpendicular to the
long axis of the ventricles:
corresponds to the pathological pattern termed as
perivenous demyelination or Dawsons fingers
Longo, D. Harrisons Principles of Internal Medicine. 18
th
ed. McGraw-Hill Companies, Inc. 2012.






When viewed in sagittal images, they extend
outward from the corpus callosum in a
fimbriated pattern.

Ropper, H. et. al., Adams and Victors Principles of Neurology, 10
th
ed. McGraw-Hill Education. 2014.





Presence of such lesions in the corpus
callosum is diagnostically useful, as this
structure is spared in many other disorders.

Ropper, H. et. al., Adams and Victors Principles of Neurology, 10
th
ed. McGraw-Hill Education. 2014.





Enhancement is another typical finding in MS.
present for about one month after the occurrence
of a lesion
Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.

Magnetic Resonance Imaging
According to the McDonald criteria for MS, the
diagnosis requires objective evidence of lesions
disseminated in time and space.
There is an important role for MRI in the
diagnosis of MS, since MRI can:
show multiple lesions (dissemination in space), some
of which can be clinically occult,
show new lesions on follow up scans (dissemination
in time)

Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.

Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.
McDonalds Criteria for MS
Longo, D. Harrisons Principles of Internal Medicine. 18
th
ed. McGraw-Hill Companies, Inc. 2012.

Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.

Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.
Attack is defined as:
Neurological disturbance of kind seen in MS
Subjective report or objective observation
At least 24 hours duration in absence of fever or infection

Time between attacks:
30 days between onset of event 1 and onset of event 2



Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.
McDonalds Criteria for MS
The diagnosis is either:
MS : all criteria fulfilled
possible MS : not all criteria fulfilled
not MS : no criteria fulfilled

Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.

Barkhof, F. et. al. Multiple Sclerosis. MR Center for MS Research,
Radiology Department of the Vrije Universiteit Medical Center. Amsterdam, Netherlands. 2014.