Migraine related white matter lesions in the differential diagnosis of multiple sclerosis: Magnetic resonance imaging features

2020 ◽  
Vol 27 (10) ◽  
pp. 2645
Author(s):  
Mehmet Yetkin
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Differential Diagnosis ◽  
White Matter ◽  
Magnetic Resonance ◽  
White Matter Lesions ◽  
Imaging Features ◽  
Resonance Imaging

Breakthrough Disease While on Multiple Sclerosis Immunomodulatory Therapy

2021 ◽  
pp. 55-56
Author(s):  
Jonathan L. Carter
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
White Matter ◽  
Magnetic Resonance ◽  
Disease Activity ◽  
Brain Magnetic Resonance Imaging ◽  
White Matter Lesions ◽  
Dimethyl Fumarate ◽  
Resonance Imaging

A 36-year-old woman with a history of relapsing-remitting multiple sclerosis was evaluated for new multiple sclerosis symptoms accompanied by new, enhancing, white matter lesions on brain magnetic resonance imaging. Her multiple sclerosis presented with L’hermitte sign when she was 24 years old. She had onset of bilateral lower extremity and left upper extremity tingling at age 26 years. Magnetic resonance imaging and cerebrospinal fluid examination at the time were supportive of the diagnosis of multiple sclerosis, and disease-modifying therapy was recommended by her neurologist. She initiated therapy with dimethyl fumarate at age 30 years after several further relapses. Surveillance magnetic resonance imaging showed new gadolinium-enhancing lesions on brain magnetic resonance imaging on each of 3 consecutive yearly scans. Urine culture and sensitivity tests were performed to rule out occult urinary tract infection; results of this testing were negative. magnetic resonance imaging of the brain concurrently showed new enhancing white matter lesions. The patient was diagnosed with clinical and radiographic breakthrough disease activity while receiving therapy for multiple sclerosis. The patient was treated with 5 days of intravenous methylprednisolone for her relapse. After discussion with the patient, it was decided to transition therapy from dimethyl fumarate to ocrelizumab infusions for her breakthrough disease activity. This decision was further supported by the patient’s concerns that she might be entering an early progressive phase of the disease. In patients with spinal-predominant multiple sclerosis, or with symptoms potentially indicating new spinal cord involvement, it may be necessary to include spinal cord imaging to assess for new disease activity.

Imaging central veins in brain lesions with 3-T T2*-weighted magnetic resonance imaging differentiates multiple sclerosis from microangiopathic brain lesions

2016 ◽  
Vol 22 (10) ◽  
pp. 1289-1296 ◽  
Author(s):  
Niraj Mistry ◽  
Rasha Abdel-Fahim ◽  
Amal Samaraweera ◽  
Olivier Mougin ◽  
Emma Tallantyre ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
White Matter ◽  
Magnetic Resonance ◽  
Validation Cohort ◽  
Brain Mri ◽  
White Matter Lesions ◽  
Brain Lesions ◽  
Central Vein ◽  
Resonance Imaging

Background: White matter lesions are frequently detected using brain magnetic resonance imaging (MRI) performed for various indications. Most are microangiopathic, but demyelination, including multiple sclerosis (MS), is an important cause; conventional MRI cannot always distinguish between these pathologies. The proportion of lesions with a central vein on 7-T T2*-weighted MRI prospectively distinguishes demyelination from microangiopathic lesions. Objective: To test whether 3-T T2*-weighted MRI can differentiate MS from microangiopathic brain lesions. Methods: A total of 40 patients were studied. Initially, a test cohort of 10 patients with MS and 10 patients with microangiopathic white matter lesions underwent 3-T T2*-weighted brain MRI. Anonymised scans were analysed blind to clinical data, and simple diagnostic rules were devised. These rules were applied to a validation cohort of 20 patients (13 with MS and 7 with microangiopathic lesions) by a blinded observer. Results: Within the test cohort, all patients with MS had central veins visible in >45% of brain lesions, while the rest had central veins visible in <45% of lesions. By applying diagnostic rules to the validation cohort, all remaining patients were correctly categorised. Conclusion: 3-T T2*-weighted brain MRI distinguishes perivenous MS lesions from microangiopathic lesions. Clinical application of this technique could supplement existing diagnostic algorithms.

Microstructural magnetic resonance imaging of cortical lesions in multiple sclerosis

2012 ◽  
Vol 19 (4) ◽  
pp. 418-426 ◽  
Author(s):  
M Filippi ◽  
P Preziosa ◽  
E Pagani ◽  
M Copetti ◽  
S Mesaros ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
White Matter ◽  
Magnetic Resonance ◽  
Diffusion Tensor ◽  
Neuronal Damage ◽  
Lesion Volume ◽  
Imaging Features ◽  
Cortical Lesions ◽  
Resonance Imaging

Background: Pathologic and magnetic resonance imaging (MRI) studies have shown that cortical lesions (CLs) are a frequent finding in multiple sclerosis (MS). Objective: To quantify microstructural damage in CLs and normal appearing (NA) cortex in relapse-onset MS patients at different stages of the disease. Methods: Brain double inversion recovery (DIR), diffusion tensor (DT) MRI and 3D T1-weighted scans were acquired from 35 relapsing–remitting (RR) patients, 23 secondary progressive (SP) patients, 12 benign (B) MS patients and 41 healthy controls (HC). Diffusivity values in CLs, cortex, white matter (WM) lesions and normal-appearing white matter (NAWM) were assessed. Results: Compared to HC, MS patients had a significantly lower fractional anisotropy (FA) and higher mean diffusivity (MD) in the cortex and NAWM. CLs had higher FA vs HC cortex and vs patients’ cortex. Compared to RRMS patients, SPMS patients had higher WM lesion volume, higher MD in the cortex, and more severe damage to the NAWM and WM lesions. Compared to SPMS patients, BMS patients had lower MD and FA of CLs. Damage in other compartments was similar between SPMS and BMS patients. Damage in CLs had a high power to discriminate BMS from SPMS (area under the curve: 79–91%), with high specificity (85%), sensitivity (100%) and accuracy (90%). Conclusions: Microstructural imaging features of CLs differ from those of WM lesions and are likely to reflect neuronal damage and microglial activation. The nature and extent of CL damage can be used to help distinguish the different MS clinical phenotypes.

A Segmentation Method for Multiple Sclerosis White Matter Lesions on Conventional Magnetic Resonance Imaging Based on Kernel Fuzzy Clustering

2013 ◽  
Vol 339 ◽  
pp. 361-365 ◽  
Author(s):  
Yan Xiang ◽  
Jian Feng He ◽  
Lei Ma ◽  
San Li Yi ◽  
Jia Ping Xu
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
White Matter ◽  
Magnetic Resonance ◽  
Automatic Segmentation ◽  
White Matter Lesions ◽  
Region Growing ◽  
Conventional Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Conventional Magnetic Resonance

Multiple sclerosis (MS) is a chronic disease that affects the central nervous system and impacts substantially on patients. MS lesions are visible in conventional magnetic resonance imaging (cMRI) and the automatic segmentation of MS lesions enables the efficient processing of images for research studies and in clinical trials. A new method for the segmentation of MS white matter lesions (WML) on cMRI is presented in this paper. Firstly the Kernel Fuzzy C-Means Clustering (KFCM) is applied to the preprocessed T1-weight (T1-w) image for extracting the white matter (WM) region. Then region growing algorithm is applied to the WM region image to make a binary mask which is then superimposed on the corresponding T2-weight (T2-w) image to yield a masked image only containing WM structures and lesions. The KFCM is then reapplied to the masked image to obtain MS lesions. The testing results show that the proposed method is able to segment WML on cMRI automatically and effectively.

scholarly journals Volumetric MRI Assessment of Brain and Spinal Cord in Finnish Twins Discordant for Multiple Sclerosis

Medicina ◽  
2012 ◽  
Vol 48 (9) ◽  
pp. 65
Author(s):  
Hanna Kuusisto ◽  
Xingchen Wu ◽  
Prasun Dastidar ◽  
Tiina Luukkaala ◽  
Irina Elovaara
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Spinal Cord ◽  
White Matter ◽  
Magnetic Resonance ◽  
Brain Size ◽  
White Matter Lesions ◽  
Resonance Imaging ◽  
Brain And Spinal Cord ◽  
The Brain

Background and Objective. Brain size, white matter hyperintensity, and the development of brain atrophy are known to be highly heritable. The decrease of brain volume starts from the very onset of multiple sclerosis and is 10-fold compared with normal aging. The aim of this study was to assess whether the brain and spinal cord volumes and the volume of white matter lesions differed between twins with multiple sclerosis and their asymptomatic co-twins. Material and Methods. A co-twin control method was used to evaluate whether the brain and spinal cord volumes differ between twins with multiple sclerosis and their co-twins. Nineteen twin pairs were studied neurologically, and the volumes of T1, T2, FLAIR, and gadolinium-enhanced lesions and those of the brain and the spinal cord were obtained by magnetic resonance imaging. Results. Significant differences in the brain (P=0.064) or spinal cord (P=0.648) volumes were not detected. Four of the 7 monozygotic and 5 of the 12 dizygotic co-twins had focal brain white matter lesions, but none fulfilled the magnetic resonance imaging criteria of Barkhof. Spinal cord lesions were not seen in any of the co-twins. Conclusions. The absence of a significant difference in the brain or spinal cord volume between the twins with multiple sclerosis and their co-twins supports the recent observation of brain size and the development of brain atrophy being highly heritable.

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