The value of T1-weighted images in the differentiation between MS, white matter lesions, and subcortical arteriosclerotic encephalopathy (SAE)

Abstract

The aim of the study was to define reliable criteria for the differentiation of MR imaging between patients with MS and with "vascular" white matter lesions/SAE. We examined 35 patients with proven MS according to the Poser criteria and 35 patients with other white matter lesions and/or SAE. The result is that with MR a differentiation can be achieved provided that T1-weighted spin-echo sequences are included and the different pattern of distribution is considered. MS plaques are predominantly located in the subependymal region, vascular white matter lesions are mainly located in the water-shed of the superficial middle cerebral branches and the deep perforating long medullary vessels in the centrum semiovale. Infratentorial lesions are more often seen in MS. Confluence at the lateral ventricles is frequently accompanied by confluent abnormalities around the third ventricle, Sylvian aqueduct, and fourth ventricle, which is uncommon in SAE. In MS many lesions visible on T2-weighted images have a cellular or intracellular composition that renders them visible also on T1-weighted ones as regions with low signal intensity and more or less distinct boundary. "Vascular" white matter lesions and SAE mainly represent demyelination and can therefore be seen on T2-weighted images, but corresponding low signal intensity lesions on T1-weighted images are uncommon. In some exceptions there are such lesions with low signal representing lacunar infarcts or widened Virchow-Robin-spaces.

Segmentation and quantification of black holes in multiple sclerosis

“…Of these various MR-based pathological markers, black holes have attracted considerable attention in MS. Black holes can reflect either acute edematous lesions, or matrix destruction with axonal loss as shown on post-mortem examination (Uhlenbrock and Sehlen, 1989;Van Walderveen et al, 1998). The edematous black holes initially exhibit enhancement on postcontrast MRI and often resolve with time.…”

Characterization of Cerebral Small Vessel Disease by Proton Spectroscopy and Morphological Magnetic Resonance

“…White matter hyperintensities on the T 2 -weighted magnetic resonance (MR) scan and diffuse white matter lucencies on the CT scan – referred to as leukoaraiosis – have been considered as the leading neuroradiological features in patients with CSVD [5, 6, 7, 8, 9, 10]. As these changes have also been extensively described in healthy elderly controls, the association between imaging criteria and CSVD remains weak.…”

New Hypointense Lesions on MRI in Relapsing-Remitting Multiple Sclerosis Patients

“…Hypointense lesions on T1-weighted images (black holes), first reported by Uhlenbrock and Sehlen [19], represent areas of permanent damage [20, 21]. Truyen et al [12]reported rather strong correlations between black holes and EDSS scores for relapsing remitting and SP MS patients over an observation period of 18–48 months.…”