BASIC DIFFERENCES BETWEEN COMMON WHITE MATTER LESIONS

1. MS VS ADEM
• Maj Satyendra
• Ref
– BMJ
– Radiopaedia
– Radiologyassistant.nl
– 31 Aug 13

2. • Multiple sclerosis
relapsing demyelinating
disease
• disseminated in space
and time
• adolescence and sixth
decade, peak at 35
years
• monophasic
• acute inflammation and
demyelination
• 1-2 weeks after viral
infection or vaccination

4. • Plaques -ovoid in shape
and perivenular in
distribution.
• Typical for MS- corpus
callosum, U-fibers,
temporal lobes,
brainstem, cerebellum
and spinal cord.
• Coronal PD image of a
brain specimen with MS
involvement

5. • involvement of U-fibers
in MS.
• RIGHT: U-fibers are not involved
in patient with hypertension.
• Juxtacortical lesions are
specific for MS.
• adjacent to the cortex
and must touch the
cortex.

6. • Typical findings for MS
• Multiple lesions adjacent
to the ventricles (red
arrow).
• Ovoid lesions
perpendicular to the
ventricles (yellow arrow).
• Multiple lesions in
brainstem and
cerebellum.

7. • Typical spinal cord lesions
in MS are relatively small
and peripherally located.
• cervical cord
• less than 2 vertebral
segments
• A spinal cord lesion with
lesion in the cerebellum
or brainstem is very
suggestive of MS.

8. • Dawson fingers
• result of inflammation
around penetrating
venules.

9. • Enhancement is another
typical finding in MS.
• enhancement present
one month after the
occurrence of a lesion.
• Simultaneous enhancing
and non-enhancing
lesions -radiological
counterpart of the clinical
dissemination in time and
space.

10. • Juxtacortical lesions
• located in the U-fibers
are also very specific for
MS.

11. • dissemination in time.
• LEFT: Single lesion on
T2WI
• RIGHT: Two new lesions
at 3 month follow-up.

12. ADEM
• Diffuse and relatively
asymmetrical lesions
• enhance simultaneously
• preferential involvement of
the cortical gray matter and
the deep gray matter of the
basal ganglia and thalami.
• axial FLAIR and T2W-images of
a young patient with ADEM
• extensive involvement of the
cortical and gray matter,
thalamus.

13. • ADEM can involve the
spinal cord, U-fibers
and corpus callosum
and sometimes show
enhancement.
• lesions are often large
and in a younger age
group

14. • Grey matterof the basal
ganglia often involved

15. • Lesions are usually
bilateral but
asymmetrical.

16. OPEN RING
• sign for demyelination
• Ring component :
represent advancing
front of demyelination
• open part of the ring
usually point towards
the grey matter

17. ADEM
• Complete recovery
within one month (50-
60%)
• Sequelae (most
commonly seizures)
(20-30%)