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CASE 6: Discussion
As part of the MR examination of the orbits, additional images are obtained of the brain. These images
show multiple ovoid white matter lesions within the frontal and parietal lobes that are bright on T2 and dark
on T1. These lesions are only located within the white matter. Note how only some of the lesions show peripheral enhancement after contrast. Note how the lesions are oriented perpendicular to the lateral
ventricles (Dawson’s fingers).
Differential Diagnosis: Ring Enhancing Lesion
- Tumor
- – Primary
- – Metastatic Disease
- Infection: Abscess
- Demyelinating Disease: Multiple Sclerosis
- Resolving Hematoma
- Radiation Necrosis (after radiation treatment of a tumor)
Diagnosis: Multiple Sclerosis
In this patient, the abnormally enhancing optic nerve (optic neuritis) in combination with the white matter lesions on the brain MR is characteristic for Multiple Sclerosis. Multiple Sclerosis is a clinical diagnosis; however, there are imaging features that can suggest the diagnosis. Establishing dissemination in space and time on imaging studies is one of the key factors in helping to make the diagnosis. To read more about this topic see article below.
Radiographics 2007;27:525-551
A different patient with multiple sclerosis. Notice how more lesions are seen on the examination at 6 years
compared to the baseline exam.
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