Example redacted MRIs with active demyelination
Important observations underlined in bold
Participant: X5
MRI BRAIN W & W/O CONTRAST
Collected on June 6, 2007 8:08 PM
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Exam: BRAIN MR Clinical History: Numbness and paresthesias.
Technique: Multiple sagittal and axial T1-weighted and axial fast spin echo T2-weighted, FLAIR, and diffusion images of the brain were obtained with additional postgadolinium axial and coronal T1-weighted images.
Findings: The ventricles are normal in size and position without midline shift.
On the T2-weighted and FLAIR images, there are multiple focal areas of abnormal increased T2-weighted signal intensity in the periventricular and subcortical white matter bilaterally, more so in the periventricular regions. A number of the periventricular lesions exhibit somewhat of a linear configuration. There are additional areas of signal abnormality within the midline pons and right cerebellum. On the T2-weighted images, there are questionable additional small foci of signal abnormality in the brain stem at the level of the medulla. Following gadolinium administration, no abnormal gadolinium enhancement is seen within the brain parenchyma. These multiple above-described abnormal areas of signal change are nonspecific, however, the above-described pattern including the linear configuration of some of the periventricular lesions raises the possibility that this represents demyelinating disease. Based solely on imaging appearance, other etiologies including ischemia, inflammation, or gliosis would not be excluded. Follow-up is advised as clinically warranted. No evidence of restricted diffusion to suggest acute infarction is seen. There is slightly increased signal intensity associated with one of the T2-weighted lesions in the deep left periventricular region on the diffusion images, however, this exhibits increased signal intensity on the corresponding ADC map indicating that this represents T2 shine through.
Incidental note is made of the presence of a retention cyst in the right maxillary sinus.
IMPRESSION: Multiple nonspecific areas of parenchymal T2-weighted signal abnormality without associated abnormal gadolinium enhancement as discussed above. The pattern raises the possibility of demyelinating disease, however, other etiologies are not excluded. Follow-up is advised for further evaluation as clinically warranted.
Participant: X5
MRI CERVICAL SPINE W/O & W CONTRAST
Collected on June 27, 2007 7:05 PM
TECHNIQUE: Pre- and postgadolinium T1-weighted sagittal and axial, proton density and T2 FSE sagittal and gradient echo axial images of the cervical spine 1.5 Tesla.
COMPARISON: No prior.
FINDINGS: Areas of increased proton density/T2 signal intensity are present in ventral and dorsal medulla. There is linear increased signal intensity extending from the medulla to C1 and there is a focal area of increased signal intensity in the substance of the cord at C1-C2 and another in the midline ventrally at C2-C3. Dorsally there is also increased T2 signal intensity in the cord at C2-C3. Ventrally in the cord there is a focus of increased T2 signal intensity at C3-C4. Lesions ventrally and dorsally in the cord at C2-C3 enhance with gadolinium. There is no cord expansion. There is questionable subtle enhancement of a small lesion at the C4 level. This is at the left of midline and axial images, not not as well demonstrated on sagittal images. There is a subtle focal area of increased T2 signal intensity in the left side of the cord at C4-C5 better demonstrated on axial and sagittal images.
Disc degenerative changes are relatively mild with greatest degree of disc degenerative change at C5-C6 and C6-C7 levels. At C2-C3 there is no herniation or stenosis. At C3-C4 there is as small central disc herniation which mildly indents the ventral surface of spinal cord. Foramina are not significantly narrowed. At C4-C5 there is minimal central disc protrusion without significant stenosis.
At C5-C6 there is mild to moderate central stenosis greater on the left due to diffuse disc osteophyte complex asymmetric to the left mild left foraminal stenosis and no significant right foraminal narrowing.
At C6-C7 there is mild central stenosis due to diffuse disc osteophyte complex with no evidence of foraminal narrowing.
C7-T1 and T1-T2 discs are normal. Canal and foramina are normal in caliber at these levels. Enhancement along posterior annulus of C5-C6 and C6-C7 discs probably indicates presence of annular tears at these levels. At both C5-C6 and C6-C7 levels there is asymmetric effacement of left axillary recess suggesting the asymmetry of disc osteophyte complex or possibly superimposed left-sided disc protrusions at these levels.
IMPRESSION: Findings are consistent with demyelination with enhancing plaques at C2-C3 and also a questionable small enhancing plaque on the left at C4 level. Disc degenerative changes and stenosis are as detailed above.
Participant: X5
MRI BRAIN W & W/O CONTRAST
Collected on February 6, 2010 12:49 PM
Results
HISTORY: Multiple sclerosis, comparison with 06/06/2007.
TECHNIQUE: T1-T2 and DWI MR head with postgadolinium images, additional T1-T2 and postgadolinium sequences are obtained in the cervical and thoracic spine.
Ventricles and cortical sulci are mildly prominent for age. There is no gross hemorrhage or extra-axial fluid collections seen and flow-voids are present in the basilar and carotid arteries at the base of the brain. There are prominent, partially confluent patchy areas of increased T2 signal in the deep white matter consistent with history of demyelination and slightly increased compared to the prior study above the tentorium but improved in the brainstem and middle cerebellar peduncle. There is no infarction. Several small areas of enhancement are seen following gadolinium administration including adjacent to the right temporal horn in its mid and posterior aspects, adjacent to the left occipital horn, right frontal subcortical white matter and left occipital lobe white matter, these are new compared to prior study.
Cervical spine examination shows normal alignment of the vertebrae and patchy signal with normal height. There is nonspecific enhancement in the C5-C6 disc with subtle increased T2 signal in the spinal cord best seen on the proton density image at the C2 and C2-C3 levels. Mild degenerative central disc bulging is also present with uncovertebral joint hypertrophy resulting in mild central canal and foraminal stenosis. The increased T2 signal changes are similar to the study from June, 2007.
The areas of increased T2 signal in the thoracic spinal cord are also better evaluated with proton density sequence and are not significantly changed from June, 2007. The spinal enhancement pattern is unremarkable. There is no disc protrusion.
CONCLUSION: There are a few additional areas of increased T2 signal in the hemispheric white matter with multiple areas of enhancement consistent with active plaques. T2 white matter abnormalities in the posterior fossa are slightly improved, findings in the cervical and thoracic spine include multiple areas of increased T2 signal which are stable compared to June, 2007.