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Multiple Sclerosis

Danial K. Hallam¹

¹University of Washington, Seattle, Washington

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A5.1

DOI:

10.1002/0471142719.mia0501s00

Online Posting Date:

May, 2001

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Abstract

Although a routine brain MR exam would suffice in many applications, specific protocols for multiple sclerosis have been developed to maximize its contribution. This unit presents one such protocol while recognizing the wide opportunity for variation depending on local clinical demand and personal preference.

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Unit Introduction
Basic Protocol: Multiple Sclerosis
Commentary
Bibliography
Figures
Tables

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Materials

Basic Protocol: Multiple Sclerosis

Materials

Normal saline (0.9% NaCl), sterile
Extravascular contrast agent (e.g., Magnevist, Omniscan, or Prohance)

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Figures

Figure A5.1.1

Fast FLAIR sagittal provides optimal visualization of small callosal multiple sclerosis lesions sometimes referred to as subependymal striations.

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Figure A5.1.2

Midline T₁-weighted sagittal image demonstrates placement of AC-PC line to be used to position transverse images.

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Figure A5.1.3

Combination of PD (A) and T₂-weighted (B) transverse images demonstrates even very small brainstem lesions as shown here in the ventral medulla. Such lesions are important for several reasons. Brainstem lesions are frequently clinically apparent and imaging confirmation is generally preferred by the clinician. Also, multiple sclerosis brainstem lesions are often located along the cisternal or ventricular surface—a feature atypical for senescent/ischemic lesions.

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Figure A5.1.4

T₂-weighted TSE transverse (A) and T₁-weighted MT spin echo transverse (B) images demonstrate multiple callosal and periventricular lesions in this patient with multiple sclerosis. The increased signal on the T₁-weighted MT sequence is seen in some but not all demyelinating lesions. It is not generally seen with senescent/ischemic lesions and so is somewhat specific for demyelinating disease.

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Figure A5.1.5

T₂-weighted TSE transverse (A) and post-contrast T₁-weighted spin echo transverse (B) images demonstrate typical enhancing demyelinating plaque. Contrast enhancement can be subtle in multiple sclerosis. Performance of T₂-weighted transverse sequence in identical location as post-contrast T₁-weighted transverse sequence aids recognition of enhancing lesions.

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Literature Cited

Literature Cited
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Key References
	Shellock, 1996. See above.
Covers a number of important patient management issues related to MR imaging, including recommended safety procedures, a list of metallic implants that have been tested for MR compatibility, and a list of other sources on MR safety.