Diffusion-weighted imaging in acute demyelinating myelopathy

Zecca, Chiara; Cereda, Carlo; Wetzel, Stephan G.; Tschuor, Silvia; Staedler, Claudio; Santini, Francesco; Nadarajah, N.; Gobbi, Claudio

doi:10.1007/s00234-011-0907-6

Cited by 13 publications

(10 citation statements)

References 31 publications

(37 reference statements)

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“…We and others have reported that acute demyelinating lesions in patients with RRMS may have restricted diffusion and may be non-enhancing on brain MRI similar to patients with acute stroke [21,22]. Comparison of age-matched ischemic stroke and RRMS patients provided no significant differences in both volume and count of PVL adjacent to any of the four anatomic regions and in total PVL volume and count (Table 4).…”

Section: Discussionmentioning

confidence: 85%

Are Periventricular Lesions Specific for Multiple Sclerosis?

Casini

Yurashevich

Vanga

et al. 2013

J Neurol Neurophysiol

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Background The presence of periventricular lesions (PVL) on MRI scans is part of the revised McDonald multiple sclerosis (MS) diagnostic criteria. However, PVL can be found in other neurological diseases including stroke and migraine. Migraine is highly prevalent in patients with MS. Objective To determine if PVL are specific for patients with MS compared to stroke and migraine. Methods We studied patients diagnosed with clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), migraine, and ischemic stroke. The number, location and the volume of PVL were identified on brain MRI scans and analyzed. Results The number and volume of PVL adjacent to the body and the posterior horn of the lateral ventricles were significantly increased on fluid-attenuated inversion recovery MRI in RRMS compared to migraine. There were no significant differences in the total number and volume of PVL in ischemic stroke patients compared to the age-matched RRMS patients nor in the number and volume of PVL adjacent to the anterior and temporal horns of the lateral ventricles on FLAIR images in migraine compared to CIS or RRMS. Conclusion In contrast to PVL adjacent to the body and the posterior horn of the lateral ventricles, PVL adjacent to the anterior and temporal horns of the lateral ventricles may not be specific for CIS/RRMS when compared to migraine, the disease highly prevalent among patients with MS. PVL are not specific for MS when compared to ischemic stroke.

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Section: Discussionmentioning

confidence: 85%

Are Periventricular Lesions Specific for Multiple Sclerosis?

Casini

Yurashevich

Vanga

et al. 2013

J Neurol Neurophysiol

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“…28 Recently, a restricted diffusion pattern has been found in acute demyelinating spinal cord lesions. 29 …”

Section: Discussionmentioning

confidence: 99%

Acute demyelinating lesions with restricted diffusion in multiple sclerosis

Balashov

Lindzen

2012

Mult Scler

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Background and objectives It is widely accepted that typical acute demyelinating lesions in relapsing–remitting multiple sclerosis (RRMS) exhibit vasogenic edema with increased diffusion, as demonstrated by an increased apparent diffusion coefficient on MRI. In contrast, acute ischemic lesions demonstrate cytotoxic edema with restricted diffusion. Recent reports have documented selected cases of acute demyelinating lesions exhibiting restricted diffusion (ADLRD) in MS. We aimed to assess the morphologies, distributions, signal characteristics and changes over time of nine ADLRD. An additional goal was to obtain clinical correlations and relate our findings to all previously published case reports describing ADLRD. Methods A retrospective case series study was performed at two academic centers. MRI characteristics of nine ADLRD found in six RRMS patients were compared with typical active symptomatic contrast-enhancing lesions with increased or normal diffusion in control RRMS patients. Results The average size of ADLRD was not significantly different from typical lesions. A periventricular location and faint signal on T2-weighted images were significantly more common for ADLRD compared with typical lesions. Two patients with ADLRD on initial MRI exhibited new ADLRD on their follow up scans. Conclusion Our results and review of prior published cases suggest that ADLRD represent a new variant of MS lesion. The restricted diffusion that is a characteristic of ADLRD on MRI is a new challenge in the differential diagnosis of stroke in young adults. The pathogenesis of ADLRD remains to be understood.

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“…Clinical use of diffusion‐weighted imaging (DWI) for evaluation of spinal pathology is increasing. The greatest benefits of DWI in the spine are in the settings of spinal cord infarctions, contusions and demyelinating lesions, and in the identification of spinal metastases and inclusion cysts such as dermoids or epidermoids . In adults, DWI has been shown to be helpful in differentiating malignant from nonmalignant vertebral compression fractures …”

Section: Introductionmentioning

confidence: 99%

“…The greatest benefits of DWI in the spine are in the settings of spinal cord infarctions, contusions and demyelinating lesions, and in the identification of spinal metastases and inclusion cysts such as dermoids or epidermoids. [2][3][4] In adults, DWI has been shown to be helpful in differentiating malignant from nonmalignant vertebral compression fractures. 5 The reduced field of view (rFOV) DWI technique used in this study replaces the slice selective 90 degree excitation pulse with a 2-dimensional 90 degree spatially selective pulse that reduces the FOV in the phase encoding direction.…”

Section: Introductionmentioning

confidence: 99%