Multiple sclerosis, visualization of plaques with differing MR techniques

As with most brain lesions, MS plaques demonstrate low signal intensity on T1- and high signal intensity on T2-weighted scans. Of note is that some MS plaques manifest low signal intensity on T1-weighted scans relative to normal appearing white matter, so called “Black Holes”. These are felt to represent areas of irreversible demyelination and axonal damage. FLAIR scans are invaluable for identification of MS plaques, and represent the clinical mainstay technique, in particular for lesions immediately adjacent to the ventricular system. On heavily T2-weighted scans such lesions may be poorly depicted, due to the high signal intensity of adjacent CSF. Double inversion recovery (DIR) is a newer scan technique, with higher lesion-white matter contrast, and improved sensitivity dependent upon lesion location

Multiple sclerosis, visualization of plaques with differing MR techniques

Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015)