Type:
Educational Exhibit
Keywords:
Anatomy, Neuroradiology brain, CNS, MR, MR-Diffusion/Perfusion, PACS, eLearning, Contrast agent-intravenous, Education and training, Inflammation
Authors:
A. P. Quispe Mauricio1, A. Tenorio Gallardo2, C. G. Linares Villavicencio1, A. Mejias Espada1, F. cabrera canal1, D. Jimenez Jurado1; 1Alcalá de Henares, Madrid/ES, 2Salamanca/ES
DOI:
10.1594/ecr2018/C-3217
Background
Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) of an immune nature,
which causes mainly demyelination,
but also axonal damage to a variable degree,
producing neurodegeneration.
It preferentially affects women between 20-45 years.
The prevalence is greater as one moves away from the equator in both hemispheres.
The majority of patients present an undulating clinical course with exacerbations and remissions in their symptomatology called recurrent remitting multiple sclerosis (RRMS) and less frequently progressive secondary (PMSS) and primary progressive (PPMS).
The diagnosis is essentially clinical diagnosis,
presenting sensory symptoms (more frequent),
blurred vision due to optic neuritis,
weakness and other motor symptoms,
diplopia and ataxia.
In the pathogenesis has been observed disruption of the blood-brain barrier,
inflammation,
demyelination,
loss of oligodendrocytes,
reactive gliosis and neuronal / axonal degeneration,
the latter being the most important cause of neurological disability.
The vascular pathology seems to play an important role since the lesions develop predominantly around small central veins and there is lymphocytic infiltration of the vein walls,
perhaps preceding the perivenular inflammatory infiltration.
Magnetic resonance imaging (MRI) is currently considered an essential technique to demonstrate the spatial and temporal dissemination of demyelinating lesions.
The diagnostic capacity of MRI is based on its high sensitivity in the detection of demyelinating lesions (plaques) both at the cerebral and spinal levels,
and in the possibility of detecting temporal variations of them.
It is essential in the diagnosis and as a prognostic marker in the initial phase of the disease.
All MS plaques are regardless of their pathological substrate or evolutionary phase,
hyperintense in the proton density and T2 enhanced sequences.
Typically visible lesions are multiple and small,
although there are variants difficult to diagnose such as: tumefactive multiple sclerosis,
Marburg variant of multiple sclerosis,
Schilder type multiple sclerosis,
Balo concentric sclerosis and multiple sclerosis opticospinal.