Multiple Sclerosis
Figure 1
Axial FLAIR image demonstrates Dawson’s Fingers (red arrow), flame-shaped T2 hyperintense lesions directed perpendicular to the ventricles with a smooth, well-defined border. These represent the demyelinating lesions characteristic of Multiple Sclerosis.
Case overview
This case illustrates the pivotal role of whole body MRI (WB-MRI) in helping to identify early disease processes, guiding personalized care, and improving long-term health outcomes.
Patient History
- A 40-year old woman underwent a WB-MRI screening after a history of nonspecific symptoms and prior investigations failed to provide a diagnosis.
- She reported blurry vision, describing the issues as a ‘fog or haze,’ occurring several times a day for varied lengths of time and intensity.
Findings
- WB-MRI screening identified moderate-to-severe fatty liver disease, consistent with metabolic dysfunction-associated steatotic liver disease (MASLD). (Figure 1 & Figure 2)
Figure 1
Figure 2
Axial Susceptibility-Weighted Imaging (SWI) shows visible dark lines or hypointensities (red arrows) that appear within white matter lesions, representing a small vein around which the lesion is formed. This is a characteristic of MS.
Figure 3
Sagittal T2 sequence through the cervical spine shows a T2 hyperintense lesion in the cervical spinal cord (red arrow), representing a demyelinating lesion.
Figure 4
Follow-up care
- Juxtacortical and periventricular white matter lesions found. In multiple sclerosis, there are specific types of brain lesions called Dawson’s fingers. These are flame-shaped areas that show up on certain brain scans and are found near the brain's ventricles. They are a sign of the damage to the protective covering of nerve fibers, which is typical in MS. (Figure 1)
- Susceptibility-weighted imaging demonstrates the Central Vessel Sign. On a special type of MRI scan, a dark line within a white matter lesion can be seen. This line represents a small vein around which the lesion has formed. This finding is typical in MS. (Figure 2)
- Additional lesions in the medulla and cervical spine. In MS, the damaged areas in the brain and spinal cord are usually spread out in different places. For this patient, we can see damaged areas in four different locations. (Figures 1, 2, & 3)
Figure 1
Figure 2
Figure 3
Figure 4
How the Prenuvo scan impacted patient care:
- The WB-MRI scan revealed previously undiagnosed MS, allowing for timely intervention and treatment. MS is a chronic autoimmune condition that affects the central nervous system (CNS), including the brain, spinal cord, and optic nerves. In MS, the immune system mistakenly attacks the myelin sheath that protects nerve fibers, leading to damage to the nerves and their axons. This damage can disrupt the transmission of nerve signals, resulting in a range of symptoms such as fatigue, weakness, and vision problems. These symptoms are often vague and can make diagnosis difficult.(1)
- The patient had multiple symptoms that were not diagnosed based on physical exam and basic testing. WB-MRI served as a critical diagnostic-screening tool in explaining the patient’s symptoms and helping to direct treatment.
- Radiation-Free High-Quality Brain Imaging with WB-MRI is a safer and preferred method for brain screening compared to CT scans, offering significantly higher accuracy in diagnosing multiple sclerosis.(2)
Figure
References
- National MS Society.
- Mills M, van Zanten M, Borri M, Mortimer PS, Gordon K, Ostergaard P, Howe FA. Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective. J Magn Reson Imaging. 2021;53(6):1555-1568. doi:10.1002/jmri.27542. https://onlinelibrary.wiley.com/doi/10.1002/jmri.27542
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