Multiple Sclerosis - what to look for on MRI! A quick overview. First slide shows Jean-Martin Charcot, one of the fathers of Neurology (the painting is a bit outdated to say the least, but interesting from a historical point of view). #radres #neurorad #FOAMrad #FOAMed 
MS diagnosis is based on the McDonald criteria. To fulfill the diagnosis of MS, a patient must have evidence (clinical or radiological) of CNS-damage involving multiple CNS-regions (dissemination in space) and having occured at multiple moments in time (dissemination in time).
This 22-year old patient was referred for an MRI of the brain because of paresthesias in both lower legs. Lumbar MRI was normal. What do we make of those white matter lesions?
Let's localize those white matter lesions a bit better. The patient has periventricular, juxtacortical, infratentorial and spinal cord lesions.
...and as such meets the MRI-requirements for dissemination in space. For dissemination in space on MRI we need at least 1 T2-hyperintense WM lesion in at least 2 out of 4 "MS-typical" regions.
On a first MRI in someone suspected of having MS, it's important to administer Gadolinium. Only so can we answer the quesion "dissemination in time". Simultaneous presence of enhancing and non-enhancing brain lesions = dissemiation in time.
Alternatively, when previous MRI-exams are available, the presence of new T2-hyperintense white matter lesions (regardless of where) suffices to fulfill the criterium "dissemination in time".
And we finish with a nice summary of the McDonald criteria and the MRI-criteria for dissemation in space and time.
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