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CentralNervousSystem

南京醫(yī)科大學(xué)一附院放射科洪汛寧hongxunning@2/3/20231CategoriesofWhiteMatterDiseaseDemyelinatingNormalmyelinisinjuredordestroyedFurtherdividedintoprimaryandsecondaryDysmyelinatingIntrinsicabnormalityofmyelinformationormaintenanceRare,usuallyseeninpediatricpopulation2/3/20232DemyelinatingDisordersPrimarydemyelinatingdiseaseMultiplesclerosisSecondarydemyelingatingdiseaseAcutedisseminatedencephalomyelitisProgressivemultifocalleukoencephalopathyOsmoticdemyelinationDisseminatedNecrotizingLeukoencephalopathyChemotherapyandradiation2/3/20233MultipleSclerosis:EpidemiologyMostcommondemyelinatingdiseaseencounteredinpractice Firstdescribedin1868byCharcotFemalepredominanceSecondtofifthdecadesoflifeNorthernEuropeanextractionTemperateclimates2/3/20234MultipleSclerosis:ClinicalPresentationEvidenceoftwoormorewhitematterlesionsseparatedbytimeandindifferentlocationsRangeofsymptomsCranialnervepalsyOpticneuritisVaguesensorycomplaintsParesisVariablepatternofpresentationExacerbationsandremissionsChronicprogressiveAttackfollowedbyabsenceofclinicaldiseaseRapidlyprogressive2/3/20235MultipleSclerosis:DiagnosisSchumacher’scriteria:twoormorewhitematterlesionswitheither…Twoormoreepisodesofworsening,eachlastingatleast24hrsandeachatleastamonthapartSlowstepwiseprogressionofsignsorsymptomsforatleastsixmonthsMRplaysroleinconfirmingclinicaldiagnosisPossitivestudywithappropriateclinicaldatastronglysupportsdiagnosisofMS2/3/20236MultipleSclerosis:PathologyMyelinbreakdownwithassociatedlymphocyteandmacrophageinfiltrationofaffectedareaAstrocyteproliferationandinfiltrationofdemyelinatedarea,withcontinuedsignsofinflammationGlioticregionswithdecreasedcellularityandnomyelin2/3/20237MultipleSclerosis:Dawson’sFingerInflammatorylesionsalongperiventricular

medullaryveinsRadiatefromventricularsurfaceLesionspreceed

demyelination2/3/20238MultipleSclerosis:ImagingAdjuncttoclinicalsignsandsymptomsConfirmorfailtoconfirmclinicalsuspicionofMSSuggestplausiblealternativediagnosisSensitivityofMRsurpassesthatofallnon-invasivetests.TypicalappearanceonMRT1:isointensetolowintensityT2:highintensityFLAIR:highintensity2/3/20239MultipleSclerosis:ImagingLocationiscriticalPeriventricularwhitematter2/3/202310MultipleSclerosis:ImagingLocationiscriticalPeriventricularwhitematterCorpuscallosum2/3/202311MultipleSclerosis:ImagingLocationiscriticalPeriventricularwhitematterCorpuscallosumVisualpathway2/3/202312MultipleSclerosis:ImagingLocationiscriticalPeriventricularwhitematterCorpuscallosumVisualpathwayMiddlecerebralpeduncle2/3/202313MultipleSclerosis:ImagingLocationiscriticalPeriventricularwhitematterCorpuscallosumVisualpathwayMiddlecerebralpeduncleCervicalspine2/3/202314MultipleSclerosis:ImagingContrastenhancementtoassesforchronicity(+)enhancementrepresentsactivediseasePolyphasicityoflesionssupportMS2/3/202315MultipleSclerosis:ImagingContrastenhancementtoassesforchronicity(+)enhancementrepresentsactivediseasePolyphasicityoflesionssupportMS2/3/202316MultipleSclerosis:ImagingVariableappearanceSmallandpunctateLarge&confluent2/3/202317TumefactiveMSAssociatedwithothernoncontiguousbrainandspinalcordlesionsLeadingedgeofenhancementandincompletering(horseshoe)Perfusion–glioma(increasedCBV),MS(usuallynot)VeinscoursethroughlesioninMSbutdisplacedbytumor2/3/202318MultipleSclerosis

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