Pathognomonic MR imaging findings in Balo concentric sclerosis

Abstract

Irregular, concentric zones of increased signal on T2-weighted cranial MR imaging studies may strongly suggest Balo concentric sclerosis (BCS), a rare but recognized variant of multiple sclerosis. Differentiating BCS from multiple sclerosis or neoplasm can be difficult clinically, but MR imaging findings noted in this case may be pathognomonic.

fig 1.

A, Fast spin-echo T2-weighted axial MR image through the centrum semiovale. This shows two separate concentric zones of demyelination in the left frontoparietal deep white matter represented as two different degrees of increased T2 signal (5300/82.2/1 [TR/TE/excitations]). B, T1-weighted axial MR image after IV administration of Gd-DTPA at the same level as A. This clearly depicts multiple enhancing concentric rings representing two separate zones of active demyelination and increased blood brain–barrier permeability (550/9/1).