Prominent perivenular spaces in multiple sclerosis as a sign of perivascular inflammation in primary demyelination

Abstract

In this study, we describe prominent perivenular spaces as a sign that is seen on high-resolution (512 x 512) transverse T2-weighted MR images in patients with multiple sclerosis. The observed widening of perivenular space is depicted as a stringlike hyperintensity projecting radially and aligned with multiple sclerosis lesions (usually small), following the course and configuration of deep venular structures. This widening may be an important sign in differentiating primary (ie, in multiple sclerosis) from secondary causes of demyelination.

Fig 1.

“Prominent perivenular spaces” sign in a 43-year-old patient with multiple sclerosis. (A) Proton attenuation image (TR/TE, 7900/17) shows a widening perivenular space as stringlike hyperintensity (arrows) projecting radially from 2 small multiple sclerosis lesions following the course and configuration of deep venular structures. (B) FLAIR MR image (TR/TE/TI, 9010/92/2500) shows the increased intensity (arrows) (not cerebrospinal fluid intensity) within these prominent perivenular spaces. (C) Enhanced T1-weighted image (TR/TE, 600/27) shows an enhancing vein (arrow) in one lesion. (D) Proton attenuation image shows another lesion (arrow) with this prominent perivenular spaces sign.

Fig 2.

(A) “Prominent perivenular space” sign (arrow) follows the central course of the veins along which the lesions spread on T2-weighted image (TR/TE, 7900/119) in a 51-year-old patient. (B) Prominent perivenular spaces sign (arrow) without apparent association with lesions on T2-weighted image in a 33-year-old patient.

Fig 3.

Schematic drawing illustrates the perivenular inflammatory infiltrates that cause lesion formation and enlarged perivenular spaces in multiple sclerosis. The prominent perivenular spaces can be with (bottom vessel) or without (top vessel) lesion association.