Magnetic Resonance Imaging of Autoimmune Demyelinating Diseases as a Diagnostic Challenge for Radiologists: Report of Two Cases and Literature Review

Abstract

The magnetic resonance characteristics of autoimmune demyelinating diseases are complex and represent a challenge for the radiologist. In this study we presented two different cases of detected autoimmune demyelinating diseases: one case of acute disseminated encephalomyelitis and one case of neuromyelitis optica, respectively. Expected and unexpected findings of magnetic resonance imaging examination for autoimmune demyelinating diseases were reported in order to provide a valuable approach for diagnosis. In particular, we highlight, review and discuss the presence of several uncommon imaging findings which could lead to a misinterpretation. The integration of magnetic resonance imaging findings with clinical and laboratory data is necessary to provide a valuable diagnosis.

Keywords: demyelinating diseases; disseminated encephalomyelitis; multiple sclerosis; neuromyelitis optica; spinal cord.

Figure 1

MRI of the brain. Axial FLAIR image (A) and unenhanced T1-weighted image (B) show a single ovoid-shaped lesion in the left frontal deep white matter, without enhancement on the T1-weighted post-gadolinium acquisition (C). Sagittal FLAIR image shows hyperintense lesions affecting the ependymal surface of the corpus callosum with a marble pattern (D). The so-called Dawson fingers are visible on the sagittal FLAIR image as hyperintense, ovoid lesions perpendicular to the body of the lateral ventricle (E). Corpus callosum and periventricular lesions don’t show enhancement on the T1-weighted post-gadolinium acquisition (F).

Figure 2

MRI of the cervical spinal cord. Sagittal T2-weighted images of the cervical spine show areas of patchy and long-segment (>1.5 vertebral body length) hyperintensity (A–C) without enhancement on the T1-weighted post-gadolinium acquisition (D). Axial T2-weighted image shows large hyperintensity involving half or more than half of the cross-sectional area of the spinal cord (E,F).

Figure 3

MRI of the thoracic spinal cord. Sagittal T2-weighted images demonstrate long segment hyperintensity of the thoracic cord without expansion or enhancement (A–C). Axial T2-weighted image shows large hyperintensity affecting all the cross-sectional area of the spinal cord (D).

Figure 4

MRI of the brain. Axial T2-weighted and FLAIR images show curve hyperintense lesions affecting the ependymal surface of frontal horns of the lateral ventricles and corpus callosum just near the genu, with a symmetrical pattern (A,B). These sub-ependymal lesions show homogeneous enhancement on the T1-weighted post-gadolinium image (C–E). No optic nerve enhancement on T1-weighted post-gadolinium images was present (F).

Figure 5

MRI of the spinal cord. Sagittal T2-weighted and STIR images show a long and continuous segment of abnormal hyperintensity affecting the cervico-thoracic spinal cord (A,B). Axial T2-weighted image shows diffuse hyperintensity involving all the cross-sectional area of the spinal cord at a more cranial level (D) and a predominant gray matter involvement at a more caudal level (E). Spinal cord swelling and enhancement were present at the segmental thoracic level, evident in both sagittal (C) and axial (F) images.