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Case Reports
. 2024 Aug 13;10(4):uaae028.
doi: 10.1093/bjrcr/uaae028. eCollection 2024 Jul.

T2-fluid attenuated inversion recovery fat-suppressed mismatch in the identification and characterization of lesions related to radiologically isolated syndrome

Darin T Okuda  1   2 , Christine Lebrun-Frenay  3
Affiliations
Case Reports

T2-fluid attenuated inversion recovery fat-suppressed mismatch in the identification and characterization of lesions related to radiologically isolated syndrome

Darin T Okuda et al. BJR Case Rep. .

Abstract

The radiologically isolated syndrome is defined by the presence of incidentally identified T2-weighted hyperintense lesions, highly suggestive of central nervous system demyelination, following an MRI study that is performed for reasons other than for the investigation of symptoms related to multiple sclerosis (MS). These individuals also have no evidence of prior neurological symptoms associated with inflammatory demyelination and no alternative explanation for the observed MRI findings. Recently, the introduction of novel imaging techniques such as the "central vein sign" has improved lesion specificity for MS. In addition, the observation of T2-fluid attenuated inversion recovery (FLAIR) mismatch characteristics associated with gliomas and in those with MS with a higher disease burden appear to provide morphological data that relate to disease severity. The value of T2-FLAIR mismatch characteristics in discrete multi-focal lesions has not yet been well defined. Here, we present the value of a fat-suppressed T2-FLAIR sequence in the identification and characterization of T2-weighted hyperintensities resulting from inflammatory demyelination.

Keywords: MRI; T2-FLAIR mismatch; central vessel sign; fat suppressed; radiologically isolated syndrome.

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Conflict of interest statement

D.T.O. received personal compensation for consulting and advisory services from Biogen, Eisai, EMD Serono, Genentech, Genzyme/Sanofi, Moderna, RVL Pharmaceuticals, Inc., Zenas BioPharma, and research support from EMD Serono/Merck and Novartis. D.T.O. has issued national and international patents along with pending patents related to other developed technologies and has received royalties for intellectual property licensed by The Board of Regents of The University of Texas System. D.T.O. is the Founder of Revert Health Inc. C.L.-F. reports no disclosures.

Figures

Figure 1.
Figure 1.
Select sequences from a 3-Tesla MRI of the brain. (A) Axial T1-weighted and (B) T2-weighted images of the brain revealing multi-focal regions of signal abnormality in locations typical for multiple sclerosis (MS). (C) Axial T2-fluid attenuated inversion recovery (FLAIR) fat-suppressed images demonstrating regions of T1-hypointensity within lesions (yellow arrows). Note the different characteristics in lesions from the FLAIR imaging sequence (D) and the fat-suppressed T2-FLAIR mismatch (B compared to C). (E) Axial FLAIR star MRI images of the brain highlighting the “central vein sign” within selected lesions in (C). The number of lesions with central vessels present suggest an origin of MS.
See this image and copyright information in PMC

References

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