Pictorial Essay ‘White dots’ on Cranial MRI: MS and Differential Diagnosis

Iris N. Kaschka, et al.
Dept. of Neuroradiology, University Hospital Erlangen, Germany

MS is the most common primary demyelinating disease of the CNS. However, differentiation from other demyelinating disorders might be challenging since clinical findings can be subtle and imaging is not always specific. This pictorial essay is intended as an overview of the spectrum of demyelinating disorders and their typical and atypical imaging findings.

The T1-weighted PSIR shows great potential in revealing MS lesions in the cervical spinal cord. While using this technique it is important to use the phase sensitive reconstruction to preserve the contrast between MS lesions and normal appearing tissue. Due to the nature of the reconstruction, and because T1 values of lesions can vary from patient to patient, for reliable depiction of lesions, the phase sensitive reconstruction is recommended. This is as, unlike the magnitude reconstruction, the phase sensitive reconstruction provides a contrast between different tissues that is largely independent of the chosen inversion time.