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Histopathology and serial, multimodal magnetic resonance imaging in a multiple sclerosis variant

Department of Neurology , Otto-von-Guericke University, 39120 Magdeburg, Germany, sabine.lindquist{at}medizin.uni-magdeburg.de, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany

N. Bodammer

Department of Neurology , Otto-von-Guericke University, 39120 Magdeburg, Germany

J. Kaufmann

Department of Neurology , Otto-von-Guericke University, 39120 Magdeburg, Germany

F. König

Department of Neuropathology, University of Goettingen, Goettingen, Germany

H.-J. Heinze

Department of Neurology , Otto-von-Guericke University, 39120 Magdeburg, Germany, Leibniz Institute for Neurobiology, 39118 Magdeburg, Germany

W. Brück

Department of Neuropathology, University of Goettingen, Goettingen, Germany

M. Sailer

Department of Neurology , Otto-von-Guericke University, 39120 Magdeburg, Germany

Defining tools in magnetic resonance imaging (MRI) representing specific pathological processes is needed to understand the complex relationship between inflammation, myelin breakdown, axonal injury and clinical symptoms in multiple sclerosis (MS) and its variants. Here, we describe a case of histologically-defined MS, in which the radiological appearance of the lesion and clinical course support the diagnosis of Balo's concentric sclerosis. Serial magnetization transfer, diffusion tensor imaging and ¹H-magnetic resonance spectroscopy, from 14 days to 13 months after biopsy, allow the contextual interpretation of specific pathological changes. In our case, acute inflammation was sensitively traced by fractional anisotropy and increased lactate in spectroscopy. In contrast, magnetization transfer ratio and the apparent diffusion coefficient monitor the sequential loss of tissue in selected rings of the lesion. The delay from the peak of symptoms in a dramatic clinical course to the maximum tissue destruction indicated through MRI suggests that compromise of axonal function may be decisive for the acute clinical situation. This is the first report comparing ¹Hmagnetic resonance spectroscopy, magnetization transfer and diffusion tensor imaging with histopathology in a patient with Balo's concentric sclerosis. Multiple Sclerosis 2007; 13: 471-482. http://msj.sagepub.com

Key Words: Balo's concentric sclerosis • diffusion-weighted imaging • histology • magnetic resonance imaging • magnetization transfer • multiple sclerosis

This version was published on May 1, 2007

Multiple Sclerosis, Vol. 13, No. 4, 471-482 (2007)
DOI: 10.1177/1352458506071329


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