This is a follow-up study, but why the diagnosis can be supported by the McDonald criteria on this images?
Even not considering the previous imaging, this study has met the McDonald diagnostic criteria for dissemination in space, characterised by: more than one infratentorial lesions, more than one juxtacortical lesions, and more than three periventricular lesions.
Besides the white matter lesions, what else catch your attention in this brain?
Generalised brain atrophy, which is a features that may be found in long standing chronic MS.
Multiple white matter T2/FLAIR hyperintense regions are noted, in keeping with the known diagnosis of multiple sclerosis. These have remained stable in appearance and number, with no definite new lesions identified, and no abnormal restricted diffusion. No intra or extra-axial collection or mass.
Brain volume is globally reduced.