Multiple sclerosis - black holes

Case contributed by Ahmed Abdrabou


Patient with known multiple sclerosis on follow up.

Patient Data

Age: 40 years old
Gender: Female

Multiple scattered supra and infratentorial white matter plaques, most of them are seen at the periventricular region perpendicular to the lateral ventricles giving the appearance of Dawson fingers, other plaques involve the subcortical U fibers, juxta cortical and brainstem. Most of the lesions show T2 shine through effect on DWI/ADC. Characteristically they display low signal on T1 WIs.

Case Discussion

T1 black hole lesions are multiple sclerosis plaques in the chronic stage when they display T1 hypointense signal that signifies axonal destruction and irreversible damage.

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