This patient's imaging demonstrates classic characteristics of multiple sclerosis (diagnosed formally seven years ago) including perpendicular periventricular lesions (Dawson fingers) and lesions that have incomplete circumferential enhancement (open ring sign).  Central vein sign may be represented best on T2-weighted images, demonstrated as hyperintense lesions with a thin linear hypointensity that runs completely through the lesion. 

This case was submitted with supervision and input from:
Ryan Rigsby, M.D. Neuroradiology Fellow
Mayo Clinic, Jacksonville
Department of Diagnostic and Interventional Radiology