Radiology Teaching Files > Case 4011233

Contributed by: Virginia Mason Medical Center.
Patient: 50 year old female
History: This is a 50-year old female with a long-standing diagnosis of multiple sclerosis who was referred for routine follow-up MRI of the brain. She has been taking interferon beta 1a.

Fig. 1: T2-weighted axial MRI

Fig. 2: FLAIR sequence axial MRI
Findings: T2-weighted and FLAIR images show bilateral periventricular white matter changes, ovoid in shape and oriented perpendicular to the ventricular surfaces.
Diagnosis: Periventricular white matter changes consistent with established diagnosis of multiple sclerosis, unchanged from prior exam dated 3/04.

Classically, the lesions of multiple sclerosis are periventricular, ovoid, and oriented perpendicularly to the ventricular surface. These are occasionally called Dawson fingers, after neuropathologist James Dawson, who identified the perivascular distribution of inflammatory cells and the resulting fingerlike appearance of affected veins and venules in MS brain tissues.

Inflammation and breakdown of the blood-brain barrier leads to hyperintensity on T2-weighted images, as seen here. The FLAIR technique dampens ventricular CSF signal, which brings out the contrast of the MS lesions.

In general, MRI is an essential and very sensitive tool in the diagnosis and management of MS. However, it is not a specific test for MS, as there are mimics of MS on MRI. These include: postviral encephalomyelitis, Lyme Disease, Behcet Syndrome, sarcoidosis, Sjogren's syndrome, progressive multifocal leukencephalopathy (PML), and others. Consequently, it is generally not advisable to make a firm diagnosis of MS on the basis of a single scan. 


Dangond, Fernando. "Multiple Sclerosis.", 2005.

Calabresi, Peter A. "Diagnosis and Management of Multiple Sclerosis." American Family Physician, 2004 Nov 15, 70(10):1935-44.

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Additional Details:

Case Number: 4011233Last Updated: 02-28-2006
Anatomy: Cranium and Contents   Pathology: Non-Infectious Inflammatory Disease
Modality: MRExam Date: 02-15-2006Access Level: Readable by all users
Keywords: multiple sclerosis dawson fingers

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