Female, 51 years old, with history of multiple sclerosis and numbness. The previously demonstrated oval tumefactive lesion within the left posterior corona radiata has significantly decreased in size compared to prior examination. This lesion demonstrates a FLAIR hyperintense and minimally diffusion restricting rim with a T1 hypointense, T2 hyperintense and partially FLAIR suppressing center. Single voxel spectroscopy of this lesion demonstrates mild elevation of choline, reduction of creatine and NAA, and pathologic quantities of both lactate and lipid.Numerous additional smaller FLAIR hyperintense lesions are again seen within the juxtacortical and periventricular white matter and the corpus callosum without significant interval change. The brainstem and cerebellum are relatively preserved. Mild callosal thinning and generalized parenchymal volume loss are demonstrated. No evidence of significant mass effect is observed. No findings to suggest intracranial hemorrhage or any abnormal extra-axial fluid collections are detected. The ventricles are stable in size and morphology.
1.Numerous small lesions are identified in the juxtacortical and periventricular regions compatible with multiple sclerosis. No new or growing lesions are evident.2.A dominant tumefactive lesion within the left posterior corona radiata has significantly diminished in size. Single voxel spectroscopy of this lesion demonstrates a spectrum with characteristic features of active inflammation. Decreased NAA within the center of the lesion likely reflects some degree of neuronal loss.