Enhancing patterns in multiple sclerosis: Evolution and persistence

BACKGROUND AND PURPOSE: Contrast enhancement on MR images of patients with multiple sclerosis (MS) is known to be associated with abnormalities of the blood-brain barrier (BBB), However, little is known about diagnostic patte rns and common features of enhanced MS lesions. This study was designed to evaluate initial enhancement patterns, changes in these enhancing patterns, and duration of enhancement in a cohort of patients with MS. METHODS: Twenty-five patients with clinically definite MS were studied retr ospectively. The appearance of enhancing lesions and sequential changes in the appearance on axial contrast-enhanced spin-echo images were evaluated. The enhancing lesions were classified as nodular, ringlike, or "other" (eg, arclike), RESULTS: Of 301 new enhancing lesions, 205 (68%) showed nodular enhancement , 70 (23%) a ring pattern, and 26 (9%) a pattern neither nodular nor ringli ke (eg, arclike). Two hundred eighty (93%) of 301 enhancing lesions disappe ared within 6 months, and seven (2%) lesions showed persistent enhancement longer than 6 months, The other 14 (5%) lesions, which disappeared by the t ime of the next scan, were excluded, because the course between two examina tions was longer than 6 months. Of nine persisting nodular enhancing lesion s on the follow-up images, seven were decreased in size, whereas all of two persisting ringlike enhancing lesions on the follow-up images were larger than before. CONCLUSION: Nodular enhancement is the predominant enhancement pattern for new MS lesions, and the temporal course of enhancement is usually shorter t han 6 months. The appreciation of the evolution of MS-enhanced lesions aids in both identifying new MS lesions and distinguishing these lesions from o ther pathologic entities. This may be helpful in clinically evaluating the stage of MS lesions.