Top: Side-by-side axial T1 MR image from two 29-year-old-female patients with MS, both with a disease duration of 6 years and a very mild disability score.

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High-signal-intensity lesions on T2-weighted MR images

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Presentation transcript:

Top: Side-by-side axial T1 MR image from two 29-year-old-female patients with MS, both with a disease duration of 6 years and a very mild disability score (EDSS) of 1.5. Top: Side-by-side axial T1 MR image from two 29-year-old-female patients with MS, both with a disease duration of 6 years and a very mild disability score (EDSS) of 1.5. Note that one exhibits noticeably more brain atrophy, reflected by enlarged subarachnoid spaces (1), ventricles (2), sulci (3) as well as T1-lesions (“black holes”) (4). These 2 images demonstrate the great heterogeneity in the MS course and pathogenesis. Bottom: The WBNAA spectrum from each of these women, normalized for brain tissue volume. Note that the one on the left is significantly lower than the one on the right, demonstrating that not only does she lose tissue faster but that the quality of the remaining tissue is worse (ie, neuronal dysfunction and damage precedes atrophy). mI indicates myo-Inositol; Cho, choline; Cr, creatine; glx, glutamine/glutamate; acq., acquisition. D.J. Rigotti et al. AJNR Am J Neuroradiol 2007;28:1843-1849 ©2007 by American Society of Neuroradiology