MRI characteristics of periaqueductal lesions in multiple sclerosis

Athina Papadopoulou; Yvonne Naegelin; Katrin Weier; Michael Amann; Jochen Hirsch; Stefanie von Felten; Oezguer Yaldizli; Till Sprenger; Ernst Wilhelm Radue; Ludwig Kappos; Achim Gass

doi:10.1016/j.msard.2014.01.001

MRI characteristics of periaqueductal lesions in multiple sclerosis

Mult Scler Relat Disord. 2014 Jul;3(4):542-51. doi: 10.1016/j.msard.2014.01.001. Epub 2014 Jan 18.

Authors

Affiliations

¹ Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; Medical Image Analysis Center, Schanzenstrasse 55, CH-4056 Basel, Switzerland. Electronic address: athina.papadopoulou@usb.ch.
² Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: yvonne.naegelin@usb.ch.
³ Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: katrin.weier@usb.ch.
⁴ Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; Medical Image Analysis Center, Schanzenstrasse 55, CH-4056 Basel, Switzerland; Department of Radiology and Nuclear Medicine, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: michael.amann@usb.ch.
⁵ Department of Radiology and Nuclear Medicine, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: jochen.hirsch@mevis.fraunhofer.de.
⁶ Clinical Trial Unit, University Hospital Basel, Schanzenstrasse 55, CH-4056 Basel, Switzerland. Electronic address: stefanie.vonfelten@usb.ch.
⁷ Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: oezguer.yaldizli@usb.ch.
⁸ Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland; Medical Image Analysis Center, Schanzenstrasse 55, CH-4056 Basel, Switzerland; Department of Radiology and Nuclear Medicine, Division of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: till.sprenger@usb.ch.
⁹ Medical Image Analysis Center, Schanzenstrasse 55, CH-4056 Basel, Switzerland. Electronic address: ernst-wilhelm.radue@usb.ch.
¹⁰ Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: ludwig.kappos@usb.ch.
¹¹ Department of Neurology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: achim.gass@medma.uni-heidelberg.de.

PMID: 25877067
DOI: 10.1016/j.msard.2014.01.001

Abstract

Background: In multiple sclerosis (MS), periaqueductal lesions (PAL) have been described histopathologically.

Objectives: We sought to investigate the frequency and characteristics of PAL on magnetic resonance images (MRIs) in patients with MS or clinically isolated syndrome (CIS).

Methods: We analyzed proton density (PD)-weighted MRIs of 247 MS and 10 CIS patients. PAL were identified based on their abnormal hyperintensity and lesion shape on at least two consecutive slices. Patients with and without PAL were compared for clinical characteristics in a propensity score weighted analysis.

Results: We identified PAL in 48/257 patients (18.7%), 34 of which had CIS or relapsing-remitting MS and 14 a progressive disease course. The shape of PAL was often circular (65%), or/and wedge-like (42%). Multi-planar image analysis in a subgroup of patients with double inversion recovery sequences revealed that 36% of PAL were periventricular lesions of the third ventricle extending towards the aqueduct. We found an association of PAL and brainstem functional system.

Conclusions: Although PAL may be underreported in MS, they are relatively frequent and found at all clinical stages and in CIS. They could be considered as a variant of periventricular lesions in the supratentorial midbrain and thus be useful in the diagnosis of MS.

Keywords: Brainstem symptoms; Multiple sclerosis; Periaqueductal lesions.