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. 2015 Jul 7;85(1):18–28. doi: 10.1212/WNL.0000000000001587

Figure 1. In vivo leptomeningeal enhancement: Radiology.

Figure 1

(A) Examples of leptomeningeal contrast enhancement in 4 representative MS cases. Foci of high signal (boxes) on 3T postcontrast T2-FLAIR images indicate leptomeningeal enhancement. From left to right: a 54-year-old woman with relapsing-remitting MS (EDSS score = 1.5); a 51-year-old woman with primary progressive MS (EDSS score = 6.5); a 38-year-old woman with relapsing-remitting MS (EDSS score = 1); and a 62-year-old man with primary progressive MS (EDSS score = 6.5). The findings are magnified in the corresponding boxes (arrows). In no case was enhancement present on precontrast T2-FLAIR scans (not shown). Extracerebral tissues have been masked for clarity. (B) Longitudinal assessment of leptomeningeal enhancement. High signal indicating leptomeningeal enhancement within a parietal sulcus (arrows) was stable over 4 years in a 55-year-old man with relapsing-remitting MS (EDSS score = 2.5). (C) Signal intensity on different MRI sequences. Three foci of leptomeningeal enhancement are visible on postcontrast T2-FLAIR scans (left column), but not on the corresponding precontrast T2-FLAIR (middle column). In the right column, postcontrast T1-weighted images show minimal abnormal signal that would not routinely be classified as enhancement. The first row shows images from a 42-year-old woman with relapsing-remitting MS (EDSS score = 2); second row: 30-year-old woman with relapsing-remitting MS (EDSS score = 6); and third row: 61-year-old woman with primary progressive MS (EDSS score = 6). (D) Association with meningeal vessels: high-resolution 7-tesla MRI from a 51-year-old woman with primary progressive MS (EDSS score = 6.5) shows that leptomeningeal enhancement is perivascular. T2*-weighted gradient-echo scans showing (a) the vessel (red arrow) as it appears before contrast injection; (b) bright signal around the vessel 5 minutes after contrast injection; (c) an enlarging area of bright signal 20 minutes postcontrast; and (d) partially resolving signal 40 minutes postcontrast, reflecting mixing with the slightly less bright CSF. Other vessels did not show the same finding. EDSS = Expanded Disability Status Scale; MS = multiple sclerosis; T2-FLAIR = T2-weighted, fluid-attenuated inversion recovery.