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

Figure 2. Leptomeningeal enhancement: Multimodal MRI-histopathology examination.

Figure 2

In vivo 3-tesla postcontrast T2-FLAIR MRI. The presence of stable focal leptomeningeal contrast enhancement in the right middle frontal sulcus is depicted in the 7 available postcontrast T2-FLAIR MRI scans (coronal reformations) acquired on different 3-tesla MRI scanners between 2010 and 2013. Leptomeningeal enhancement (white arrows) is located deep within the sulcus, adjacent to the cerebral cortex, and visible on 4 consecutive coronal 1-mm T2-FLAIR sections (inset, representative scans from October 2011). The expected location of in vivo leptomeningeal enhancement is indicated with red arrows in the postmortem MRI and histologic representative sections. Postmortem 7-tesla MRI: Extensive cortical and juxtacortical signal abnormality affects the brain parenchyma adjacent to the sulcus where leptomeningeal enhancement was detected in vivo (CISS sequence, 150-μm isotropic voxel resolution, representative slices). The cortical signal abnormality was not detected on in vivo MRI, although juxtacortical signal abnormality was noted. Myelin staining: In vivo and postmortem MRI-guided histopathology allowed precise localization of the target area. Serial LFB-PAS staining and myelin/proteolipid protein (PLP) immunohistochemistry were performed every 100 µm (10-μm-thick cryosections). Representative sections are well matched to both in vivo and postmortem MRI. CISS = constructive interference in steady state; LFB-PAS = Luxol fast blue/periodic acid–Schiff; PLP = proteolipid protein; T2-FLAIR = T2-weighted, fluid-attenuated inversion recovery.