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. 2021 Apr 5;21:146. doi: 10.1186/s12883-021-02165-0

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© The Author(s) 2021

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 1 — Selected MRI findings in our Multiple Sclerosis (MS) case. At the baseline exam (September 2016, upper row) a typical radiological MS pattern was present. When the patient presented a subacute clinical worsening (July 2019, middle row), brain MRI scan showed the presence of four new confluent Fluid Attenuated Inversion Recovery (FLAIR) hyperintense lesions (red arrows), with involvement of the U-fibers, a sharp border between the superficial aspect of the lesion and the overlying cortex and an ill-defined deeper border. Three of these lesions showed a punctate peripheral contrast-enhancement (green arrows) and a mild, but consistent, hypointense subcortical rim in Spoiled Gradient Recalled (SPGR) images (blue arrows), suggestive of PML lesions. Along with these lesions, a left frontal oval-shaped lesion showed a different pattern of contrast enhancement compared to the other lesions (orange arrow), in absence of hypointense signal in SPGR images (yellow arrow), more suggestive of active MS rather than a PML lesion. At a follow-up examination (January 2020, lower row), the PML lesions showed an almost complete resolution, in absence of significant sequelae, while the oval-shaped FLAIR hyperintense lesion was still present, although reduced in volume