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Updated: May 8, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Atypical idiopathic inflammatory demyelinating lesions (IIDL): conventional and diffusion-weighted MR imaging (DWI)
Claus Koelblinger1, Julia Fruehwald-Pallamar, Klaus Kubin
1Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria.
Introduction:
The purpose of this study was to evaluate MR imaging characteristics with conventional and advanced MR imaging techniques in patients with IIDL.
Methods:
MR images of the brain in 42 patients (20 male, 22 female) with suspected or known multiple sclerosis (MS) from four institutions were retrospectively analyzed. Lesions were classified into five different subtypes: (1) ring-like lesions; (2) Balo-like lesions; (3) diffuse infiltrating lesions; (4) megacystic lesions; and (5) unclassified lesions. The location, size, margins, and signal intensities on T1WI, T2WI, and diffusion-weighted images (DWI), and the ADC values/ratios for all lesions, as well as the contrast enhancement pattern, and the presence of edema, were recorded.
Results:
There were 30 ring-like, 10 Balo-like, 3 megacystic-like and 16 diffuse infiltrating-like lesions were detected. Three lesions were categorized as unclassified lesions. Of the 30 ring-like lesions, 23 were hypointense centrally with a hyperintense rim. The mean ADC, measured centrally, was 1.50 ± 0.41 × 10(-3) mm(2)/s. The mean ADC in the non-enhancing layers of the Balo-like lesions was 2.29 ± 0.17 × 10(-3) mm(2)/s, and the mean ADC in enhancing layers was 1.03 ± 0.30 × 10(-3) mm(2)/s. Megacystic lesions had a mean ADC of 2.14 ± 0.26 × 10(-3)mm(2)/s. Peripheral strong enhancement with high signal on DWI was present in all diffuse infiltrating lesions. Unclassified lesions showed a mean ADC of 1.43 ± 0.13 mm(2)/s.
Conclusion:
Restriction of diffusion will be seen in the outer layers of active inflammation/demyelination in Balo-like lesions, in the enhancing part of ring-like lesions, and at the periphery of infiltrative-type lesions.
Insights
This study analyzed MRI characteristics of inflammatory demyelinating lesions (IDL) in multiple sclerosis patients. Diffusion restriction highlights active inflammation in specific lesion types, aiding diagnosis.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Inflammatory demyelinating lesions (IDL) are a hallmark of multiple sclerosis (MS).
- Accurate characterization of IDL subtypes is crucial for diagnosis and management.
- Conventional and advanced Magnetic Resonance Imaging (MRI) techniques offer insights into lesion pathology.
Purpose of the Study:
- To evaluate the MR imaging characteristics of various IDL subtypes.
- To differentiate lesion types using conventional and advanced MRI sequences.
- To correlate imaging findings with diffusion characteristics.
Main Methods:
- Retrospective analysis of brain MRI from 42 suspected/known MS patients.
- Classification of lesions into five subtypes: ring-like, Balo-like, diffuse infiltrating, megacystic, and unclassified.
- Detailed recording of lesion location, size, margins, signal intensities (T1WI, T2WI, DWI), ADC values, contrast enhancement, and edema.
Main Results:
- Identified 30 ring-like, 10 Balo-like, 3 megacystic, and 16 diffuse infiltrating lesions.
- Ring-like lesions showed central hypointensity with hyperintense rim; mean ADC 1.50 × 10(-3) mm(2)/s.
- Balo-like lesions had restricted diffusion in enhancing layers (mean ADC 1.03 × 10(-3) mm(2)/s).
- Diffuse infiltrating lesions exhibited peripheral enhancement and high DWI signal.
Conclusions:
- Diffusion restriction is observed in active inflammatory/demyelinating areas.
- Specific patterns of diffusion restriction aid in identifying active inflammation within Balo-like, ring-like, and infiltrative lesions.
- Advanced MRI techniques, particularly DWI and ADC mapping, are valuable for characterizing IDL activity.
