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MRI mimics of multiple sclerosis.

Esther Sánchez Aliaga1, Frederik Barkhof1

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Handbook of Clinical Neurology
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Multiple sclerosis (MS) diagnosis relies on lesion dissemination. However, various conditions mimic MS on MRI, necessitating careful evaluation of imaging red flags and clinical data for accurate diagnosis.

Keywords:
MRIMS mimicsdifferential diagnosismagnetic resonance imagingred flags

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Area of Science:

  • Neurology
  • Radiology
  • Neuroimaging

Background:

  • Multiple sclerosis (MS) diagnosis requires demonstrating dissemination of lesions in space and time (DIS/DIT) and excluding other neurologic disorders.
  • Magnetic resonance imaging (MRI) supports MS diagnosis through lesion morphology, distribution, and specific anatomic involvement.
  • Numerous inherited and acquired disorders can mimic MS on MRI, presenting with DIT/DIS evidence.

Purpose of the Study:

  • To review the radiologic appearance of common MS mimickers.
  • To highlight differential features that distinguish MS from other conditions on MRI.
  • To emphasize the importance of MRI red flags in the differential diagnosis of MS-like lesions.

Main Methods:

  • Review of radiologic findings in conditions mimicking MS.
  • Analysis of MRI characteristics, including lesion morphology and distribution.
  • Correlation of imaging findings with clinical history, demographics, and serologic data.

Main Results:

  • Hypoxic-ischemic vasculopathy, inflammatory disorders, vasculitis, and toxic/metabolic/infectious conditions can mimic MS on MRI.
  • Specific MRI red flags (infarcts, microbleeds, meningeal enhancement, calcifications) aid in differentiating non-MS disorders.
  • Comprehensive evaluation combining MRI, patient history, and serology is crucial for correct diagnosis.

Conclusions:

  • Many conditions can mimic multiple sclerosis on MRI, posing diagnostic challenges.
  • Identifying "MRI red flags" and integrating imaging with clinical information are essential for accurate diagnosis.
  • Distinguishing MS from its mimics requires a thorough and multifaceted diagnostic approach.