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Updated: Mar 20, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Incidental Lesions Suggesting Multiple Sclerosis
Purpose Of Review:
Neurologists are frequently asked to consult on patients with incidentally observed anomalies on brain MRI that may be suggestive of multiple sclerosis (MS). The identification of such findings has important clinical management implications. This review provides an overview and practical clinical approach options for clinicians.
Recent Findings:
An increase in the number of brain MRI studies performed annually is expected to result in detection of a corresponding greater number of unanticipated anomalies. A disproportionate number of patients referred to neurologists for this reason have punctate subcortical T2 hyperintensities that appear nonspecific in origin rather than having imaging features concerning for MS. However, in some instances, the MRI characteristics appear to be typical for demyelination. When these features are observed, efforts should be pursued to identify an accurate explanation for the preclinical findings through rigorous clinical evaluation, paraclinical testing, and utilization of longitudinal imaging.
Summary:
The identification of subjects with incidental T2 hyperintensities highly suggestive of MS is important for patient counseling and management. Continued neurologic evaluations and reassessment of the original clinical impression are recommended to ensure accurate interpretation of the available data.
Insights
Neurologists often encounter incidental brain MRI findings. Differentiating nonspecific T2 hyperintensities from multiple sclerosis (MS) requires careful evaluation for accurate patient management.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Brain MRI is increasingly used, leading to more incidental anomaly detection.
- Consultations for incidental findings often involve potential indicators of multiple sclerosis (MS).
Observation:
- A significant number of referred patients present with punctate subcortical T2 hyperintensities.
- These hyperintensities are frequently nonspecific, not clearly indicative of MS.
Findings:
- Some MRI findings, however, exhibit characteristics typical of demyelination.
- Rigorous clinical evaluation, paraclinical testing, and longitudinal imaging are crucial for diagnosis.
Implications:
- Accurate identification of MS-suggestive findings is vital for patient counseling and management.
- Ongoing neurological assessment is recommended to refine diagnoses and ensure appropriate care.
