Stable multiple sclerosis on follow-up MRI — reading activity, not just lesion count
Clinical context
A patient with known multiple sclerosis undergoing routine follow-up brain MRI with and without intravenous gadolinium, compared with a prior contrast-enhanced study.
Key finding
Multiple T2/FLAIR hyperintense white matter plaques involve the bilateral frontoparietal and periventricular white matter, right temporal subcortical white matter, and the junction of the left inferior cerebellar peduncle and brainstem. None show diffusion restriction, abnormal post-contrast enhancement, or T1 "black hole" change, and overall lesion burden and distribution are stable with no new lesions. Mild prominence of the bilateral perioptic CSF sleeves and a partial empty sella are again noted, unchanged.
Teaching point
In MS surveillance the key deliverable is disease activity, not merely lesion tally: absence of enhancement and diffusion restriction argues against active demyelination, stability against the prior study excludes new lesions, and the absence of T1 black holes signals no new fixed axonal loss.
Teaching case shown for educational purposes. Anonymized; no identifiable patient data. A radiology report is a specialist opinion and must be interpreted with the full clinical context by the treating physician.