MS brain MRI report results can seem confusing or even alarming, especially if you’ve had an MRI to evaluate multiple sclerosis (MS) or already have a diagnosis. However, understanding terms like juxtacortical, periventricular, or enhancement after contrast injection is crucial. It puts you in the driver’s seat, helping you interpret what they mean and what they say about the activity or severity of the disease.
This guide breaks down the most common MRI terms associated with MS, allowing you to better understand your report and feel more confident in your care.
I’m Dr. Vahid Alizadeh. In this article from the “What Does My Report Say?” series, I’ll help you decode the key MRI terms commonly seen in patients with multiple sclerosis.
Real-Life Scenario: A Patient’s Journey
Emily, a 32-year-old woman, began experiencing episodes of vision problems and numbness in her hands. Her doctor ordered a brain MRI with contrast. The report included terms like juxtacortical lesions, T1 black holes, enhancing plaques, and Dawson’s fingers. Feeling overwhelmed, she searched for reliable explanations to understand what it all meant.
What Do These Medical Terms Mean?
Term: Juxtacortical Lesions
Simple Definition: Lesions located near the outer surface of the brain, close to the cerebral cortex.
Why It Matters: These lesions are commonly seen in MS and are one of the hallmark locations supporting the diagnosis.
Term: Periventricular Lesions
Simple Definition: Lesions situated around the brain’s ventricles (fluid-filled spaces).
Why It Matters: Another classic location for MS plaques. Their presence helps fulfill diagnostic criteria.
Term: Enhancing Lesions
Definition: Lesions that appear brighter after the injection of contrast agent (gadolinium), which highlights areas of active inflammation.
What It Means: Active inflammation is occurring at the time of imaging. Enhancement typically lasts a few weeks, indicating recent, acute disease activity.
Term: New Lesions Compared to Prior MRI
Why It Matters: If a lesion is new compared to previous MRIs, it suggests disease progression or a recent relapse. Even without enhancement, a new lesion can still indicate recent disease activity.
Term: Dawson Fingers
Definition: Finger-like projections of demyelination extending outward from the ventricles, typically observed in multiple sclerosis (MS).
Why It Matters: Named after Dr. James Dawson, these lesions align along small veins and are highly characteristic of MS.
Term: Infratentorial Lesions
Definition: Lesions found below the tentorium cerebelli—in the brainstem or cerebellum.
Why It Matters: Lesions in these areas are part of the diagnostic criteria and may cause balance problems, vertigo, or facial weakness.
Term: T1 Hypointense Lesions (T1 Black Holes)
Definition: Lesions that appear dark on T1-weighted images.
What It Means: These often reflect chronic damage and neuronal loss, not just inflammation. The darker and more persistent the lesion, the more severe the tissue damage will be.
Term: Neuronal Loss
Definition: Death or degeneration of nerve cells in the brain.
Why It Matters: MS causes not only inflammation but also long-term injury to neurons. This leads to permanent symptoms and contributes to brain atrophy over time.
Term: Brain Parenchymal Atrophy
Definition: Shrinkage or volume loss of brain tissue.
Why It Happens: Chronic inflammation and damage associated with MS cause neurons and supporting tissue to deteriorate, resulting in a reduction of brain volume over time.
What Is the McDonald’s Criteria?
The McDonald Criteria is a set of international guidelines used to diagnose multiple sclerosis. It helps determine whether the findings meet:
- Dissemination in space: Lesions in multiple typical MS locations (periventricular, juxtacortical, infratentorial, spinal cord)
- Dissemination in time: Both new and old lesions or the presence of enhancing and non-enhancing lesions at the same time
Meeting these criteria supports a confident diagnosis of MS.
MS Brain MRI Report: What Does It Say About My Condition?
If your MRI report includes enhancing lesions, new plaques, or classic features such as Dawson’s fingers, it suggests active MS. But it’s important to know:
- Not all lesions mean a current relapse.
- T1 black holes reflect older damage.
- Lesion count, size, location, and enhancement all provide clues.
Monitoring changes over time is key. Comparing scans is essential for tracking progression.
Why You Should Get an Expert to Review Your Report
MS is a complex disease. An expert can:
- Distinguish MS lesions from other conditions
- Determine activity level and chronicity
- Guide decisions about therapy and follow-up
At AI-PACS, we offer expert second opinions to help clarify your report and ensure nothing important is missed.
Next Steps: Let’s Help You Understand Your Report
If you’ve received an MRI report and are unsure what the MS-related terms mean, we’re here to help you understand it fully.
📁 Submit your report for expert review:
https://ai-pacs.com/online-report/
