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Case: Balo concentric sclerosis on MRI, DTI, MR Spectrocopy

Case Study
Trofimova, Tatyana, MD, PhD St. Petersburg, Institute of Human Brain, Russian Academy of Sciences
Malakhova, Elena, M.D. St. Petersburg, Institute of Human Brain, Russian Academy of Sciences

Balo concentric sclerosis on MRI, DTI, MR Spectrocopy

Patient history

A 50-year-old female was admitted to the hospital with complaints of left hand clumsiness, unsteadiness of gait, periodical headaches. During the last year she had suffered from neck pain, left hand little finger numbness and weakness in her upper and lower left extremities.

MR examination

The exam was performed on Achieva 3.0T X-series with the 8-channel SENSE Head coil.

The ExamCard consisted of:
T2W_TSE
T2W_DRIVE
FLAIR_longTR
DWI_E SENSE

Post contrast: T1_3D_POST SENSE after bolus of Gd contrast agent.
DTI_high_ISO tractography and proton spectroscopy.

Images


Axial, sagittal and coronal T2-weighted and FLAIR images demonstrate a large lesion (32x29x36mm) with a concentric pattern without evidence of perifocal edema and mass effect, located at the border of right frontal and parietal lobes. Another smaller lesion (15x18x11mm) with the same concentric pattern is seen in the right frontal lobe.



 T1W pre-contrast Immediately after the contrast injection 15 minutes post contrast
T1W pre-contrast
Immediately after the contrast injection
15 minutes post contrast

Immediately after the contrast injection there was no enhancement of the lesion. The image acquired 15 minutes post contrast shows medium intensity focal peripheral concentric enhancement of the lesion (arrows).


 DTI fiber tractography
DTI fiber tractography

DTI Fiber tractography reveals a damage of the fibers in the right hemisphere within the lesion location (arrows).


 Single voxel spectroscopy
Single voxel spectroscopy

Single-voxel MR Spectroscopy of the concentric lesion shows an increased choline peak (Cho), minimally decreased N-acetyl aspartate peak (NAA) and pathological lipid-lactate complex (Lac, Lip) peaks.

Diagnosis:

The finding is consistent with demyelinating multiple disease of the right hemisphere (Balo's Concentric Sclerosis).


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Case Study
Achieva 3.0T X-series
Release 2, Release 3
Brain, Neuro
 

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