Visualizing Odd shaped lesions

Öztoprak B, Öztoprak I, Yıldız ÖK. The effect of venous anatomy on the morphology of multiple sclerosis lesions: a susceptibility-weighted imaging study.Clin Radiol. 2016 Mar 7. pii: S0009-9260(16)00080-5. doi: 10.1016/j.crad.2016.02.005. [Epub ahead of print]

AIM:To investigate the cause of morphology in non-ovoid multiple sclerosis (MS) lesions lacking a radial course and typical shape.
MATERIALS AND METHODS:Non-ovoid atypical lesions without perpendicular extensions to the ventricle were investigated in 95 MS patients by retrospective examination of T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. The relationship between the morphology of these atypical lesions detected in 38 patients and central vein anatomy was examined using susceptibility-weighted imaging (SWI).
RESULTS: A central venous structure was observed in 107 (65.6%) of 163 atypical lesions in 38 patients. The distribution of atypical lesions grouped by their shape was as follows: (1) V- or Y-shaped lesions (n=27, 48.6%) were observed where veins bifurcated; (2) crescent-shaped lesions (n=9, 8.4%) were observed where veins formed an arc; (3) patchy lesions comprised 48.6% (n=52) of the atypical lesions and involved multiplemedullary veins or medullary veins showing a “caput medusae” distribution; (4) ovoid lesions with a non-radial course (n=19, 17.7%) were generally observed where medullary veins converged to form internal cerebral vein branches.
CONCLUSION:Unlike typical MS plaques, non-ovoid atypical lesions make the differential diagnosis of MS challenging. Demonstration of the relationship between venous anatomy and lesion morphology in atypical lesions using SWI will aid in the differential diagnosis.

This study looks at odd shaped lesions and they can find a blood vessel at the core in about 70% of the time, maybe look abit harder or have a more powerful machine and they would have found blood vessels in all of them, if they are MS lesions. 

Because when you look in Pathology, blood vessels are lurking their somewhere, and yes you will find a bit of a lesion without blood vessel. 

But imagine having an apple and taking a slice off the edge, there will be no pips in it, however you know every apple has pips in the core. DrK may tell you some day about MRI showing the blood vessel in it?. It is the decay of transverse magnetization seen with gradient-echo sequences…Yep I don’t understand that either:-(.

However you can always read

However seeing Y shaped lesions surely gives use the hint that the lesion is developing around a blood vessel that is branching

              Nice video from DrB although Muzak is abit Cheesy

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  • "However seeing Y shaped lesions surely gives use the hint that the lesion is developing around a blood vessel that is branching"

    How can you explain this in terms of autoimmunity or viral (EBV) infection?

    • The white cells leave the blood and form a lesion simples. The answer is too simple. WWas the question cryptic.

    • Why around a branch?
      Why around the ventricles?
      Why MS specific lesions are ovoid and follow the course of a vein? Why not circular?

      A proper MS theory should answer these questions as the refer to MS specific findings.

    • This is hardly an answer. The fact is that autoimmune theory cannot explain the very few findings that are characteristic of MS:
      1. periventricular distribution of most lesions
      2. lesions of ovoid shape that follow the course of veins

      If you have an idea please share it with us.

      You said above that lesions form around veins because "white cells leave the blood". Can you tell us how the specific point of leakage is selected? Who decides it? Something in the blood or something in the white matter?

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