Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Lisanti, C. J. Articles by Bradley, W. G. Search for Related Content PubMed PubMed Citation Articles by Lisanti, C. J. Articles by Bradley, W. G., Jr.

American Journal of Neuroradiology 26:2033-2036, September 2005
© 2005 American Society of Neuroradiology

BRAIN

The Ependymal "Dot-Dash" Sign: An MR Imaging Finding of Early Multiple Sclerosis

Christopher J. Lisanti^a, Patrick Asbach^b and William G. Bradley, Jr.^c

^a From the Departments of Radiology, Wilford Hall Medical Center Lackland AFB, TX
^b Charité-Universitaetsmedizin Berlin, Humboldt University, Berlin, Germany
^c University of California, San Diego, San Diego, CA

Address correspondence to William G. Bradley, Jr., Department of Radiology, University of California, San Diego, 200 West Arbor Drive, San Diego, CA 92103-8224

BACKGROUND AND PURPOSE: Corpus callosum lesions are of specific interest in the evaluation of suspected multiple sclerosis in brain MR imaging. Using thin-section sagittal fluid-attenuated inversion recovery images, researchers have shown that the finding of "subcallosal striations" correlates significantly with the diagnosis of multiple sclerosis. Using the same MR imaging technique, we describe a finding of ependymal irregularity that we call the "Dot-Dash" sign, which we believe to be associated with early multiple sclerosis.

METHODS: Sagittal 2-mm fast fluid-attenuated inversion recovery images were obtained in 70 patients. Thirty-five patients had multiple sclerosis according to the Poser criteria, and 35 were age-matched controls. The images were reviewed in a blinded fashion by an experienced neuroradiologist for the presence or absence of the Dot-Dash sign.

RESULTS: The correlation between the Dot-Dash sign and definite clinical multiple sclerosis is highly significant (P < .001), with a sensitivity of 91.4% and a specificity of 65.7%. In the age group of 50 years, the sensitivity was 95.7% and the specificity, 71.9%.

CONCLUSION: The Dot-Dash sign of ependymal irregularity on thin-section sagittal fluid-attenuated inversion recovery images is an early marker for multiple sclerosis, which is particularly useful in the younger patient. This finding appears to be more sensitive for early lesion detection than any other multiple sclerosis imaging finding yet described in the literature.