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

Christopher J. Lisantia, Patrick Asbachb 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



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  		FIG 1. Sagittal fluid-attenuated inversion recovery image (TR/TE/TI, 8800/130/2200) shows a normal smooth ependymal stripe (arrows) without irregularity, subcallosal striations, or Dot-Dash sign.



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  		FIG 2. Sagittal fluid-attenuated inversion recovery images (TR/TE/TI, 8800/130/2200) from 2 different patients with multiple sclerosis (A, B) show the typical Dot-Dash sign. The arrows indicate the dots, whereas the dashes are the hypointense areas between the dots.



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  		FIG 3. Sagittal fluid-attenuated inversion recovery images (TR/TE/TI, 8800/133/2200) are from a patient with recurrent relapsing multiple sclerosis. A shows the typical Dot-Dash sign (arrows). The patient developed worsening neurologic symptoms, and a follow-up image obtained 7 weeks later (B) showed interval development of confluent callosal and white matter lesions (arrowheads) and an additional Dot-Dash sign in the posterior ependyma.



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  		FIG 4. Sagittal fluid-attenuated inversion recovery image (TR/TE/TI, 8800/130/2200) shows confluent subependymal and callosal white matter hyperintensity (arrows), which is typical of chronic white matter ischemic changes. There is no evidence of either the Dot-Dash sign or subcallosal striations.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X