Year: 2026 | Month: March | Volume: 16 | Issue: 3 | Pages: 233-245
DOI: https://doi.org/10.52403/ijhsr.20260329
Role of Magnetic Resonance Imaging in the Evaluation of Central Nervous System Demyelinating Disorders and Their Mimics: A Retrospective Observational Study at a Tertiary Care Centre in South India
Sayali Kothawade1, Seetha Pramila V.V2, Parthasarathi3
1Junior Resident, Department of Radiodiagnosis, Rajarajeswari Medical College, Bengaluru, India
2Professor, Department of Radiodiagnosis, Rajarajeswari Medical College, Bengaluru, India
3Professor and Head of Department, Department of Radiodiagnosis, Rajarajeswari Medical College, Bengaluru, India
Corresponding Author: Dr. Sayali Kothawade
ABSTRACT
Background: Demyelinating disorders of the central nervous system (CNS) comprise a heterogeneous group of inflammatory diseases characterized by damage to the myelin sheath, resulting in neurological dysfunction. These disorders commonly involve the brain, optic nerves, and spinal cord and present with varied clinical manifestations. Early and accurate diagnosis is essential for timely treatment and improved patient outcomes. Magnetic resonance imaging (MRI) is the most sensitive imaging modality for detecting and characterizing demyelinating lesions because of its superior soft-tissue contrast and ability to delineate white matter abnormalities. However, several non-demyelinating conditions may mimic demyelinating disorders on MRI, posing diagnostic challenges in clinical practice.
Methods: This retrospective observational study was conducted in the Department of Radiodiagnosis at Rajarajeswari Medical College, a tertiary care centre in South India. MRI examinations of 30 patients with clinical suspicion of demyelinating disease were reviewed. The study included cases of multiple sclerosis, optic neuritis, acute disseminated encephalomyelitis, transverse myelitis and neuromyelitis optica spectrum disorder. MRI sequences evaluation included T1-weighted, T2-weighted, fluid-attenuated inversion recovery (FLAIR), diffusion-weighted imaging (DWI) and contrast-enhanced sequences where available. Imaging features such as lesion morphology, anatomical distribution, optic nerve involvement, spinal cord lesions, and enhancement characteristics were analyzed.
Results: Among the 30 patients, multiple sclerosis was the most frequently observed demyelinating disorder. MRI findings commonly demonstrated periventricular and juxtacortical white matter plaques oriented perpendicular to the lateral ventricles. Optic neuritis showed optic nerve enlargement with contrast enhancement, while acute disseminated encephalomyelitis presented with multifocal bilateral hyperintense lesions in the cerebral white matter. Transverse myelitis and neuromyelitis optica spectrum disorder demonstrated long-segment intramedullary hyperintensity of the spinal cord on T2-weighted imaging. In addition, several non-demyelinating conditions such as cerebral vasculitis and leukodystrophies were identified as radiological mimics. MRI proved valuable in distinguishing these mimics from true demyelinating disorders based on lesion distribution and imaging characteristics.
Conclusion: MRI plays a crucial role in the evaluation of CNS demyelinating disorders and their mimics. Recognition of characteristic imaging patterns and awareness of potential mimicking conditions enables accurate diagnosis and facilitates timely clinical management.
Key words: Demyelinating disorders, Magnetic resonance imaging, Multiple sclerosis, Neuromyelitis optica spectrum disorder, Acute disseminated encephalomyelitis, Optic neuritis, Transverse myelitis, MRI mimics.