Fig. 4

Male patient aged 27 years old, known case of MS on follow-up presented by clinical signs of activity. A, B Axial pre and post contrast T1WI: show multiple hypointense lesions in the periventricular white matter with no definite enhancing lesions on post contrast study. C Axial pre-contrast FLAIR shows multiple foci of high signal intensity at periventricular white matter. D Axial CE-FLAIR: shows nodular enhancement of MS plaques (arrows) which were not detected in pre contrast FLAIR (denoting more number of enhancing lesions shown in CE-FLAIR sequence without corresponding enhancement in post contrast T1W image. E, F Axial pre and post contrast FLAIR at same level: measurements of the SI, denoting the difference between pre and post contrast and confirms the presence of enhancement (CEI = 506, Lesion to background contrast ration = 0.12). Final Diagnosis: A case of MS with signs of activity