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March 1978

Cranial CT and Multiple Sclerosis: Contrast-Enhancing Lesions

Author Affiliations

Midwest Clinic Consultants in Neurology and Psychiatry 105 S 49th St Omaha, NE 68132

Arch Neurol. 1978;35(3):183. doi:10.1001/archneur.1978.00500270065017

To the Editor.—  The contrast enhancement of acute, active lesions of multiple sclerosis as visualized on cranial computerized tomography (CT) has been previously described,1-3 (also J. K. Campbell, oral communication, Aug 27, 1976, and written communication, May 10, 1977, and E. S. Sears, oral communication, Aug 27, 1977, written communication, July 19, 1977). This contrast enhancement is believed to result from a loosening of the blood-brain barrier with subsequent extravasation of the iodine contrast material through the blood-brain barrier into the surrounding parenchyma. This theory is supported by the following evidence.1. Gado and co-workers4.5 have shown that cranial CT lesions enhance by contrast either because of the blood pool of the lesion or because of extravasation of the iodinated material through a defective blood-brain barrier.2. Edema is well recognized neuropathologically within regions of acute and subacute demyelination in cases of multiple sclerosis. Edema also appears to