PMC7370552_01
(a)-(i): (a) axial FLAIR, (b) T1 TSE and (c) T2 TSE revealed multiple well-circumscribed concentric lamellar lesions in the bihemispheric white matter involving the corpus callosum that showed alternate bands of iso-/hypointensity on T1-weighted images and alternate hypo-/hyperintensity on T2-weighted/FLAIR images. (d) DWI (b = 1000) showed restricted diffusion of the lesions, in particular along the margins. (e) Apparent diffusion coefficient (ADC) map confirms alternate bands of diffusion restriction showing low signal intensity. (f) After intravenous administration of gadolinium, all of the lesions demonstrated an "onion-like" patchy enhancement on post-contrast T1-weighted images. (g, h) % "Double Inversion Recovery sequences (DIR) showed detailed lamellar structure of the lesions due to high sensitivity in detection of juxta and subcortical lesions. (i) MR spectroscopy revealed elevated choline and lactate peaks and decreased N-acetylaspartate peak."
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(a)-(d) Stereotactic biopsy obtained from frontal right paraventricular lesion showed ((a) H&E 20x) gliosis and many swollen reactive eosinophilic astrocytes ((b) GFAP immunostain 20x) with a number of instances of perivascular cuffing. Axonal stain showed long stretches of intact axon ((c) neurofilament immunostain 20x) and macrophages were found in a perivascular and parenchymal distribution ((d) CD68 immunostain 20x).
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In addition, perivascular and periventricular macrophages were found (Figure 2).