7 Tesla MRI of Balo's concentric sclerosis versus multiple sclerosis lesions


  • J.R. Behrens
  • J. Wanner
  • J. Kuchling
  • L. Ostendorf
  • L. Harms
  • K. Ruprecht
  • T. Niendorf
  • S. Jarius
  • B. Wildemann
  • R.M. Gieß
  • M. Scheel
  • J. Bellmann-Strobl
  • J. Wuerfel
  • F. Paul
  • T. Sinnecker


  • Annals of Clinical and Translational Neurology


  • Ann Clin Transl Neurol 5 (8): 900-912


  • BACKGROUND: Baló's concentric sclerosis (BCS) is a rare condition characterized by concentrically layered white matter lesions. While its pathogenesis is unknown, hypoxia-induced tissue injury and chemotactic stimuli have been proposed as potential causes of BCS lesion formation. BCS has been suggested to be a variant of multiple sclerosis (MS). Here, we aimed to elucidate similarities and differences between BCS and MS by describing lesion morphology and localization in high-resolution 7 Tesla (7 T) magnetic resonance imaging (MRI) scans. METHODS: Ten patients with Baló-type lesions underwent 7 T MRI, and 10 relapsing remitting MS patients served as controls. The 7 T MR imaging protocol included 3D T(1)-weighted (T(1)w) magnetization-prepared rapid gradient echo, 2D high spatial resolution T(2)*-weighted (T(2)*w) fast low-angle shot and susceptibility-weighted imaging. RESULTS: Intralesional veins were visible in the center of all but one Baló-type lesion. Four Baló-type lesions displayed inhomogeneous intralesional T(2)*w signal intensities, which are suggestive of microhemorrhages or small ectatic venules. Eight of 10 BCS patients presented with 97 additional lesions, 36 of which (37%) had a central vein. Lesions involving the cortical gray matter and the U-fibers were not detected in BCS patients. CONCLUSION: Our findings support the hypothesis that BCS and MS share common pathogenetic mechanisms but patients present with different lesion phenotypes.