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Meaning Of Involvement Of Callososeptal Interface Remains Concerning For Demyelination?

Posted on Sun, 9 Mar 2014

Question: Technique Axial flair, Dwl,ADC,T1,SW1 Coronal T1, T2 Flair I have on previous mri report scan say I have two white hyperinsensity lesions on the centrum semiovale, one is dorment the other has grown to 1.2cm. Just had new report back and it says Minimal change in the appearance of the multiple flair hyperinsensitivities within the deep white matter. No interval increase in size of the lesions. However there is a new very small lesion within the insular lobe of the right side measuring 2mm. As previous there is signal abnormality within the callososeptal interface. No areas of restricted diffusion to suggest recent infarct or acute demyelinating plaques. Ventricles, basal cisterns and cortical suici are patent and symmetrical. Normal flow voids within the dominant intracerebral arteries and dural venous sinuses. Normal appearance of the orbits, pituitary gland and craniocervical junction. Conclusion Stable appearance of the non- specific white matter change. The involvement of the callososeptal interface remains concerning for demyelination. What does all this mean in English meaning Thanks XXXX

Answered by Dr. Indu Kumar (1 hour later)

Brief Answer: Lesions less than five in number can be ignored. Detailed Answer: Hello XXXX Thanks for writing to HCM In MRI,FLAIR or T2 weighted hyper intensities less than five in number in deep white matter of brain can be ignored. Mostly it is due to ischemic changes(decreased blood supply) that involves small blood vessels.However demyelination,Lyme's disease should also be ruled out with follow up scans.Diabetes mellitus also aggravates the situation. Hyper intensities more than five in number should be the cause of concern and it need investigations. In your case involvement of the callososeptal interface of brain remains concerning for demyelination. You need monitoring of conditions that leads to ischemic changes like hypertension,altered lipid profile,diabetes mellitus. You need investigations like routine hemogram,RBS,LFT,RFT,Lipid profile,ultrasound of abdomen. If there is any more physical problems then it should be treated. Other findings of brain are normal. You can also consult neurologist for detailed evaluation. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (15 hours later)

Thank you for that what does it mean when it says involvement of the callososeptal interface remains concerning for demyelination.

Answered by Dr. Indu Kumar (5 hours later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXX Thanks for writing back In brain callososeptal interface is located on the inferior surface of the corpus callosum,where septum pellucidum abuts it. It is believed that T2 hyperintense lesions affecting this region are specific for multiple sclerosis(Demyelinating disease).However it is not universal,ischemic lesions can also involve the same region. You need follow up and clinical correlation. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar