The dilemma of bright spots detected on magnetic resonance imaging of the brain for the diagnosis of multiple sclerosis: A retrospective evaluation of nonspecific white matter lesions

Objective: With advances in magnetic resonance imaging (MRI) technology, nonspecific white matter lesions (NSWMH) are often incidentally detected on T2-weighted images. The origin of these lesions is unknown. In younger individuals, these findings may prompt consideration of multiple sclerosis (MS) as a possible diagnosis. In the presence of these lesions, the misinterpretation of radiological diagnostic criteria can lead to the overdiagnosis of MS. This study aims to address the management of patients with NSWMH. Method: This retrospective study involved patients referred to our MS outpatient clinic, suspected of having MS following the detection of T2-hyperintense lesions, who were subsequently diagnosed with NSWMH between 2017 and 2021. We collected data on patients' medical complaints, neurological examinations, brain MRI findings, and results from additional investigations from our hospital's data system. Results: The study included 70 patients (87.1% female), with an average age of 40.87 +/- 8.13 years (range, 19 to 55 years). The average follow-up period was 22.1 +/- 16.5 months. MRI analysis showed the number and location of lesions to be subcortical (12.06 +/- 14.01), cortical/juxtacortical (1.2 +/- 2.2), periventricular (0.91 +/- 1.42), in the corpus callosum (0.38 +/- 0.23), and in the posterior fossa (0.05 +/- 0.07). Lesions were bilaterally located in 63% of cases. Only two patients developed new lesions, as observed in the first follow-up MRI, with no further changes in subsequent MRIs during the long-term follow-up. Conclusion: Neurologists need to distinguish between NSWMH and MS lesions. Ultimately, MRI serves as a supportive diagnostic tool, with clinical findings taking precedence over all other diagnostic methods.