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Imaging evaluation of demyelinating processes of the central nervous system
  1. Alice Boyd Smith1,2,
  2. James G Smirniotopoulos1,2
  1. 1Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington DC, USA
  2. 2Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Science, Bethesda, Maryland, USA
  1. Correspondence to Dr Alice Boyd Smith, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA; alsmith{at}


Demyelinating processes involving the central nervous system have a variety of aetiologies and can be separated into primary and secondary demyelinating processes. The classic example of primary demyelination is multiple sclerosis. Secondary demyelination, where the aetiology is known, includes infectious, metabolic and toxic disease processes. The underlying component of all demyelinating disorders is damage to the myelin sheath and/or the oligodendrocyte, the cell forming the myelin sheath. These processes often have similar imaging findings, making knowledge of the patient's history, physical examination and laboratory evaluation imperative for developing a differential diagnosis. This pictorial essay provides a review of the imaging of these diverse disorders.

  • Multiple sclerosis
  • demyelination
  • acute disseminated encephalomyelitis
  • progressive multifocal leucoencephalopathy
  • infectious disease/HIV
  • neuropathology
  • neuroradiology
  • paediatric radiology

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  • The opinions or assertions contained herein are the private views of the authors and are not to be construed as official nor as reflecting the views of the Departments of the United States Air Force, Army, Navy or Defense.

  • Adapted from Polman et al.10

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

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