Use MRI Black Holes and Spinal Cord Lesions in Multiple Sclerosis to guide the working diagnosis and next step; let the main risk or management issue drive escalation, treatment choice, and follow-up.

On a non-contrast T1 scan, you might spot dark focal areas known as black holes.; When a brand-new, active lesion develops, the gadolinium contrast enhancement typically remains visible for a window of about two to six weeks.; These correspond to previous hyperintense lesions seen on T2, but on T1, they signify permanent, irreversible axonal loss.; They are remarkably common, showing up in up to 75% of individuals, with the vast majority of these plaques concentrated in the cervical spinal cord region.; No, there is a well-known mismatch here.