Dot-Dash sign

Which of the following condition is associated with ‘Dot-Dash sign’?

A. Motor Neuron Disease

B. Multiple sclerosis

C. Alzheimer’s disease

D. Spinal Muscular Atrophy

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Which is the primary technique for identifying white matter lesions caused by multiple sclerosis?

A. CT Scan

B. PET-CT

C. Cerebral Angiography

D. MR imaging

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‘Dot-Dash’ sign

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MR imaging finding that is also highly sensitive for multiple sclerosis—an ependymal irregularity -“Dot-Dash” sign.

This sign appears to suggest a diagnosis of multiple sclerosis at an earlier stage

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‘Dot-Dash’ sign correlates with ependymal perivenular inflammation-an early histopathological event in multiple sclerosis-which is a more sensitive biomarker for the early diagnosis of multiple sclerosis via MRI technology.

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‘Dot-Dash’ sign

Look at the – High signal along the ependymal surface

Case courtesy of Frank Gaillard, Radiopaedia.org. From the case rID: 9941

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1. Dot-Dash’ sign is best seen on sagittal FLAIR
2. Seen along the inferior surface of the corpus callosum and roof of the lateral ventricle bodies.
3. It is seen as tiny (~1 mm) dots of high signal along the ependymal surface that may coalesce into short dash.

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Clinical significance –

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Dot-Dash’ sign – distinguish multiple sclerosis from neuromyelitis optica which less frequently demonstrate this sign.

Presence of Dot-Dash’ sign suggest – Multiple sclerosis

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Most sensitive single finding for multiple sclerosis in the MR imaging-

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Subcallosal striations

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What is the histopathologic basis of the Dot-Dash sign presence in early multiple sclerosis?

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Early multiple sclerosis lesions start around the subependymal venous wall

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