Distribution of multiple sclerosis lesions detected by brain magnetic resonance imaging in Erbil city

  • Dina Nasih Tawfeeq Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
  • Shawnam Nasih Dawood Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
Keywords: Multiple Sclerosis, Magnetic Resonance Imaging, Distribution, Lesion


Background and objective: Many epidemiological studies and clinical manifestation studies of multiple sclerosis have been done in Iraq. Up to our knowledge, no such observational study to the radiological feature of the multiple sclerosis lesion has been done yet in Erbil in comparison to other worldwide studies. This study aimed to assess the distribution of multiple sclerosis lesions in brain regions detected by magnetic resonance imaging among Erbil population.

Methods: This was a cross-sectional study conducted at the College of Medicine, Hawler Medical University, from April 2018 to July 2019. A review of magnetic resonance imaging scans of the brain of 120 patients was done. Special attention was directed toward identifying the variance in multiple sclerosis lesions distribution in the brain regions and their MR signal intensity characteristics.

Results: Periventricular lesions were observed in more than 90% of the study sample. The next common was juxtacortical lesions (24.8%), followed by corpus callosum lesions (16.8 %), while brain stem lesions were the least observed proportions. No significant difference was detected in the distribution of multiple sclerosis lesions among ethnicities and genders, except for basal ganglia lesions, which were significantly more common in women (P = 0.016).The magnetic resonance imaging signal intensity of the lesion was significantly variable among disease duration.

Conclusion: The T2 hyper intense lesions were most commonly seen in the periventricular region. Juxtacortical and corpus callosum lesions were also frequently observed. The proportions of the brain stem and cerebellum lesions appeared to be lower in comparison to previous studies.


Sarbu N, Shih RY, Jones RV, Horkayne-Szakaly I, Oleaga L, Smirniotopoulos JG. White matter diseases with radiologic-pathologic correlation. Radiographics 2016; 36(5):1426–47.

Filippi M, Rocca MA. MR imaging of multiple sclerosis. Radiology 2011; 259(3):659–81.

Rovira À, Wattjes MP, Tintoré M, Tur C, Yousry TA, Sormani MP, et al. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis—clinical implementation in the diagnostic process. Nat Rev Neurol 2015; 11(8):471.

Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, Comi G, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2018; 17(2):162–73.

Khamseh F, Rahimian E, Ommi Z, Abolhasani E, ShariatPanahi M. Fatigue in multiple sclerosis: cross-sectional correlation with brain MRI findings. Iran J Neurol 2010; 9(29):745–50.

Dutta R, Trapp BD. Relapsing and progressive forms of multiple sclerosis–insights from pathology. Current opinion in neurology. 2014; 27(3):271.

Carroll WM. 2017 McDonald MS diagnostic criteria: Evidence-based revisions. Mult Scler J 2018; 24(2)92–5.

MoraalB, Wattjes MP, Geurts JJ, Knol DL, van Schijndel RA, Pouwels PJ, et al. Improved detection of active multiple sclerosis lesions: 3D subtraction imaging. Radiology 2010; 255(1):154–63.

Tardif CL, Bedell BJ, Eskildsen SF, Collins DL, Pike GB. Quantitative magnetic resonance imaging of cortical multiple sclerosis pathology. Mult Scler Int 2012; 2012:11.

Kira JI. Multiple sclerosis in the Japanese population. Lancet Neurol2003;2(2):117–27.

Mohammed EM. Multiple sclerosis is prominent in the Gulf States. Pathogenesis 2016; 3(2):19–38.

Al-Hamadani HA, Abdalla AS, Al-Saffar AJ. The course of early-onset multiple sclerosis in Iraqi children. World J Pediatr 2012; 8(1):47–51.

Hasan ZN, Hasan HA, Sabah AS. Clinical and radiological study of Iraqi multiple sclerosis patients with childhood onset. Neurosciences (Riyadh) 2011; 16(3):229–32.

Mohammed HA, Aboud HN, Hassan B. Multiple Sclerosis Clinic in Iraq, an Endeavourforan Unraveling Database. AJCEM 2018;6(3):69.

Falah Y, Al-Araji A. Multiple sclerosis in Iraq: History, epidemiology and the future. TOFIQ J Med Sci 2014; 1(1):62–8.

Tatekawa H, Sakamoto S, Hori M, Kaichi Y, Kunimatsu A, Akazawa K, et al. Imaging differences between neuromyelitisoptica spectrum disorders and multiple sclerosis: a multi-institutional study in Japan. AJRN 2018; 39(7):1239–47.

Brownlee WJ, Hardy TA, Fazekas F, Miller DH. Diagnosis of multiple sclerosis: progress and challenges. Lancet 2017; 389(10076):1336–46.

Altintas A, Petek B, Isik N, Terzi M, Bolukbasi F, Tavsanli M, et al. Clinical and radiological characteristics of tumefactive demyelinating lesions: follow-up study. Mult Scler J2012; 18(10):1448-53.

Sahraian MA, Radue EW, Haller S, Kappos L. Black holes in multiple sclerosis: definition, evolution, and clinical correlations. Acta Neurol Scand 2010; 122:1–8.

Stadelmann C, Wegner C, Brück W. Inflammation, demyelination, and degeneration—recent insights from MS pathology. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease 2011; 1812(2):275–82.

Charil A, Yousry TA, Rovaris M, Barkhof F, De Stefano N, Fazekas F, et al. MRI and the diagnosis of multiple sclerosis: expanding the concept of "no better explanation." Lancet Neurol 2006; 5(10):841–52.

World Health Organization. Atlas: multiple sclerosis resources in the world; 2008.

Turkey AM, Al-Fahid S, Al-Saffar K, Neurophthalmological manifestations in multiple sclerosis. Zanco J Med Sci 2010; 108(1):109–10.

Sahraian MA, Khorramnia S, Ebrahim MM, Moinfar Z, Lotfi J, Pakdaman H. Multiple sclerosis in Iran: a demographic study of 8,000 patients and changes over time. European Neurology 2010; 64(6):331–6.

Al-Araji A, Mohammed AI. Multiple sclerosis in Iraq: Does it have the same features encountered in Western countries? J Neurol Sci 2005; 234(1–2):67–71.

Alroughani R, Ahmed SF, Behbehani R, Khan R, Thussu A, Alexander KJ, et al. Increasing prevalence and incidence rates of multiple sclerosis in Kuwait. Mult Scler J 2014; 20(5):543–7.

Davoudi Y, Foroughipour M, Torabi R, Layegh P, Matin N, Shoeibi A. Diffusion weighted imaging in acute attacks of multiple sclerosis. Iran J Radiol 2016; 13(2).

El-Salem K, Al-Shimmery E, Horany K, Al-Refai A, Al-Hayk K, Khader Y. Multiple sclerosis in Jordan: a clinical and epidemiological study. J Neurol 2006; 253(9):1210–6.

Ghassemi R, Narayanan S, Banwell B, Sled JG, Shroff M, Arnold DL. Canadian Pediatric Demyelinating Disease Network. Quantitative determination of regional lesion volume and distribution in children and adults with relapsing-remitting multiple sclerosis. PLoS One 2014; 9(2):e85741.

Alroughani R, Al Hashel J, Lamdhade S, Ahmed SF. Predictors of conversion to multiple sclerosis in patients with clinical isolated syndrome using the 2010 revised McDonald criteria. ISRN Neurology 2012; 2012.

Yamout B, Alroughani R, Al-Jumah M, Khoury S, Abouzeid N, Dahdaleh M, et al. Consensus guidelines for the diagnosis and treatment of multiple sclerosis. Curr Med Res Opin 2013; 29(6):611–21.

Kira JI. Neuromyelitisoptica and opticospinal multiple sclerosis: mechanisms and pathogenesis. Pathophysiology 2011; 18(1):69–79.

Al-Hashel J, Besterman AD, Wolfson C. The prevalence of multiple sclerosis in the Middle East. Neuroepidemiology 2008; 31(2):129–37.

Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, et al. Harrison's principles of internal medicine. 17thed. New York: McGraw-Hill Medical Publishing Division; 2008. P. 2611–20.

Lo CP, Kao HW, Chen SY, Chu CM, Hsu CC, Chen YC, et al. Comparison of diffusion-weighted imaging and contrast-enhanced T1-weighted imaging on a single baseline MRI for demonstrating dissemination in time in multiple sclerosis. BMC Neurol 2014; 14(1):100.

Sahraian MA, Radue EW, Haller S, Kappos L. Black holes in multiple sclerosis: definition, evolution, and clinical correlations. Acta Neurol Scand 2010; 122(1):1–8.

Choi SR, Howell OW, Carassiti D, Magliozzi R, Gveric D, Muraro PA, et al. Meningeal inflammation plays a role in the pathology of primary progressive multiple sclerosis. Brain 2012; 135(10):2925–37.

Totaro R, Di Carmine C, Carolei A. Tumefactive demyelinating lesions in patients with relapsing remitting multiple sclerosis treated with Fingolimod. J Neurol Neurophysiol S 2014; 12:7–12.

Lucchinetti CF, Gavrilova RH, Metz I, Parisi JE, Scheithauer BW, Weigand S, et al. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain 2008; 131(7):1759–75.

De Stefano N, Giorgio A, Battaglini M, Rovaris M, Sormani MP, Barkhof F, et al. Assessing brain atrophy rates in a large population of untreated multiple sclerosis subtypes. Neurology 2010; 74(23):1868–76.

Burton EV. Optic Neuritis: Clinical Manifestations, Pathophysiology, and Management. In Minagar A., editor. Neuroinflammation Academic Press; 2018. P. 337–53.

Chatterjee S, Commowick O, Afacan O, Warfield SK, Barillot C. Identification of Gadolinium contrast enhanced regions in MS lesions using brain tissue microstructure information obtained from diffusion and T2 relaxometry MRI. 21st International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2018), Sep 2018, Grenade, Spain. P. 63–71.

How to Cite
Tawfeeq, D., & Dawood, S. (2021). Distribution of multiple sclerosis lesions detected by brain magnetic resonance imaging in Erbil city. Zanco Journal of Medical Sciences (Zanco J Med Sci), 25(1), 446-455. https://doi.org/10.15218/zjms.2021.006
Original Articles