Which imaging feature is most indicative of Multiple Sclerosis on MRI?

The presence of white matter lesions on MRI is the most indicative feature of Multiple Sclerosis (MS). In MS, these lesions, often referred to as plaques, are typically found in the periventricular, juxtacortical, and infratentorial regions of the brain, as well as in the spinal cord. The lesions represent areas of demyelination caused by the autoimmune processes associated with the disease.

These white matter lesions can appear as hyperintense spots on T2-weighted MRI scans and are crucial for making a diagnosis of MS as they correlate with the pathology of demyelination and inflammation that characterize the disease. Other imaging findings, like atrophy of the brain and ventricular enlargement, can occur in MS but are more often seen in later stages of the disease or in advanced cases, and they are not as specific for the diagnosis compared to the presence of white matter lesions. Bone fractures are not associated with MS, making them irrelevant to the question.