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Table 2: MR imaging characteristics and temporal evolution of new lesions in MELAS
Sequence Intensity No. of Lesions: Deep No. of Lesions: Cortical
Acute (first week) Total: 5 Total: 36
 T1 (spin-echo) ↓ 0 24
 T2 (spin-echo) ↑ 5 36
T2 sparing of superficial cortex 23
 T2 FLAIR ↑ 5 36
 DWI (b = 1000) ↑ 0 34
 ADC ↓ 0 30
 SWI ↓ 0 0
Subacute (second-to-fourth weeks) 
 Prior low ADC 0 30
  Follow-up imaging available 0 29
  T1 ↑ 12
  T2: black toenail sign ↓ 21
  SWI ↓ 7
 Prior normal/high ADC 5 6
  Follow-up imaging available 5 6
  T1 ↑ 0 0
  T2: black toenail ↓ 0 0
  SWI ↓ 0 0
Chronic (>3 mo) 
 Prior low ADC 0 30
  Follow-up imaging available 0 19
  Volume loss 19
 Prior normal/high ADC 5 6
  Follow-up imaging available 4 4
  Volume loss 2 0
 ¹H-MRS performed Doublet at 1.3 ppm 5 Patients 
  Long TE (288 ms) Elevated 5 Patients 
  Intermediate TE (144 ms) Inverted 5 Patients 
  Affected white matter 5 Patients 
  Nonaffected white matter 3 Patients 
Note:—↓ indicates hypointense signal; ↑, hyperintense signal.