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Memory dysfunction in multiple sclerosis corresponds to juxtacortical lesion load on fast fluid-attenuated
D M Moriarty1, A J Blackshaw, P R Talbot
1Division of Imaging Science and Biomedical Engineering, University of Manchester, UK.
Background And Purpose:
MR imaging is a sensitive diagnostic tool and paraclinical marker of disease activity and prognosis in multiple sclerosis (MS), yet the role of MR imaging of MS is controversial. The aim of this study was to describe the relationship between cognitive function and MS lesion size and position, as shown on comparative images from conventional spin-echo (CSE) and fast fluid-attenuated inversion-recovery (fast FLAIR) MR studies.
Methods:
CSE and fast FLAIR sequences consisted of 40 noncontiguous, 3-mm-thick axial sections matched for geometric position in 18 patients with relapsing-remitting MS. Lesions were scored for size, anatomic position, and their comparative appearance on CSE and fast FLAIR images. The neuropsychological assessment tested general psychological performance, memory, and frontal lobe executive function.
Results:
Fast FLAIR images showed significantly more small (146 versus six) and medium-sized (18 versus four) juxtacortical lesions than did CSE sequences. Small juxtacortical lesions displayed only on fast FLAIR images had a distinctive appearance, suggestive of small areas of perivascular inflammation. The number of these lesions corresponded to reduced performance on the fifth and delayed trials of the Rey Auditory Verbal Learning memory function test.
Conclusion:
Fast FLAIR images show small lesions at the juxtacortical boundary that are not seen on CSE studies. The presence of such lesions correlates with impaired retention of information in memory tasks, which is characteristic of cognitive problems in patients with MS.
Insights
Fast fluid-attenuated inversion-recovery (fast FLAIR) MRI detects more small lesions in multiple sclerosis (MS) patients. These juxtacortical lesions correlate with memory impairment, offering insights into MS cognitive dysfunction.
Area of Science:
- Neuroimaging
- Neurology
- Cognitive Science
Background:
- Multiple sclerosis (MS) diagnosis and prognosis rely on MR imaging, though its role remains debated.
- Conventional spin-echo (CSE) and fast fluid-attenuated inversion-recovery (fast FLAIR) MR techniques offer different views of MS lesions.
Purpose of the Study:
- To investigate the relationship between cognitive function and the size/location of MS lesions.
- To compare lesion detection between CSE and fast FLAIR MR imaging.
Main Methods:
- 18 patients with relapsing-remitting MS underwent matched CSE and fast FLAIR MRI scans.
- Lesions were assessed for size, location, and appearance on both imaging types.
- Neuropsychological tests evaluated general performance, memory, and executive function.
Main Results:
- Fast FLAIR identified significantly more small and medium juxtacortical lesions than CSE (146 vs. 6 small; 18 vs. 4 medium).
- Distinctive small juxtacortical lesions seen only on fast FLAIR suggest perivascular inflammation.
- The number of these fast FLAIR-specific lesions correlated with poorer performance on memory tests.
Conclusions:
- Fast FLAIR MRI reveals subtle juxtacortical lesions missed by CSE in MS.
- These newly detected lesions are associated with memory deficits, highlighting their clinical relevance in MS cognitive impairment.