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Updated: Aug 7, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Significance of T2 lesions in multiple sclerosis: A 13-year longitudinal study
Richard A Rudick1, Jar-Chi Lee, Jack Simon
1Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland, OH, USA. rudickr@ccf.org
Objective:
To evaluate the relation between T2 lesions and disease severity in relapsing-remitting multiple sclerosis (MS).
Methods:
This article describes a 13-year longitudinal study in 30 patients.
Results:
Patients were 36.3 +/- 6.0 years old, had MS for 6.1 +/- 5.8 years, Expanded Disability Status Scale was 2.2 +/- 0.8, and brain parenchymal fraction (BPF) was 0.825 +/- 0.015 at study entry. At last visit, Expanded Disability Status Scale was 4.4 +/- 1.95, Multiple Sclerosis Functional Composite was -0.34 +/- 1.7, and BPF was 0.774 +/- 0.037. Baseline T2 lesion volume correlated with the BPF of the last visit (r = -0.66; p < 0.0001), magnetization transfer ratio (MTR) in normal-appearing brain tissue (r = -0.52; p = 0.004), and lesion MTR (r = -0.76; p < 0.0001). Change in T2 lesion volume in the first 2 years correlated with BPF of the last visit (r = -0.40; p = 0.03), normal-appearing brain tissue MTR (r = -0.44; p = 0.015), lesion MTR (r = -0.46; p = 0.018), Multiple Sclerosis Functional Composite scores (r = -0.50; p = 0.005), and Paced Auditory Serial Addition Task scores (r = -0.52; p = 0.003). Age was a significant covariate for clinical but not magnetic resonance imaging outcomes.
Interpretation:
T2 lesions in relapsing-remitting MS correlate strongly with brain tissue loss and brain tissue integrity 13 years later, and with clinical disease severity, though age significantly impacts the clinical correlation. The results provide direct evidence for the disability threshold hypothesis in MS and support monitoring T2 lesions in relapsing-remitting MS.
Insights
In relapsing-remitting multiple sclerosis (MS), T2 lesions strongly predict long-term brain tissue loss and clinical severity. Monitoring these lesions is crucial for understanding disease progression and patient outcomes.
Area of Science:
- Neuroscience
- Radiology
- Clinical Neurology
Background:
- Relapsing-remitting multiple sclerosis (MS) is characterized by inflammatory lesions in the brain.
- The relationship between early T2 lesion burden and long-term disease progression remains an area of active investigation.
Purpose of the Study:
- To investigate the longitudinal correlation between T2 lesion volume and subsequent brain tissue loss and clinical disability in patients with relapsing-remitting MS.
Main Methods:
- A 13-year longitudinal study involving 30 patients with relapsing-remitting MS.
- Assessment of T2 lesion volume, brain parenchymal fraction (BPF), magnetization transfer ratio (MTR), and clinical scores including Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC).
Main Results:
- Baseline T2 lesion volume significantly correlated with later BPF (r = -0.66) and MTR (r = -0.52 to -0.76).
- Changes in T2 lesion volume within the first two years predicted later BPF, MTR, MSFC, and Paced Auditory Serial Addition Task scores.
- Age was a significant factor in clinical outcomes but not in MRI-derived measures.
Conclusions:
- T2 lesions in early relapsing-remitting MS are strong predictors of long-term brain tissue integrity and clinical disease severity.
- Findings support the disability threshold hypothesis in MS and underscore the importance of monitoring T2 lesions for disease management.
