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Updated: Jul 15, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Histopathology and serial, multimodal magnetic resonance imaging in a multiple sclerosis variant
S Lindquist1, N Bodammer, J Kaufmann
1Department of Neurology , Otto-von-Guericke University, 39120 Magdeburg, Germany. sabine.lindquist@medizin.uni-magdeburg.de
Abstract:
Defining tools in magnetic resonance imaging (MRI) representing specific pathological processes is needed to understand the complex relationship between inflammation, myelin breakdown, axonal injury and clinical symptoms in multiple sclerosis (MS) and its variants. Here, we describe a case of histologically-defined MS, in which the radiological appearance of the lesion and clinical course support the diagnosis of Balo's concentric sclerosis. Serial magnetization transfer, diffusion tensor imaging and 1H-magnetic resonance spectroscopy, from 14 days to 13 months after biopsy, allow the contextual interpretation of specific pathological changes. In our case, acute inflammation was sensitively traced by fractional anisotropy and increased lactate in spectroscopy. In contrast, magnetization transfer ratio and the apparent diffusion coefficient monitor the sequential loss of tissue in selected rings of the lesion. The delay from the peak of symptoms in a dramatic clinical course to the maximum tissue destruction indicated through MRI suggests that compromise of axonal function may be decisive for the acute clinical situation. This is the first report comparing 1H-magnetic resonance spectroscopy, magnetization transfer and diffusion tensor imaging with histopathology in a patient with Balo's concentric sclerosis.
Insights
This study details a rare case of Balo's concentric sclerosis, a variant of multiple sclerosis (MS). Advanced MRI techniques correlated with histopathology to reveal inflammation and tissue damage in MS lesions.
Area of Science:
- Neuroimaging
- Neuropathology
- Multiple Sclerosis Research
Background:
- Understanding the pathological basis of multiple sclerosis (MS) requires advanced imaging tools to correlate inflammation, myelin breakdown, and axonal injury with clinical symptoms.
- Balo's concentric sclerosis (BCS) is a rare variant of MS characterized by concentric rings of demyelination and relative preservation of myelin.
Observation:
- This study presents a case of histologically-confirmed MS with radiological and clinical features suggestive of BCS.
- Serial advanced magnetic resonance imaging (MRI) techniques, including magnetization transfer (MT), diffusion tensor imaging (DTI), and 1H-magnetic resonance spectroscopy (1H-MRS), were employed over 14 days to 13 months post-biopsy.
- The imaging data allowed for the interpretation of specific pathological changes within the BCS lesion.
Findings:
- Acute inflammation in the BCS lesion was detected using fractional anisotropy (FA) from DTI and increased lactate levels via 1H-MRS.
- The sequential loss of tissue in concentric rings of the lesion was monitored by magnetization transfer ratio (MTR) and apparent diffusion coefficient (ADC).
- A temporal delay between peak clinical symptoms and maximum MRI-detected tissue destruction suggests axonal function compromise is critical in the acute phase of BCS.
Implications:
- This is the first study to integrate 1H-MRS, MT, and DTI with histopathology in a patient with BCS.
- The findings highlight the utility of advanced MRI techniques in characterizing the complex pathological processes underlying MS variants.
- Correlating imaging biomarkers with histopathology provides crucial insights into the relationship between tissue damage and clinical presentation in MS.
