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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Clinically benign multiple sclerosis despite large T2 lesion load: can we explain this paradox?
S Strasser-Fuchs1, C Enzinger, S Ropele
1Department of Neurology, Division of Neuroradiology, Medical University, Graz, Austria.
Multiple Sclerosis (Houndmills, Basingstoke, England)
|November 8, 2007
Summary
Clinically benign multiple sclerosis (MS) patients with significant brain lesions show preserved function, but advanced MRI and spectroscopy did not reveal underlying structural or metabolic differences compared to progressive MS. Functional compensation likely involves brain plasticity.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Conventional MRI in multiple sclerosis (MS) can underestimate disability.
- Quantitative MRI and magnetic resonance spectroscopy (MRS) may detect subtle tissue damage.
- The study investigates if non-conventional MRI/MRS metrics explain preserved function despite high lesion load in benign MS (BMS).
Purpose of the Study:
- To test the hypothesis that quantitative MRI and MRS metrics indicate less brain abnormality in clinically benign MS (BMS) patients with large T2 lesion load, explaining their preserved function.
- To compare advanced imaging metrics between BMS and secondary progressive MS (SPMS) patients.
Main Methods:
- Quantitative MRI (magnetization transfer imaging) and proton MRS were performed on 13 BMS and 15 SPMS patients.
- Metrics included magnetization transfer ratio (MTR), magnetization transfer rate (kfor), brain parenchymal fraction (BPF), and brain metabolite concentrations.
- Patients were matched for disease duration, and disability was assessed using the expanded disability status score (EDSS).
Main Results:
- BMS patients had significantly lower EDSS scores than SPMS patients (2.1 vs. 6.2).
- BMS patients had a comparable, even slightly higher, T2 lesion load than SPMS patients (41.2 cm³ vs. 27.9 cm³).
- No significant differences were found in MTR, kfor, BPF, or key brain metabolite levels (N-acetyl-aspartate, choline, myoinositol) between BMS and SPMS groups.
Conclusions:
- Advanced quantitative MRI and MRS metrics did not explain the preserved clinical function in BMS patients with substantial T2 lesion load.
- The findings suggest that mechanisms other than preserved brain morphologic or metabolic integrity, such as brain plasticity, underlie functional compensation in benign MS.
