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Updated: Jul 2, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Evidence for relative cortical sparing in benign multiple sclerosis: a longitudinal magnetic resonance imaging study
M Calabrese1, M Filippi, M Rovaris
1The Multiple Sclerosis Centre of Veneto Region - First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy.
Background:
Using double inversion recovery (DIR) MRI, cortical lesions can be seen in the brain of patients with multiple sclerosis (MS). The burden of such lesions seems to be well correlated with the severity of MS-related disability.
Objective:
To investigate whether the extent of cortical damage in patients with benign MS (BMS) might contribute to explain their favorable clinical status.
Methods:
Forty-eight patients with BMS (Expanded Disability Status Scale [EDSS] score < or =3.0 and disease duration > or =15 years) and 96 patients with non-disabling, early relapsing-remitting (RR) MS (EDSS score < or =3.0 and disease duration < or =5 years) were studied. Brain MRI, including a DIR and a fluid-attenuated inversion recovery (FLAIR) sequence, was acquired at baseline and after 12 months. On DIR images, intracortical (ICL) and cortical-subcortical lesions (CSL) were identified and their number and volume calculated. Total white matter (WM) lesion volume was quantified on FLAIR images.
Results:
Compared with early RRMS, patients with BMS had lower number of ICL at both study time points (P < or = 0.001 for both comparisons). At one-year follow-up, a significant increase of ICL and CSL number and total volume was observed only in early patients with RRMS. The number and volume of cortical lesions was not correlated with WM lesion volume. Total ICL number at baseline, total cortical lesion volume at baseline, and total cortical lesion volume change were independent predictors of MS phenotype.
Conclusion:
In patients with BMS, the selective sparing of the cortex from disease-related focal pathology might be one of the factors associated to their favorable clinical status, independently of the (possible) accrual of WM lesions.
Insights
Patients with benign multiple sclerosis (MS) show fewer cortical lesions, contributing to their favorable clinical status. This sparing of the brain cortex is independent of white matter lesion accumulation.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Cortical lesions visualized by double inversion recovery (DIR) MRI in multiple sclerosis (MS) correlate with disability.
- Understanding the extent of cortical damage in benign MS (BMS) may explain favorable clinical outcomes.
Purpose of the Study:
- To investigate if cortical damage extent explains the favorable clinical status in benign MS (BMS).
Main Methods:
- Compared 48 BMS patients (EDSS ≤3.0, disease duration >15 years) with 96 early relapsing-remitting MS (RRMS) patients (EDSS ≤3.0, disease duration ≤5 years).
- Acquired brain MRI (DIR and FLAIR sequences) at baseline and 12 months.
- Quantified intracortical lesions (ICL), cortical-subcortical lesions (CSL), and white matter (WM) lesion volume.
Main Results:
- BMS patients had significantly fewer ICL compared to early RRMS patients at both time points.
- ICL and CSL volume increased over one year only in early RRMS patients.
- Cortical lesion burden did not correlate with WM lesion volume; ICL and CSL volume were independent predictors of MS phenotype.
Conclusions:
- Selective sparing of the cortex from focal pathology in BMS patients may contribute to their favorable clinical status.
- This cortical sparing is independent of white matter lesion accrual.
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01:19Multiple Sclerosis l: Introduction
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