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Updated: Jun 29, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Spinal cord grey matter lesions in multiple sclerosis detected by post-mortem high field MR imaging
C P Gilmore1, J J G Geurts, N Evangelou
1Department of Neurology, Queens Medical Centre NHS Trust, Nottingham, UK. chris.gilmore@nottingham.ac.uk
Background:
Post-mortem studies demonstrate extensive grey matter demyelination in MS, both in the brain and in the spinal cord. However the clinical significance of these plaques is unclear, largely because they are grossly underestimated by MR imaging at conventional field strengths. Indeed post-mortem MR studies suggest the great majority of lesions in the cerebral cortex go undetected, even when performed at high field. Similar studies have not been performed using post-mortem spinal cord material.
Aim:
To assess the sensitivity of high field post-mortem MRI for detecting grey matter lesions in the spinal cord in MS.
Methods:
Autopsy material was obtained from 11 MS cases and 2 controls. Proton Density-weighted images of this formalin-fixed material were acquired at 4.7 Tesla before the tissue was sectioned and stained for Myelin Basic Protein. Both the tissue sections and the MR images were scored for grey matter and white matter plaques, with the readers of the MR images being blinded to the histopathology results.
Results:
Our results indicate that post-mortem imaging at 4.7 Tesla is highly sensitive for cord lesions, detecting 87% of white matter lesions and 73% of grey matter lesions. The MR changes were highly specific for demyelination, with all lesions scored on MRI corresponding to areas of demyelination.
Conclusion:
Our work suggests that spinal cord grey matter lesions may be detected on MRI more readily than GM lesions in the brain, making the cord a promising site to study the functional consequences of grey matter demyelination in MS.
Insights
High-field post-mortem MRI effectively detects spinal cord grey matter lesions in multiple sclerosis (MS). This imaging technique shows promise for studying MS-related grey matter demyelination and its functional impact.
Area of Science:
- Neuroimaging
- Neuropathology
- Multiple Sclerosis Research
Background:
- Grey matter demyelination is extensive in multiple sclerosis (MS) but often underestimated by conventional MRI.
- Previous studies focused on brain lesions, leaving spinal cord grey matter lesions under-investigated.
- Post-mortem MRI at high field strengths may improve lesion detection.
Purpose of the Study:
- To evaluate the sensitivity of high-field post-mortem magnetic resonance imaging (MRI) for identifying grey matter lesions in the spinal cords of MS patients.
- To compare the detection rates of grey matter versus white matter lesions in the spinal cord.
Main Methods:
- Autopsy-derived spinal cord tissue from 11 MS cases and 2 controls was analyzed.
- Proton Density-weighted MRI was performed at 4.7 Tesla on formalin-fixed tissue.
- Histopathological staining for Myelin Basic Protein was used for comparison, with blinded readers assessing both MRI and tissue sections for lesions.
Main Results:
- Post-mortem MRI at 4.7 Tesla demonstrated high sensitivity for spinal cord lesions, detecting 87% of white matter and 73% of grey matter lesions.
- The observed MRI changes were highly specific for demyelination.
- All lesions identified on MRI correlated with histopathologically confirmed areas of demyelination.
Conclusions:
- High-field post-mortem MRI is a sensitive tool for detecting spinal cord grey matter lesions in MS.
- Spinal cord grey matter lesions may be more readily detectable via MRI than those in the brain.
- The spinal cord presents a promising site for investigating the functional effects of grey matter demyelination in MS.
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