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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Gray matter pathology in (chronic) MS: modern views on an early observation
Jeroen J G Geurts1, Peter K Stys, A Minagar
1Dept. of Pathology, VU University Medical Center, Amsterdam, The Netherlands. j.geurts@vumc.nl
Abstract:
Involvement of the gray matter (GM) in the pathology of multiple sclerosis (MS) was already recognized in the early days of MS research, but the detection of (cortical) GM lesions under the microscope and with magnetic resonance imaging (MRI) techniques was initially suboptimal and could only recently be enhanced. The visualization of GM lesions in vivo opens new doors for studies focusing on clinical, especially cognitive, effects of GM pathology, as well as for monitoring of neuroprotective treatment. However, so far little is known about what causes GM pathology. In this review, several pathogenetic mechanisms will be discussed, affecting the MS brain both from the 'outside-in' and from the 'inside-out'. Also, the use and reliability of MRI atrophy measures as a monitoring tool for GM damage in the therapeutic setting will be reviewed.
Insights
Gray matter (GM) lesions in multiple sclerosis (MS) are increasingly detectable with advanced MRI. This review explores GM pathology mechanisms and MRI
Area of Science:
- Neurology
- Neuroimaging
- Pathology
Background:
- Gray matter (GM) involvement in multiple sclerosis (MS) is long recognized.
- Early detection of GM lesions was limited by suboptimal microscopy and magnetic resonance imaging (MRI) techniques.
- Recent advancements have significantly improved in vivo visualization of GM lesions.
Purpose of the Study:
- To review pathogenetic mechanisms underlying GM pathology in MS.
- To discuss the clinical implications of GM lesions, particularly cognitive effects.
- To evaluate MRI atrophy measures for monitoring GM damage in therapeutic settings.
Main Methods:
- Review of existing literature on MS pathology and neuroimaging.
- Discussion of 'outside-in' and 'inside-out' pathogenetic mechanisms.
- Analysis of the reliability of MRI atrophy measures for therapeutic monitoring.
Main Results:
- Improved MRI techniques enhance detection of cortical and deep GM lesions in MS.
- GM pathology is linked to cognitive deficits in MS patients.
- Understanding GM lesion pathogenesis is crucial for developing targeted therapies.
Conclusions:
- Enhanced visualization of GM lesions offers new avenues for clinical research and treatment monitoring in MS.
- Further research is needed to elucidate the precise causes of GM pathology in MS.
- MRI atrophy measures show potential for monitoring neuroprotective treatments targeting GM damage.
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