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Updated: Jun 22, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
T2 hypointensity in the deep gray matter of patients with benign multiple sclerosis
A Ceccarelli1, M Filippi, M Neema
1Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, Milan, Italy.
Background:
Gray matter (GM) magnetic resonance imaging (MRI) T2 hypointensity, a putative marker of iron deposition, commonly occurs in multiple sclerosis (MS). However, GM T2 hypointensity in benign MS (BMS) has not yet been characterized.
Objective:
To determine the presence of deep GM T2 hypointensity in BMS, compare it to secondary progressive (SP) MS and assess its association with clinical and diffusion tensor (DT) MRI measures.
Methods:
Thirty-five cognitively unimpaired BMS, 26 SPMS patients, and 25 healthy controls were analyzed for normalized T2-intensity in the basal ganglia and thalamus, global T2 hyperintense lesion volume, global atrophy, and white matter and GM DT metrics.
Results:
BMS and SPMS patients showed deep GM T2 hypointensity compared with controls. T2 hypointensity was similar in both MS subgroups and moderately correlated (r = -0.45 to 0.42) with DT MRI metrics. GM T2 hypointensity in BMS showed a weak to moderate correlation (r = -0.44 to -0.35) with disability.
Conclusions:
GM in BMS is not spared from structural change including iron deposition. However, while T2 hypointensity is related to global tissue disruption reflected in DT MRI, the expression of benign versus non-benign MS is likely related to other factors.
Insights
Gray matter (GM) in benign multiple sclerosis (MS) shows iron deposition, similar to secondary progressive MS. This finding suggests structural changes occur even in milder forms of MS, though other factors likely determine disease progression.
Area of Science:
- Neuroimaging
- Neurology
- Biomarkers
Background:
- Gray matter (GM) T2 hypointensity on MRI is a marker for iron deposition in multiple sclerosis (MS).
- This phenomenon has not been previously characterized in benign MS (BMS).
Purpose of the Study:
- To investigate deep GM T2 hypointensity in BMS.
- To compare BMS with secondary progressive MS (SPMS) and healthy controls.
- To assess the relationship between GM T2 hypointensity and clinical/diffusion tensor (DT) MRI measures.
Main Methods:
- Analysis of normalized T2-intensity in basal ganglia and thalamus.
- Quantification of T2 hyperintense lesion volume, atrophy, and DT metrics in white matter and GM.
- Inclusion of 35 BMS, 26 SPMS patients, and 25 healthy controls.
Main Results:
- Both BMS and SPMS groups exhibited deep GM T2 hypointensity compared to controls.
- T2 hypointensity levels were comparable between BMS and SPMS.
- Moderate correlations were observed between GM T2 hypointensity and DT MRI metrics (r = -0.45 to 0.42).
- Weak to moderate correlations found between GM T2 hypointensity in BMS and patient disability (r = -0.44 to -0.35).
Conclusions:
- Benign MS gray matter is affected by structural changes, including iron deposition.
- While T2 hypointensity correlates with tissue disruption, it may not solely determine the benign versus non-benign MS phenotype.
- Other factors likely influence the clinical expression and progression of MS.
