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Updated: Jun 17, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Brain MRI findings in long-standing and disabling multiple sclerosis in 84 patients
Dimitri Renard1, Giovanni Castelnovo, Philippe-Jean Bousquet
1Department of Neurology, CHU Nîmes, Hôpital Caremeau, Place du Pr Debré, 30029 Nîmes Cedex 4, France.
Objective:
To look for cerebral white matter MRI changes in patients with long-standing and disabling MS.
Methods:
We analyzed retrospectively brain MRIs (performed 10 or more years after symptom onset) of patients with MS diagnosis and expanded disability status scale of 6 or more. The following parameters were analyzed: total number of brain T2 hyperintensities; number of brainstem, cerebellar, corpus callosum, basal ganglia, and juxtacortical T2 hyperintensities; diffuse leukoencephalopathy score; total number of T1 hypointensities.
Results:
Eighty-four patients were included. The mean time between symptom onset and MRI was 20.2 years. Eight percent had less than 9 cerebral T2 hyperintensities. Posterior fossa, juxtacortical, and corpus callosum T2 hyperintensities, and T1 hypointensities lacked in respectively 19%, 12%, 47%, and 8%. Overall, normal MRI was not seen, 6% had abnormal MRI but did not meet Barkhof's criteria, and the remaining 94% had MRI abnormalities fulfilling Barkhof's criteria. Moderate or severe diffuse leukoencephalopathy was seen in 69%. Extensive diffuse leukoencephalopathy predominant to nodular lesions was seen in 5%.
Conclusions:
Despite long-standing and disabling MS, typical MRI abnormalities lacked in a minority of patients, and 6% did not fulfil Barkhof's criteria. The majority showed moderate or severe diffuse leukoencephalopathy.
Insights
In long-standing multiple sclerosis (MS), most patients show diffuse white matter changes on MRI, though typical criteria are met by most, not all. Diffuse leukoencephalopathy is common in disabling MS.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Multiple Sclerosis (MS) is a chronic neurological disease characterized by demyelination and axonal damage.
- Long-standing and disabling MS often involves significant cerebral white matter changes.
- Standard MRI criteria (e.g., Barkhof's criteria) are used to diagnose MS and assess disease burden.
Purpose of the Study:
- To investigate the prevalence and characteristics of cerebral white matter MRI changes in patients with long-standing and disabling MS.
- To evaluate the extent to which these patients fulfill established MRI diagnostic criteria.
Main Methods:
- Retrospective analysis of brain MRIs from 84 patients with MS diagnosis and Expanded Disability Status Scale (EDSS) of 6 or more, performed at least 10 years post-symptom onset.
- Assessment of T2 hyperintensities (total, regional), T1 hypointensities, diffuse leukoencephalopathy score, and adherence to Barkhof's criteria.
Main Results:
- The mean time from symptom onset to MRI was 20.2 years.
- 94% of patients met Barkhof's criteria for MS MRI abnormalities; 6% did not.
- Moderate or severe diffuse leukoencephalopathy was observed in 69% of patients, with 5% showing extensive nodular lesions.
Conclusions:
- Even in long-standing, disabling MS, a small proportion of patients may not meet typical MRI criteria.
- The majority of patients with severe MS exhibit significant diffuse white matter changes, particularly diffuse leukoencephalopathy, on MRI.
Related Concept Videos
01:19Multiple Sclerosis l: Introduction
01:24Magnetic Resonance Imaging