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Updated: Jun 3, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
The relationship between normal cerebral perfusion patterns and white matter lesion distribution in 1,249 patients
Christopher M Holland1, Arnaud Charil, Istvan Csapo
1Center for Neurological Imaging and Partners MS Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Background And Purpose:
The pathological differences underlying the clinical disease phases in multiple sclerosis (MS) are poorly characterized. We sought to explore the relationship between the distribution of white matter (WM) lesions in relapsing-remitting (RR) and secondary progressive (SP) MS and the normal regional variability of cerebral perfusion.
Methods:
WM lesions were identified and quantified on a single magnetic resonance imaging scan from 1,249 patients with MS. The spatial distribution of lesions was compared between early RR, late RR, and SP MS in the context of normal cerebral perfusion patterns provided by a single-photon emission-computed tomography atlas of healthy individuals.
Results:
Patients with SP MS had more distinct and larger lesions than patients with RR MS. Across all subjects, lesions were present in regions of relatively lower normal perfusion than normal appearing WM. Further, lesions in SP MS were more common in areas of lower perfusion as compared to the lesion distribution in early and late RR MS.
Conclusion:
Chronic plaques were more prevalent in WM regions with lower relative perfusion. Lesions in more highly perfused regions were more commonly observed in early RR MS and therefore, may be more likely to successfully remyelinate and resolve.
Insights
In multiple sclerosis (MS), chronic plaques in white matter (WM) are linked to lower cerebral perfusion. Lesions in highly perfused areas may resolve, suggesting a potential for remyelination in early relapsing-remitting MS.
Area of Science:
- Neuroimmunology
- Neuroimaging
- Neurology
Background:
- Pathological differences between multiple sclerosis (MS) clinical phases are not well understood.
- Investigating white matter (WM) lesion distribution in relation to cerebral perfusion is crucial.
Purpose of the Study:
- To explore the link between WM lesion distribution in relapsing-remitting (RR) and secondary progressive (SP) MS.
- To compare lesion patterns with normal regional cerebral perfusion variability.
Main Methods:
- Magnetic resonance imaging (MRI) used to identify and quantify WM lesions in 1,249 MS patients.
- Spatial distribution of lesions compared across early RR, late RR, and SP MS subtypes.
- Comparison performed against a single-photon emission-computed tomography (SPECT) atlas of healthy individuals' perfusion patterns.
Main Results:
- SP MS patients exhibited larger and more distinct WM lesions than RR MS patients.
- WM lesions were predominantly found in areas of lower relative perfusion compared to normal-appearing WM.
- Lesions in SP MS were more frequently located in low-perfusion zones than in early or late RR MS.
Conclusions:
- Chronic MS plaques are more common in WM regions with reduced relative perfusion.
- Lesions in higher-perfusion areas were more frequent in early RR MS, suggesting a greater potential for remyelination and resolution.
