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Updated: Apr 15, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Identification of cortical lesions using DIR and FLAIR in early stages of multiple sclerosis
Pierre Kolber1, Swantje Montag, Vinzenz Fleischer
1Department of Neurology, Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
Abstract:
The use of non-routine MRI sequences such as DIR has highlighted the role of gray matter (GM) pathology in multiple sclerosis (MS). The aim of this study was to assess the detection and relevance of cortical lesions (CLs) using MRI in early (<5 years) MS patients. 3D DIR and 3D FLAIR images at 3T from 122 patients [93 relapsing-remitting MS (RRMS), 29 clinically isolated syndrome (CIS)] were scored for CLs by two blinded readers. Patients were divided into two groups depending on the presence or absence of CLs. For FLAIR, 51 CLs were identified, of which 13 were purely intracortical and 38 mixed CLs; for DIR, this was 60 in total and 16 and 44, respectively. In both groups, there was no difference in GM fraction. Neuropsychological testing was performed for a subgroup of 66 patients. In 22.1 % of patients CLs were identified. The number of CLs revealed an association with lower working memory scores and semantical word fluency. Overall, CLs imaged with 3D FLAIR and 3D DIR sequences are found more frequently in RRMS patients than CIS and may also be a correlate for mild neuropsychological pathology.
Insights
Cortical lesions (CLs) are detectable in early multiple sclerosis (MS) using advanced MRI. These CLs correlate with reduced working memory and verbal fluency in MS patients.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Gray matter (GM) pathology plays a role in multiple sclerosis (MS).
- Non-routine MRI sequences like Double Inversion Recovery (DIR) aid in detecting GM pathology.
- Cortical lesions (CLs) are a key feature of MS pathology.
Purpose of the Study:
- To assess the detection and relevance of cortical lesions (CLs) using MRI in early MS patients.
- To evaluate the association between CLs and neuropsychological deficits.
Main Methods:
- 122 early MS patients (CIS and RRMS) underwent 3T MRI using 3D DIR and 3D FLAIR sequences.
- Two blinded readers scored images for CLs.
- Neuropsychological testing was performed on a subgroup of 66 patients.
Main Results:
- Cortical lesions (CLs) were identified in 22.1% of patients.
- DIR and FLAIR sequences detected 60 and 51 CLs, respectively.
- The number of CLs correlated with lower working memory and semantic verbal fluency scores.
Conclusions:
- 3D FLAIR and 3D DIR sequences effectively image CLs in early MS.
- CLs are more frequent in relapsing-remitting MS (RRMS) than clinically isolated syndrome (CIS).
- CLs may indicate mild neuropsychological impairment in MS.
