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Updated: Apr 14, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Gadolinium-based MRI characterization of leptomeningeal inflammation in multiple sclerosis
Martina Absinta1, Luisa Vuolo1, Anuradha Rao1
1From the Translational Neuroradiology Unit (M.A., L.V., A.R., G.N., P.S., D.S.R.), Neuroimmunology Clinic (I.C.M.C., J.O., K.F.), and Flow Cytometry Core Facility (D.M.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Neuroimaging Research Unit (M.A.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Neurology and Radiology (L.V.), University of Florence, Italy; Department of Neurology (M.I.R.-M., P.A.C., C.A.P.), Johns Hopkins School of Medicine, Baltimore; and Diagnostic Radiology Department (J.A.B., D.S.R.), Clinical Center, NIH, Bethesda, MD.
Objective:
To determine the frequency and nature of leptomeningeal contrast enhancement in multiple sclerosis (MS) via in vivo 3-tesla postcontrast T2-weighted, fluid-attenuated inversion recovery (FLAIR) MRI and 7-tesla postmortem MRI-pathology correlation.
Methods:
Brain MRI, using the postcontrast T2-weighted, FLAIR technique, was prospectively collected in 299 MS cases and 37 age-matched neurologically healthy controls. Expert raters evaluated focal gadolinium enhancement in the leptomeningeal compartment. Two progressive MS cases came to autopsy after in vivo MRI characterization. Pathologic and immunohistochemical examination assessed the association of enhancement with leptomeningeal inflammation and adjacent cortical demyelination.
Results:
Focal contrast enhancement was detected in the leptomeningeal compartment in 74 of 299 MS cases (25%) vs 1 of 37 neurologically healthy controls (2.7%; p = 0.001). Enhancement was nearly twice as frequent (p = 0.009) in progressive MS (39/118 cases, 33%) as in relapsing-remitting MS (35/181, 19%). Enhancing foci generally remained stable throughout the evaluation period (up to 5.5 years). Pathology showed perivascular lymphocytic and mononuclear infiltration in the enhancing areas in association with flanking subpial cortical demyelination.
Conclusion:
Leptomeningeal contrast enhancement occurs frequently in MS and is a noninvasive, in vivo marker of inflammation and associated subpial demyelination. It might therefore enable testing of new treatments aimed at eliminating this inflammation and potentially arresting progressive MS.
Insights
Leptomeningeal contrast enhancement is common in multiple sclerosis (MS), indicating inflammation and cortical demyelination. This MRI finding may help test new treatments for progressive MS.
Area of Science:
- Neuroimaging
- Neuropathology
- Immunology
Background:
- Leptomeningeal contrast enhancement on MRI is investigated in multiple sclerosis (MS).
- Utilized 3-tesla postcontrast T2-weighted FLAIR MRI and 7-tesla postmortem MRI-pathology correlation.
- Study included 299 MS cases and 37 healthy controls.
Discussion:
- Focal leptomeningeal enhancement detected in 25% of MS cases versus 2.7% of controls.
- Enhancement was more frequent in progressive MS (33%) than relapsing-remitting MS (19%).
- Enhancing foci demonstrated stability over time (up to 5.5 years).
Key Insights:
- Pathology confirmed leptomeningeal inflammation (lymphocytic and mononuclear infiltration) in enhancing areas.
- Associated subpial cortical demyelination was observed adjacent to enhancing regions.
- Leptomeningeal enhancement serves as an in vivo marker for MS-related inflammation and demyelination.
Outlook:
- Leptomeningeal enhancement can guide the development of targeted therapies for MS.
- Potential to test novel treatments aimed at reducing inflammation and halting MS progression.
- Noninvasive MRI marker facilitates clinical trials for neuroinflammatory diseases.
