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Updated: Apr 13, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
DIR-visible grey matter lesions and atrophy in multiple sclerosis: partners in crime?
Steven H P van de Pavert1, Nils Muhlert2, Varun Sethi1
1NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK.
Background:
The extent and clinical relevance of grey matter (GM) pathology in multiple sclerosis (MS) are increasingly recognised. GM pathology may present as focal lesions, which can be visualised using double inversion recovery (DIR) MRI, or as diffuse pathology, which can manifest as atrophy. It is, however, unclear whether the diffuse atrophy centres on focal lesions. This study aimed to determine if GM lesions and GM atrophy colocalise, and to assess their independent relationship with motor and cognitive deficits in MS.
Methods:
Eighty people with MS and 30 healthy controls underwent brain volumetric T1-weighted and DIR MRI at 3 T, and had a comprehensive neurological and cognitive assessment. Probability mapping of GM lesions marked on the DIR scans and voxel- based morphometry (assessing GM atrophy) were carried out. The associations of GM lesion load and GM volume with clinical scores were tested.
Results:
DIR-visible GM lesions were most commonly found in the right cerebellum and most apparent in patients with primary progressive MS. Deep GM structures appeared largely free from lesions, but showed considerable atrophy, particularly in the thalamus, caudate, pallidum and putamen, and this was most apparent in secondary progressive patients with MS. Very little co-localisation of GM atrophy and lesions was seen, and this was generally confined to the cerebellum and postcentral gyrus. In both regions, GM lesions and volume independently correlated with physical disability and cognitive performance.
Conclusions:
DIR-detectable GM lesions and GM atrophy do not significantly overlap in the brain but, when they do, they independently contribute to clinical disability.
Insights
Grey matter (GM) lesions and GM atrophy in multiple sclerosis (MS) rarely overlap but independently impact physical and cognitive function. This study clarifies their distinct roles in MS-related disability.
Area of Science:
- Neuroimaging
- Neurology
- Multiple Sclerosis Research
Background:
- Grey matter (GM) pathology is increasingly recognized in multiple sclerosis (MS), presenting as focal lesions or diffuse atrophy.
- The relationship between focal GM lesions and diffuse GM atrophy in MS remains unclear.
- This study investigates the spatial overlap and independent clinical relevance of GM lesions and atrophy in MS.
Purpose of the Study:
- To determine if grey matter (GM) lesions and GM atrophy colocalize in the brains of individuals with multiple sclerosis (MS).
- To assess the independent contributions of GM lesions and GM atrophy to motor and cognitive deficits in MS patients.
Main Methods:
- Eighty MS patients and 30 healthy controls underwent 3 T MRI, including double inversion recovery (DIR) and T1-weighted sequences.
- Probability mapping of DIR-visible GM lesions and voxel-based morphometry for GM atrophy were performed.
- Associations between GM lesion load, GM volume, and clinical assessments (neurological and cognitive) were analyzed.
Main Results:
- DIR-detectable GM lesions were most frequent in the right cerebellum, particularly in primary progressive MS.
- Deep GM structures showed significant atrophy, especially in secondary progressive MS, with minimal focal lesions.
- Little colocalization of GM atrophy and lesions was observed, primarily in the cerebellum and postcentral gyrus.
Conclusions:
- Grey matter (GM) lesions and GM atrophy in multiple sclerosis (MS) generally do not overlap spatially.
- Both DIR-detectable GM lesions and GM atrophy independently contribute to clinical disability in MS patients.
- Understanding these distinct pathologies is crucial for assessing MS progression and patient outcomes.
