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Updated: Apr 3, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Direct MRI detection of impending plaque development in multiple sclerosis
Martina Absinta1, Govind Nair1, Pascal Sati1
1Division of Neuroimmunology and Neurovirology (M.A., G.N., P.S., I.C.M.C., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Neuroimaging Research Unit (M.A., M.F.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
Objectives:
To detect and localize MRI signal changes prior to the parenchymal contrast enhancement that classically defines the radiologic onset of the developing white matter lesion in multiple sclerosis (MS).
Methods:
We reviewed 308 high-resolution (≤1 mm(3) voxels) MRI scans at 3T and 7T in 29 patients with active MS. The presence of pre-parenchymal enhancement abnormalities before the appearance of parenchymal enhancement was evaluated in all available scans.
Results:
Pre-enhancement signal changes were noted in 26 of 162 enhancing lesions (16%) as linear enhancement of the central vein and/or perivenular hyperintense signal on T2 fluid-attenuated inversion recovery or T2* images. They occur up to 2 months before focal enhancement within the parenchyma in 10% of cases.
Conclusions:
In some lesions, the abrupt opening of the blood-brain barrier, detected by contrast enhancement on MRI, can have directly visible antecedent MRI changes centered on the central vein. We propose that these findings might be the basis for prior reports of subtle pre-parenchymal enhancement changes in quantitative MRI indices. In line with the venulocentric model of lesion development, our findings are consistent with the centrality of early perivenular events in lesion formation in vivo.
Insights
Early MRI signal changes in multiple sclerosis (MS) lesions, centered on the central vein, precede contrast enhancement. These findings support the venulocentric model of MS lesion development.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system.
- The radiologic onset of MS white matter lesions is classically defined by parenchymal contrast enhancement on MRI.
- Early detection of lesion development is crucial for understanding MS pathogenesis and treatment.
Purpose of the Study:
- To identify and locate MRI signal alterations preceding the contrast enhancement that marks the onset of MS white matter lesions.
- To investigate early, pre-parenchymal enhancement changes in active MS lesions.
Main Methods:
- Review of 308 high-resolution MRI scans (3T and 7T) from 29 patients with active MS.
- Evaluation for pre-parenchymal enhancement abnormalities occurring before visible parenchymal enhancement.
- Analysis of T2 fluid-attenuated inversion recovery and T2* images for signal changes.
Main Results:
- Pre-enhancement signal changes were observed in 16% of enhancing lesions (26 out of 162).
- These changes manifested as linear enhancement of the central vein and/or perivenular hyperintense signals.
- These early changes occurred up to two months before focal parenchymal enhancement in 10% of cases.
Conclusions:
- Visible antecedent MRI changes, centered on the central vein, can precede the abrupt opening of the blood-brain barrier detected by contrast enhancement.
- These findings support the venulocentric model of MS lesion development, highlighting the importance of early perivenular events.
- The observed pre-enhancement changes may explain previous reports of subtle pre-parenchymal enhancement in quantitative MRI studies.
