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Updated: Mar 17, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
The Contribution of Cortical Lesions to a Composite MRI Scale of Disease Severity in Multiple Sclerosis
Fawad Yousuf1, Gloria Kim1, Shahamat Tauhid1
1Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Objective:
To test a new version of the Magnetic Resonance Disease Severity Scale (v.3 = MRDSS3) for multiple sclerosis (MS), incorporating cortical gray matter lesions (CLs) from 3T magnetic resonance imaging (MRI).
Background:
MRDSS1 was a cerebral MRI-defined composite scale of MS disease severity combining T2 lesion volume (T2LV), the ratio of T1 to T2LV (T1/T2), and whole brain atrophy [brain parenchymal fraction (BPF)]. MRDSS2 expanded the scale to include cerebral gray matter fraction (GMF) and upper cervical spinal cord area (UCCA). We tested the contribution of CLs to the scale (MRDSS3) in modeling the MRI relationship to clinical status.
Methods:
We studied 51 patients [3 clinically isolated syndrome, 43 relapsing-remitting, 5 progressive forms, age (mean ± SD) 40.7 ± 9.1 years, Expanded Disability Status Scale (EDSS) score 1.6 ± 1.7] and 20 normal controls by high-resolution cerebrospinal MRI. CLs required visibility on both fluid-attenuated inversion-recovery (FLAIR) and modified driven equilibrium Fourier transform sequences. The MACFIMS battery defined cognitively impaired (n = 18) vs. preserved (n = 33) MS subgroups.
Results:
EDSS significantly correlated with only BPF, UCCA, MRDSS2, and MRDSS3 (all p < 0.05). After adjusting for depressive symptoms, the cognitively impaired group had higher severity of MRI metrics than the cognitively preserved group in regard to only BPF, GMF, T1/T2, MRDSS1, and MRDSS2 (all p < 0.05). CL number was not significantly related to EDSS score or cognition status.
Conclusion:
CLs from 3T MRI did not appear to improve the validity of the MRDSS. Further studies employing advanced sequences or higher field strengths may show more utility for the incorporation of CLs into composite scales.
Insights
Cortical gray matter lesions (CLs) on 3T MRI did not improve the Magnetic Resonance Disease Severity Scale (MRDSS) for multiple sclerosis (MS). Further research with advanced MRI may reveal utility for CLs in MS severity scales.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- The Magnetic Resonance Disease Severity Scale (MRDSS) is a composite scale for assessing multiple sclerosis (MS) disease severity using cerebral MRI metrics.
- Previous versions (MRDSS1, MRDSS2) included lesion volume, atrophy, and spinal cord area.
- This study evaluated a new version (MRDSS3) incorporating cortical gray matter lesions (CLs).
Purpose of the Study:
- To test the validity of a new Magnetic Resonance Disease Severity Scale version (MRDSS3) for multiple sclerosis (MS).
- To assess the contribution of cortical gray matter lesions (CLs) detected by 3T MRI to the scale's performance.
- To model the relationship between MRI metrics and clinical status in MS patients.
Main Methods:
- Studied 51 MS patients and 20 controls using high-resolution cerebrospinal MRI.
- Identified CLs using fluid-attenuated inversion-recovery (FLAIR) and modified driven equilibrium Fourier transform sequences.
- Assessed cognitive function using the MACFIMS battery to define cognitively impaired and preserved subgroups.
Main Results:
- The Expanded Disability Status Scale (EDSS) correlated significantly with brain parenchymal fraction (BPF), upper cervical spinal cord area (UCCA), MRDSS2, and MRDSS3.
- Cognitively impaired MS patients showed higher severity in BPF, gray matter fraction (GMF), T1/T2 ratio, MRDSS1, and MRDSS2 compared to cognitively preserved patients, after adjusting for depressive symptoms.
- The number of CLs did not significantly correlate with EDSS score or cognitive status.
Conclusions:
- Cortical gray matter lesions (CLs) detected by 3T MRI did not enhance the validity of the Magnetic Resonance Disease Severity Scale (MRDSS).
- The current study suggests that CLs may not be a significant contributor to MS severity as measured by existing scales.
- Further research using advanced MRI sequences or higher field strengths is recommended to explore the potential utility of CLs in composite MS severity scales.
