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Updated: Jan 27, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Leptomeningeal Contrast Enhancement Is Related to Focal Cortical Thinning in Relapsing-Remitting Multiple Sclerosis:
N Bergsland1, D Ramasamy2, E Tavazzi2
1From the Buffalo Neuroimaging Analysis Center (N.B., D.R., E.T., R.Z.) npbergsland@bnac.net.
Background And Purpose:
Leptomeningeal inflammation is associated with the development of global cortical gray matter atrophy in multiple sclerosis. However, its association with localized loss of tissue remains unclear. The purpose of this study was to evaluate the relationship between leptomeningeal contrast enhancement, a putative marker of leptomeningeal inflammation, and focal cortical thinning in MS.
Materials And Methods:
Forty-three patients with relapsing-remitting MS and 15 with secondary-progressive MS were imaged on a 3T scanner. Cortical reconstruction was performed with FreeSurfer. Leptomeningeal contrast-enhancement foci were visually identified on 3D-FLAIR postcontrast images and confirmed using subtraction imaging. Leptomeningeal contrast-enhancement foci were mapped onto the cortex, and ROIs were obtained by dilating along the surface multiple times (n = 5, 10, 15, 20, 25, 30, 35, 40). Resulting ROIs were then mapped onto the homologous region of the contralateral hemisphere. Paired t tests compared the thickness of the cortex surrounding individual leptomeningeal contrast-enhancement foci and the corresponding contralateral region. Results were corrected for the false discovery rate.
Results:
Differences between ipsilateral and contralateral ROIs progressively decreased with larger ROIs, but no significant effects were detected when considering the entire MS sample. In patients with relapsing-remitting MS only, significantly reduced cortical thickness was found for 5 dilations (-8.53%, corrected P = .04) and 10 dilations (-5.20%, corrected P = .044).
Conclusions:
Focal leptomeningeal contrast enhancement is associated with reduced thickness of the surrounding cortex in patients with relapsing-remitting MS, but not in those with secondary-progressive MS. Our results suggest that pathology associated with the presence of leptomeningeal contrast-enhancement foci has a stronger, localized effect on cortical tissue loss earlier in the disease.
Insights
Leptomeningeal inflammation, a marker of inflammation in multiple sclerosis (MS), is linked to localized cortical thinning in early MS. This association was not observed in later stages of the disease, suggesting inflammation impacts tissue loss early on.
Area of Science:
- Neuroimaging
- Neurology
- Inflammation
Background:
- Leptomeningeal inflammation is linked to global gray matter atrophy in multiple sclerosis (MS).
- The association between leptomeningeal inflammation and focal cortical thinning in MS is not well understood.
- Leptomeningeal contrast enhancement (LMCE) is a potential marker for leptomeningeal inflammation.
Purpose of the Study:
- To investigate the relationship between LMCE and focal cortical thinning in MS patients.
- To determine if LMCE is associated with localized tissue loss in the cortex.
Main Methods:
- 43 relapsing-remitting MS (RRMS) and 15 secondary-progressive MS (SPMS) patients underwent 3T MRI.
- Cortical reconstruction was performed using FreeSurfer.
- LMCE foci were identified on postcontrast 3D-FLAIR images, mapped to the cortex, and compared with contralateral regions to assess cortical thickness.
Main Results:
- No significant differences in cortical thickness were found for the overall MS sample.
- In RRMS patients, significantly reduced cortical thickness was observed around LMCE foci (5 dilations, P=.04; 10 dilations, P=.044).
- This localized cortical thinning effect was not significant in SPMS patients.
Conclusions:
- Focal LMCE is associated with reduced cortical thickness in the surrounding areas in RRMS patients.
- The findings suggest that leptomeningeal inflammation has a localized effect on cortical tissue loss, particularly in earlier stages of MS.
- Pathology related to LMCE appears to impact tissue loss more significantly in the early, relapsing-remitting phase of MS.
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