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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Characterization of gray-matter multiple sclerosis lesions using double inversion recovery, diffusion,
M Andrea Parra Corral1, Sindhuja T Govindarajan1, Patricia Stefancin1
1Departments of Radiology and Neurology, Stony Brook University Hospital 101 Nicolls Rd, Stony Brook Medicine, Stony Brook, New York, 11794, USA.
Purpose:
To investigate gray-matter (GM) lesions in relapsing-remitting multiple sclerosis (MS) using double-inversion recovery (DIR) MRI, determine GM lesions prevalence, spatial distribution and characterize their contrast-enhancement, diffusion characteristics and compare them to white-matter (WM) lesions. This is the first study, to our knowledge, to investigate GM MS lesions using double-inversion recovery MRI, to determine GM lesion prevalence and location, and characterize contrast-enhancement and diffusion characteristics, compared to WM lesion characteristics in the same patients. We also correlated GM lesion counts, volume and apparent diffusion coefficient (ADC) with total brain, WM, and GM volumes, as well as 25-foot walk test as a clinical disability.
Materials And Methods:
This retrospective study included 44 relapsing-remitting MS patients (12M/32F, 41 ± 13 years) and 24 age-matched healthy controls (14M/10F, 36 ± 13 years). Lesions were segmented based on DIR and grouped into GM, subcortical WM, and periventricular WM lesions. ADC was tabulated for contrast-enhancing and non-enhancing lesions. Unpaired two sample t-tests were used for comparison between groups. Linear regression was used to evaluate the relationship between number of GM lesions, number of total lesions, total GM lesion volume, and total WM lesion volume with brain volumes and clinical data.
Results:
GM MS lesions were present in the majority (86.4%, 38/44) of RRMS patients based on DIR, suggesting GM damage plays an important role in MS pathogenesis. The majority of the GM lesions were located in the frontal lobe. The percentage of lesions in GM that were contrast-enhanced was similar to those in WM, suggesting that blood-brain barrier integrity is likely affected similarly in GM and WM. Contrast-enhanced GM lesions showed higher ADC. GM lesion count and volume were correlated with global and regional brain atrophy, and with more severe disability group.
Conclusion:
This study characterized GM MS lesions using double-inversion recovery, contrast-enhanced and diffusion MRI. Understanding GM lesion pathophysiology using MRI in vivo, may prove useful for improving targeted therapy and monitoring disease progression.
Insights
Gray matter lesions are common in relapsing-remitting multiple sclerosis (MS), impacting brain atrophy and disability. Double-inversion recovery MRI reveals these lesions, aiding in understanding MS progression and targeted therapy.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system.
- Gray matter (GM) damage is increasingly recognized as a significant contributor to MS pathogenesis and disability.
- Previous imaging techniques have limitations in detecting GM lesions.
Purpose of the Study:
- To investigate gray matter (GM) lesions in relapsing-remitting MS (RRMS) using double-inversion recovery (DIR) MRI.
- To determine the prevalence, spatial distribution, and characteristics (contrast-enhancement, diffusion) of GM lesions.
- To compare GM lesions with white matter (WM) lesions and correlate them with clinical disability.
Main Methods:
- Retrospective analysis of 44 RRMS patients and 24 healthy controls.
- Lesion segmentation using DIR MRI, categorized into GM, subcortical WM, and periventricular WM.
- Analysis of contrast enhancement and apparent diffusion coefficient (ADC) for lesions.
- Correlation of lesion burden and ADC with brain volumes and the 25-foot walk test.
Main Results:
- GM MS lesions were detected in 86.4% of RRMS patients, predominantly in the frontal lobe.
- Contrast enhancement in GM lesions was similar to WM lesions, suggesting compromised blood-brain barrier.
- Contrast-enhanced GM lesions exhibited higher ADC.
- GM lesion count and volume correlated with brain atrophy and increased disability.
Conclusions:
- DIR MRI effectively characterizes GM lesions in RRMS.
- GM lesions play a crucial role in MS pathogenesis, contributing to brain atrophy and disability.
- Understanding GM lesion pathophysiology aids in developing targeted therapies and monitoring disease progression.
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