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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
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Histopathology-validated recommendations for cortical lesion imaging in multiple sclerosis.
Piet M Bouman1, Martijn D Steenwijk1, Petra J W Pouwels2
1Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.
Brain : a Journal of Neurology
|September 5, 2020
Summary
Double inversion recovery and phase-sensitive inversion recovery MRI sequences show higher sensitivity for detecting cortical lesions in multiple sclerosis than conventional MRI. These advanced sequences are recommended for improved lesion assessment, despite overall sensitivity remaining below 25%.
Area of Science:
- Neuroimaging
- Radiology
- Pathology
Background:
- Cortical demyelinating lesions are crucial in multiple sclerosis (MS) but difficult to detect via MRI.
- Current MRI techniques, including double inversion recovery (DIR), have limited sensitivity for histopathologically validated cortical lesions.
- Phase-sensitive inversion recovery (PSIR) has been proposed as a more sensitive alternative to DIR, but lacked histopathological validation.
Purpose of the Study:
- To compare the sensitivity and specificity of commonly used MRI sequences (T2, FLAIR, DIR, PSIR) for detecting histopathologically validated cortical lesions in progressive multiple sclerosis at clinical field strength.
- To determine which MRI sequence offers the best visualization of cortical lesions in MS.
Main Methods:
- Retrospective analysis of post-mortem MRI on brain slices from 23 MS patients at 3 Tesla.
- Comparison of T1, proton-density/T2, FLAIR, DIR, and PSIR sequences against histopathological staining for myelin (proteolipid protein).
- Calculation of sensitivity and specificity for each MRI sequence, including a retrospective unblinded analysis to assess maximum potential.
Main Results:
- Histopathology revealed 224 cortical lesions, predominantly subpial.
- Sensitivity for T1, PD/T2, FLAIR, DIR, and PSIR was 8.9%, 5.4%, 5.4%, 22.8%, and 23.7%, respectively.
- DIR and PSIR showed significantly higher sensitivity and specificity compared to conventional sequences, with PSIR identifying more lesions in retrospective analysis.
Conclusions:
- At 3 Tesla, DIR and PSIR MRI sequences are superior to T1, PD/T2, and FLAIR for detecting cortical lesions in multiple sclerosis.
- While sensitivity remains under 25%, DIR and PSIR offer high pathological specificity and are recommended for optimal cortical lesion assessment in MS.
- PSIR demonstrated a slight advantage over DIR in retrospective lesion detection, warranting further investigation.
