Related Experiment Video
Updated: Sep 30, 2025
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
The expansion and severity of chronic MS lesions follows a periventricular gradient
Samuel Klistorner1, Michael H Barnett2, Stuart L Graham3
1Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Background And Objectives:
Expansion of chronic lesions in multiple sclerosis (MS) patients and recently described cerebrospinal fluid (CSF)-related gradient of tissue damage are linked to microglial activation. The aim of this study was to investigate whether lesion expansion is associated with proximity to ventricular CSF spaces.
Methods:
Pre- and post-gadolinium three-dimensional (3D)-T1, 3D FLAIR and diffusion tensor images were acquired from 36 relapsing-remitting MS (RRMS) patients. Lesional activity was analysed between baseline and 48 months at different distances from the CSF using successive 1 mm thick concentric bands radiating from the ventricles.
Results:
Voxel-based analysis of the rate of lesion expansion demonstrated a clear periventricular gradient decreasing away from the ventricles. This was particularly apparent when lesions of equal diameter were analysed. Periventricular lesional tissue showed higher degree of tissue destruction at baseline that significantly increased during follow-up in bands close to CSF. This longitudinal change was proportional to degree of lesion expansion. Lesion-wise analysis revealed a gradual, centrifugal decrease in the proportion of expanding lesions from the immediate periventricular zone.
Discussion:
Our data suggest that chronic white matter lesions in close proximity to the ventricles are more destructive, show a higher degree of expansion at the lesion border and accelerated tissue loss in the lesion core.
Insights
Multiple sclerosis (MS) lesions near cerebrospinal fluid (CSF) spaces expand more rapidly and show greater tissue damage. Proximity to CSF influences lesion activity and expansion in MS patients.
Area of Science:
- Neuroimaging
- Neurology
- Pathology
Background:
- Microglial activation is linked to chronic lesion expansion in multiple sclerosis (MS).
- A cerebrospinal fluid (CSF)-related gradient of tissue damage has been observed.
- The relationship between lesion expansion and proximity to CSF spaces requires investigation.
Purpose of the Study:
- To determine if lesion expansion in MS is associated with proximity to ventricular CSF spaces.
- To analyze the impact of CSF proximity on chronic lesion activity and tissue damage.
Main Methods:
- Acquisition of 3D-T1, 3D FLAIR, and diffusion tensor images from 36 relapsing-remitting MS patients.
- Analysis of lesional activity over 48 months using concentric bands at varying distances from CSF.
- Voxel-based analysis and lesion-wise analysis to assess expansion rates and tissue destruction.
Main Results:
- A clear gradient of lesion expansion was observed, decreasing with distance from ventricles.
- Periventricular lesions exhibited greater baseline tissue destruction, increasing significantly over time near CSF.
- Longitudinal changes in tissue destruction correlated with the degree of lesion expansion.
Conclusions:
- Chronic white matter lesions near ventricles are more destructive.
- These periventricular lesions demonstrate increased expansion at their borders and accelerated tissue loss.
- Proximity to CSF is a significant factor influencing the progression of MS lesions.
