The clinical-radiological paradox in multiple sclerosis: myth or truth?

Area of Science:

• Neurology
• Neuroimaging
• Clinical Research

Background:

• Multiple sclerosis (MS) is a complex inflammatory and demyelinating disease with variable progression.
• A notable characteristic of MS is the often-observed discrepancy between clinical symptoms and radiological findings, termed the clinical-radiological paradox.

Purpose of the Study:

• To investigate the existence of the clinical-radiological paradox in a specific cohort of MS patients.
• To determine the relationship between the location of lesions and the degree of clinical disability.

Main Methods:

• Retrospective analysis of data from 95 patients with multiple sclerosis.
• Manual calculation of lesion loads (LLs) in the whole brain and specific regions (periventricular, juxtacortical, posterior fossa, spinal cord) using MRI.
• Correlation of lesion loads with the Kurtzke Expanded Disability Status Scale (EDSS) scores.

Main Results:

• A significant correlation was found between high lesion loads and high EDSS scores in the overall cohort and in patients with relapsing-remitting MS (RRMS).
• EDSS scores were significantly correlated with lesion loads in the posterior fossa and spinal cord regions.

Conclusions:

• The findings suggest that the clinical-radiological paradox in MS may be a myth.
• Evidence supports a direct relationship between the anatomical location of lesions and the resulting neurological deficits in patients with MS.