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Updated: Sep 11, 2025
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Differentiation of MS lesions through analysis of microvascular distribution
Linda Sundvall1, Irene Klærke Mikkelsen2, Simon F Eskildsen2
1Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
Abstract:
Conventional MRI is crucial for diagnosing multiple sclerosis (MS) but lacks precision, leading to the clinico-radiological paradox and misdiagnosis risk, especially when confronted with unspecific lesions not related to MS. Advancements in perfusion-weighted imaging (PWI) with an algorithm designed for diseases with anticipated contrast agent extravasation offer insight into microvascular impairment and flow heterogeneity. Our study aimed to assess these factors in MS patients and their association with clinically relevant white matter injury and disease course. We evaluated 60 adults with white matter lesions (WML), including 50 diagnosed with MS or MS syndromes and 10 non-diseased symptomatic controls (SC) with unspecific WML. MRI included conventional three-dimensional (3D) T2-weighted fluid-attenuated inversion recovery (T2-FLAIR), 3D magnetization-prepared two rapid acquisition gradient-echo (MP2RAGE), post-contrast 3D T1-weighted (T1) images, and Dynamic Susceptibility Contrast (DSC) PWI at 3T. WML masks of "unspecific T2-FLAIR lesions", "MS T2-FLAIR lesions", and "MS T1-lesions" were manually outlined and validated by a neuroradiologist. DSC-derived parameters were analyzed in WML masks and healthy-appearing tissue. MS T2-FLAIR lesions showed increased flow heterogeneity and vasodilation compared to unspecific T2-FLAIR lesions in SC, as well as compared to unspecific T2-FLAIR lesions within the MS group. MS T1-lesions exhibited more homogenized flow. Our findings suggest that DSC-PWI, combined with lesion delineation, can provide clinically relevant differentiation of MS lesions from unspecific WML, highlighting potential microvascular pathology previously overlooked in MS.
Insights
Dynamic Susceptibility Contrast Perfusion-Weighted Imaging (DSC-PWI) helps differentiate multiple sclerosis (MS) lesions from other white matter lesions. This advanced MRI technique reveals microvascular differences, improving diagnostic accuracy for MS.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Conventional MRI for multiple sclerosis (MS) diagnosis faces limitations in precision, risking misdiagnosis due to unspecific white matter lesions (WML).
- Perfusion-weighted imaging (PWI) offers insights into microvascular impairment and flow heterogeneity, crucial for understanding MS pathophysiology.
- Distinguishing MS-related WML from non-specific WML is vital for accurate diagnosis and disease management.
Purpose of the Study:
- To assess microvascular impairment and flow heterogeneity in MS patients using Dynamic Susceptibility Contrast (DSC) PWI.
- To investigate the association of these PWI parameters with white matter injury and disease course in MS.
- To evaluate DSC-PWI's capability in differentiating MS lesions from unspecific WML.
Main Methods:
- Sixty adults (50 MS/MS syndromes, 10 symptomatic controls with unspecific WML) underwent 3T MRI.
- Imaging included conventional T2-FLAIR, MP2RAGE, post-contrast T1, and DSC-PWI.
- Manual delineation of unspecific T2-FLAIR, MS T2-FLAIR, and MS T1 lesions was performed, with DSC parameters analyzed within these regions and healthy-appearing tissue.
Main Results:
- MS T2-FLAIR lesions exhibited increased flow heterogeneity and vasodilation compared to unspecific T2-FLAIR lesions (in controls and within the MS group).
- MS T1-lesions demonstrated more homogenized blood flow.
- DSC-PWI parameters, when combined with lesion delineation, showed significant differences between MS and unspecific WML.
Conclusions:
- DSC-PWI provides clinically relevant differentiation between MS lesions and unspecific white matter lesions.
- The findings highlight potential microvascular pathology in MS that may be overlooked by conventional MRI.
- This advanced imaging approach can enhance diagnostic precision and understanding of MS pathogenesis.
