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Updated: Jan 24, 2026

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Leptomeningeal enhancement in multiple sclerosis demonstrates posterior predilection and T1 alterations in the

Ashley A Thommana1, Erin S Beck1,2, Matthew A Greenwald1

  • 1Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.

Multiple Sclerosis Journal - Experimental, Translational and Clinical
|January 23, 2026
PubMed
Abstract

Insights

Leptomeningeal enhancement (LME) on MRI may indicate meningeal inflammation in multiple sclerosis (MS). This study found LME in 73% of participants, with altered cortical T1 relaxation times near LME suggesting subtle tissue changes.

Area of Science:

  • Neuroimaging
  • Radiology
  • Neurology

Background:

  • Leptomeningeal enhancement (LME) is a potential magnetic resonance imaging (MRI) biomarker for meningeal inflammation in multiple sclerosis (MS).
  • High-sensitivity 3D inversion-prepared fast-spin-echo sequence with real-reconstruction inversion recovery (Real-IR) MRI at 3 tesla (T) effectively detects LME.

Purpose of the Study:

  • To determine the prevalence of LME across different brain regions in MS patients.
  • To investigate the association between LME and subclinical cortical pathology.

Main Methods:

  • Utilized 3T Real-IR MRI to map LME distribution in 90 adults (78 with MS).
  • Analyzed T1 relaxation times in cortical regions adjacent to and beneath LME using 7T MRI in a subset of 15 participants.

Main Results:

  • LME was detected in 73% of participants, with a predilection for posterior brain regions.
  • Elevated cortical T1 relaxation times were observed beneath LME compared to homologous and adjacent cortical areas (p < 0.0052).
  • Cortical lesions were found near LME in 3 out of 15 participants.

Conclusions:

  • Observed regional LME variations suggest topographical differences in the blood-meningeal barrier.
  • Detected alterations in cortical T1 relaxation times near LME may indicate early, subtle tissue changes preceding overt cortical lesions.
Keywords:
MRIMultiple sclerosisblood-cerebrospinal fluid barrierleptomeningeal enhancementreal inversion-recovery MRI

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