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Updated: Feb 13, 2026

Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
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Whole-brain in situ postmortem MR imaging using a combination of sequences for cortical lesion detection in multiple

Piet M Bouman1,2, Jeroen J G Geurts3,4, Laura E Jonkman4,5

  • 1MS Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands. p.bouman@amsterdamumc.nl.

La Radiologia Medica
|February 12, 2026
PubMed
Abstract

Insights

Detecting multiple sclerosis cortical lesions with MRI remains difficult, even with advanced sequences. Combining Double Inversion Recovery (DIR) and Phase-Sensitive Inversion Recovery (PSIR) MRI sequences offers the best detection rates but still has limitations.

Area of Science:

  • Neuroimaging
  • Neuropathology
  • Multiple Sclerosis Research

Background:

  • Cortical lesions are a hallmark of multiple sclerosis (MS).
  • Detecting MS-related cortical lesions via magnetic resonance imaging (MRI) presents significant challenges.
  • Histopathological validation of combined MRI sequence performance for cortical lesion detection in routine clinical settings is lacking.

Purpose of the Study:

  • To determine the detection rate of histopathologically validated cortical lesions.
  • To evaluate the combined performance of multiple MRI sequences in postmortem in situ imaging for multiple sclerosis (MS).

Main Methods:

  • Five MRI sequences (PSIR, DIR, FLAIR, 3D-T₁, PD/T₂) were acquired at 3T in 18 postmortem MS brains.
  • 66 tissue samples were histopathologically analyzed for myelin to identify cortical lesion types I-IV.
  • Cortical lesions were assessed prospectively and retrospectively on MRI, blinded and unblinded to histopathology.

Main Results:

  • Histopathology revealed 115 cortical lesions in 16/18 patients.
  • Prospective assessment using combined MRI sequences detected 17.4% of lesions with 100% specificity.
  • The combination of DIR and PSIR sequences improved detection by 43% compared to conventional sequences; retrospective assessment reached 40% detection.

Conclusions:

  • Cortical lesion detection in MS using advanced MRI remains limited, even in controlled postmortem studies.
  • The combination of DIR and PSIR sequences demonstrates superior performance over conventional MRI sequences.
  • These findings establish a benchmark for MRI-based cortical lesion detection and highlight current technological limitations in identifying MS cortical pathology.
Keywords:
Cortical lesionsDiagnosisMagnetic resonance imagingMultiple sclerosis

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