Related Experiment Videos
Histopathologic correlate of hypointense lesions on T1-weighted spin-echo MRI in multiple sclerosis
M A van Walderveen1, W Kamphorst, P Scheltens
1MR Center for MS Research, Department of Radiology, Academic Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Abstract:
Postmortem unfixed whole brains from five multiple sclerosis (MS) patients were examined by MRI using a T2- and T1-weighted spin-echo (SE) sequence and histology to investigate the histopathologic characteristics of hypointense lesions on T1-weighted SE MR images. The degree of hypointensity was scored semiquantitatively by two blinded observers in reference to normal-appearing white matter. Signal intensities of the lesions and the normal-appearing white matter were measured to obtain contrast ratios. Hematoxylin-eosin stain was used to assess degree of matrix destruction (decrease of density of the neuropil) and cellularity of a lesion, Klüver-Barrera stain for degree of demyelination, Bodian stain for axonal density, and immunostaining of glial fibrillary acid protein for reactive astrocytes and fibrillary gliosis. Nineteen lesions were selected for analysis. Nearly all lesions were compatible with the chronic MS plaque: hypocellularity, absence of myelinated axons, in the presence of reactive astrocytes. Contrast ratios of the lesions were highly correlated (R = -0.90; p < 0.01), with degree of hypointensity scored semiquantitatively. Degree of hypointensity on T1-weighted SE images did not correlate with degree of demyelination or number of reactive astrocytes, but was associated with axonal density (R = -0.71; p = 0.001). A trend was found with degree of matrix destruction (R = 0.45; p = 0.052). We conclude that, in our limited sample, hypointense lesions seen on T1-weighted SE MR images are associated histopathologically with severe tissue destruction, including axonal loss. Our results need to be substantiated in a larger study on more varied patient material to evaluate the use of hypointense lesions as a surrogate marker of persistent deficit in MS patients.
Insights
Hypointense lesions on T1-weighted MRI in multiple sclerosis (MS) brains indicate severe tissue destruction and axonal loss. These findings suggest hypointense lesions may serve as a marker for persistent deficits in MS patients.
Area of Science:
- Neuroimaging
- Neuropathology
- Multiple Sclerosis Research
Background:
- Multiple Sclerosis (MS) is a chronic neurological disease.
- Understanding the histopathological basis of MRI lesions is crucial for MS patient management.
Purpose of the Study:
- To investigate the histopathologic characteristics of hypointense lesions on T1-weighted spin-echo (SE) Magnetic Resonance Imaging (MRI) in postmortem multiple sclerosis (MS) brains.
- To explore the correlation between MRI lesion appearance and tissue damage.
Main Methods:
- Postmortem unfixed whole brains from five MS patients were analyzed using T2- and T1-weighted SE MRI and various histology stains.
- Lesion hypointensity was scored, and contrast ratios were measured.
- Histology included Hematoxylin-eosin, Klüver-Barrera, Bodian stains, and glial fibrillary acid protein immunostaining.
Main Results:
- Nineteen chronic MS plaques were analyzed.
- Lesion hypointensity on T1-weighted MRI strongly correlated with contrast ratios.
- Hypointensity was associated with severe tissue destruction and axonal loss, but not directly with demyelination or reactive astrocytes.
Conclusions:
- Hypointense lesions on T1-weighted SE MRI in MS are linked to significant tissue destruction, including axonal loss.
- Further research with larger, diverse patient cohorts is needed to validate hypointense lesions as a surrogate marker for persistent deficits in MS.