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Abstract
Objective: We used ultra-high field MRI to visualize cortical lesion types described by neuropathology in 16 patients with multiple sclerosis (MS) compared with 8 age-matched controls; to characterize the contrast properties of cortical lesions including T2*, T2, T1, and phase images; and to investigate the relationship between cortical lesion types and clinical data.
Methods: We collected, on a 7-T scanner, 2-dimensional fast low-angle shot (FLASH)-T2*-weighted spoiled gradient-echo, T2-weighted turbo spin-echo (TSE) images (0.33 × 033 × 1 mm3), and a 3-dimensional magnetization-prepared rapid gradient echo.
Results: Overall, 199 cortical lesions were detected in patients on both FLASH-T2* and T2-TSE scans. Seven-tesla MRI allowed for characterization of cortical plaques into type I (leukocortical), type II (intracortical), and type III/IV (subpial extending partly or completely through the cortical width) lesions as described histopathologically. Types III and IV were the most frequent type of cortical plaques (50.2%), followed by type I (36.2%) and type II (13.6%) lesions. Each lesion type was more frequent in secondary progressive than in relapsing–remitting MS. This difference, however, was significant only for type III/IV lesions. T2*-weighted images showed the highest, while phase images showed the lowest, contrast-to-noise ratio for all cortical lesion types. In patients, the number of type III/IV lesions was associated with greater disability (p < 0.02 by Spearman test) and older age (p < 0.04 by Spearman test).
Conclusions: Seven-tesla MRI detected different histologic cortical lesion types in our small multiple sclerosis (MS) sample, suggesting, if validated in a larger population, that it may prove a valuable tool to assess the contribution of cortical MS pathology to clinical disability.
Glossary
- ANOVA=
- analysis of variance;
- BN=
- background noise;
- CNR=
- contrast-to-noise ratio;
- DIR=
- double-inversion recovery;
- EDSS=
- Expanded Disability Status Scale;
- FLAIR=
- fluid-attenuated inversion recovery;
- FLASH=
- fast low-angle shot;
- GM=
- gray matter;
- MPRAGE=
- magnetization-prepared rapid gradient echo;
- MR=
- magnetic resonance;
- MS=
- multiple sclerosis;
- NACGM=
- normal-appearing cortical gray matter;
- RF=
- radiofrequency;
- ROI=
- region of interest;
- RRMS=
- relapsing–remitting multiple sclerosis;
- SNR=
- signal-to-noise ratio;
- SPMS=
- secondary progressive multiple sclerosis;
- TA=
- time of acquisition;
- TE=
- echo time;
- TR=
- repetition time;
- TSE=
- turbo spin-echo;
- WM=
- white matter.
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