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Ann Neurol. 2017 Oct;82(4):519-529. doi: 10.1002/ana.25020. Epub 2017 Sep 16.

Cortical pathology in multiple sclerosis detected by the T1/T2-weighted ratio from routine magnetic resonance imaging.

Author information

1
Department of Neurology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.
2
TUM Neuroimaging Center, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.
3
Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands.
4
Department of Statistics, Ludwig Maximilian University of Munich, Munich, Germany.
5
Department of Neuroradiology, Rechts der Isar Hospital, Technical University of Munich, Munich, Germany.
6
Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.

Abstract

OBJECTIVE:

In multiple sclerosis, neuropathological studies have shown widespread changes in the cerebral cortex. In vivo imaging is critical, because the histopathological substrate of most measurements is unknown.

METHODS:

Using a novel magnetic resonance imaging analysis technique, based on the ratio of T1- and T2-weighted signal intensities, we studied the cerebral cortex of a large cohort of patients in early stages of multiple sclerosis. A total of 168 patients with clinically isolated syndrome or relapsing-remitting multiple sclerosis (Expanded Disability Status Scale: median = 1, range = 0-3.5) and 80 age- and sex-matched healthy controls were investigated. We also searched for the histopathological substrate of the T1/T2-weighted ratio by combining postmortem imaging and histopathology in 9 multiple sclerosis brain donors.

RESULTS:

Patients showed lower T1/T2-weighted ratio values in parietal and occipital areas. The 4 most significant clusters appeared in the medial occipital and posterior cingulate cortex (each left and right). The decrease of the T1/T2-weighted ratio in the posterior cingulate was related to performance in attention. Analysis of the T1/T2-weighted ratio values of postmortem imaging yielded a strong correlation with dendrite density but none of the other parameters including myelin.

INTERPRETATION:

The T1/T2-weighted ratio decreases in early stages of multiple sclerosis in a widespread manner, with a preponderance of posterior areas and with a contribution to attentional performance; it seems to reflect dendrite pathology. As the method is broadly available and applicable to available clinical scans, we believe that it is a promising candidate for studying and monitoring cortical pathology or therapeutic effects in multiple sclerosis. Ann Neurol 2017;82:519-529.

PMID:
28833433
PMCID:
PMC5698772
DOI:
10.1002/ana.25020
[Indexed for MEDLINE]
Free PMC Article

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