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Mult Scler. 2019 Jun;25(7):980-986. doi: 10.1177/1352458518779952. Epub 2018 Jun 1.

Detection and clinical correlation of leukocortical lesions in pediatric-onset multiple sclerosis on multi-contrast MRI.

Author information

1
Departments of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada.
2
Department of Psychology, York University, Toronto, ON, Canada Division of Neurology, Department of Pediatrics, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada.
3
Image Processing Laboratory, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada.
4
Division of Neurology, Department of Pediatrics, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada.
5
Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
6
Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
7
Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Division of Neurology, Department of Pediatrics, The Hospital for Sick Children Research Institute, University of Toronto, Toronto, ON, Canada.

Abstract

OBJECTIVE:

To determine the frequency of cortical lesions (CLs) in patients with pediatric-onset multiple sclerosis (POMS) using multi-contrast magnetic resonance imaging (MRI), and the relationship between frontal CL load and upper limb dexterity assessed with the Nine-Hole Peg Test (9-HPT).

METHODS:

Participants completed the 9-HPT and were imaged on a 3T MRI scanner to collect T1-weighted three-dimensional (3D) magnetization prepared rapid gradient echo (MPRAGE), proton density-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. CLs were manually segmented using all MRI contrasts.

RESULTS:

We enrolled 24 participants with POMS (mean (standard deviation) age at first symptom: 13.3 (±2.7) years; mean age at scan: 18.8 (±3) years; mean disease duration of 5 (±3.2) years). A total of 391 CLs (mean, 16.3 ± 27.2; median, 7) were identified in 19 of 24 POMS patients (79%). The total number of CLs was positively associated with white matter lesion volume ( p = 0.04) but not with thalamic volume, age at the time of the scan, or disease duration. The number of frontal CLs was associated with slower performance on the 9-HPT ( p = 0.05).

CONCLUSION:

Multi-contrast 3T MRI led to a high rate of CL detection, demonstrating that cortical pathology occurs even in pediatric-onset disease. Frontal lobe CL count was associated with reduced manual dexterity, indicating that these CLs are clinically relevant.

KEYWORDS:

MRI; Pediatric; cortical lesion; leukocortical lesions; multiple sclerosis

PMID:
29852831
DOI:
10.1177/1352458518779952

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