Objective Cortical grey matter lesions are common in multiple sclerosis (MS), but usually not seen on MRI. The authors compared the performance of double inversion recovery (DIR, currently considered the best available imaging sequence for detecting cortical lesions) with phase-sensitive inversion recovery (PSIR, a sequence allowing much higher resolution scans to be obtained in a clinically feasible time).
Methods Sixty MS patients and 30 healthy controls underwent MRI scanning on a 3 Tesla scanner. The authors compared intracortical (IC) and leucocortical (LC) lesion counts obtained with a standard DIR sequence (1×1×3 mm resolution, obtained in 4 min) and a PSIR sequence (0.5×0.5×2 mm, 11 min). Lesions were marked separately on DIR and PSIR scans.
Results In the whole MS cohort, more cortical lesions were seen on the higher-resolution PSIR than the DIR scans (IC mean±SD: 18.1±9.8 vs 5.9±4.5, p<0.001; LC mean±SD: 13.4±12.9 vs 7.3±8.0, p<0.001). On PSIR, ≥1 IC lesion was seen in 60/60 MS patients and 1/30 controls, and ≥1 LC lesion in 60/60 patients and 6/30 controls. On DIR, ≥1 IC lesion was seen in 50/60 patients and 0/30 controls, and ≥1 LC lesion(s) in 60/60 patients and 5/30 controls.
Conclusions Compared with DIR, using PSIR the authors are able to detect a significantly greater number of cortical grey matter lesions. The presence of at least one IC lesion in every MS patient, but very few healthy controls, suggests that it may be a useful adjunct to conventional MRI when a diagnosis of MS is suspected but not confirmed.
- Multiple sclerosis
- cortical lesions
- grey matter
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Disclosure: The NMR Research Unit is supported by the MS Society of Great Britain and Northern Ireland and the UCL UCLH Comprehensive Biomedical Research Centre. Sethi V receives research support from Biogen Idec and Novartis. Yousry TA serves as Editor for European Radiology Journal and has received honoraria (Board Membership) from UCB, Bristol-Myers Squibb, Biogen Idec, and grants (PI or Co-PI Coordinator) from NIHR CBRC, MRC, MS Society, PSP, Stroke, BHF, Wellcome Trust, GSK, Biogen Idec, Novartis; Muhlert N reports no disclosures. Ron M reports no disclosures. Golay X has acted as a consultant for Philips Healthcare regarding the implementation of our ASL sequence in their product. Wheeler-Kingshott CA is on the advisory board for BG12 (Biogen). Miller DH DHM has received honoraria from Biogen Idec, Novartis, GlaxoSmithKline, and Bayer Schering, and research grant support for doing MRI analysis in multiple sclerosis trials sponsored by GlaxoSmithKline, Biogen Idec and Novartis. Chard DT, receives research support from the Multiple Sclerosis Society of Great Britain and Northern Ireland and holds stock in GlaxoSmithKline.
Statistical analysis completed by: Sethi V, NMR Research Unit, Department of Neuro-inflammation, UCL Institute of Neurology.
Funding The NMR Research Unit is supported by the MS Society of Great Britain and Northern Ireland and the UCL UCLH Comprehensive Biomedical Research Centre. The MS Society of Great Britain and Northern Ireland has provided financial support for staff and research costs. (Grant number 917-09).
Competing interests None.
Patient consent Informed consent form approved by local ethics committee (London Queen Square R.E.C) was used for this project and signed by every participant.
Ethics approval London Queen Square REC.
Provenance and peer review Not commissioned; externally peer reviewed.