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Research paper
A longitudinal study of cortical grey matter lesion subtypes in relapse-onset multiple sclerosis
  1. Varun Sethi1,
  2. Tarek Yousry1,2,
  3. Nils Muhlert3,
  4. Daniel J Tozer4,
  5. Daniel Altmann1,5,
  6. Maria Ron1,
  7. Claudia Wheeler-Kingshott1,
  8. David H Miller1,6,
  9. Declan T Chard1,6
  1. 1NMR Research Unit, Department of Neuroinflammation, Queen Square MS Centre, UCL Institute of Neurology, London, UK
  2. 2Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, UK
  3. 3School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, UK
  4. 4Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
  5. 5Medical Statistics Department, London School of Hygiene & Tropical Medicine, London, UK
  6. 6National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, London, UK
  1. Correspondence to Dr Declan T Chard, Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG, UK; d.chard{at}ucl.ac.uk

Abstract

Background Cortical grey matter (GM) lesions are common in multiple sclerosis (MS), but little is known about their temporal evolution. We investigated this in people with relapsing–remitting (RR) and secondary progressive (SP) MS.

Methods 27 people with RRMS, and 22 with SPMS were included in this study. Phase-sensitive inversion recovery scans were acquired on 2 occasions. Cortical GM lesions were classified as intracortical (IC, only involving GM) and leucocortical (LC, mixed GM–white matter (WM)); WM lesions touching the cortex as juxtacortical (JC). On follow-up scans, new IC, LC and JC lesions were identified, and any change in classification of lesions previously observed was noted. WM lesion counts in the whole brain were assessed on PD/T2-weighted scans.

Results Over a mean (SD) of 21.0 (5.8) months, the number of new IC lesions per person per year was greater in SPMS (1.6 (1.9)) than RRMS (0.8 (1.9)) (Mann-Whitney p=0.039). All new LC lesions arose from previously seen IC lesions (SPMS 1.4 (1.8) per person per year, and RRMS 1.1 (1.0)), and none arose de novo, or from previously seen JC lesions. Changes in cortical GM (either new IC or IC converting to LC) lesion counts did not correlate with the changes in WM lesion counts.

Conclusions New cortical GM lesions rarely arise from the WM and the rate of new IC lesion formation is not closely linked with WM lesion accrual. IC lesion formation appears to be more common in SPMS than RRMS.

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