Article Text

Research paper
DIR-visible grey matter lesions and atrophy in multiple sclerosis: partners in crime?
  1. Steven H P van de Pavert1,
  2. Nils Muhlert1,2,
  3. Varun Sethi1,
  4. Claudia A M Wheeler-Kingshott1,
  5. Gerard R Ridgway3,4,
  6. Jeroen J G Geurts5,
  7. Maria Ron1,
  8. Tarek A Yousry6,
  9. Alan J Thompson1,7,
  10. David H Miller1,7,
  11. Declan T Chard1,7,
  12. Olga Ciccarelli1,7
  1. 1NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
  2. 2School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Cardiff, Glamorgan, UK
  3. 3Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK
  4. 4Nuffield Department of Clinical Neurosciences, FMRIB Centre, University of Oxford, Oxford, UK
  5. 5Department Anatomy & Neurosciences, Section of Clinical Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
  6. 6Sara Koe PSP Research Centre, UCL Institute of Neurology, London, UK
  7. 7NIHR UCL/UCLH Biomedical Research Centre, London, UK
  1. Correspondence to Steven Harry Pieter van de Pavert, Institute of Neurology, University College London, WC1N 3BG, UK; s.pavert{at}


Background The extent and clinical relevance of grey matter (GM) pathology in multiple sclerosis (MS) are increasingly recognised. GM pathology may present as focal lesions, which can be visualised using double inversion recovery (DIR) MRI, or as diffuse pathology, which can manifest as atrophy. It is, however, unclear whether the diffuse atrophy centres on focal lesions. This study aimed to determine if GM lesions and GM atrophy colocalise, and to assess their independent relationship with motor and cognitive deficits in MS.

Methods Eighty people with MS and 30 healthy controls underwent brain volumetric T1-weighted and DIR MRI at 3 T, and had a comprehensive neurological and cognitive assessment. Probability mapping of GM lesions marked on the DIR scans and voxel- based morphometry (assessing GM atrophy) were carried out. The associations of GM lesion load and GM volume with clinical scores were tested.

Results DIR-visible GM lesions were most commonly found in the right cerebellum and most apparent in patients with primary progressive MS. Deep GM structures appeared largely free from lesions, but showed considerable atrophy, particularly in the thalamus, caudate, pallidum and putamen, and this was most apparent in secondary progressive patients with MS. Very little co-localisation of GM atrophy and lesions was seen, and this was generally confined to the cerebellum and postcentral gyrus. In both regions, GM lesions and volume independently correlated with physical disability and cognitive performance.

Conclusions DIR-detectable GM lesions and GM atrophy do not significantly overlap in the brain but, when they do, they independently contribute to clinical disability.

  • MRI

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