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Evidence for relative cortical sparing in benign multiple sclerosis: a longitudinal magnetic resonance imaging study

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

M Filippi

Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute and University, Milan, Italy

M Rovaris

Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute and University, Milan, Italy

V Bernardi

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

M Atzori

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

I Mattisi

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

A Favaretto

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

P Grossi

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

L Barachino

Neuroradiology Unit, Euganea Medica, Albignasego, Padua, Italy

L Rinaldi

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

C Romualdi

CRIBI – Biotechnology Centre and Department of Biology, University of Padua, Padua, Italy

P Perini

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

P Gallo

The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy

Background

Using double inversion recovery (DIR) MRI, cortical lesions can be seen in the brain of patients with multiple sclerosis (MS). The burden of such lesions seems to be well correlated with the severity of MS-related disability.

Objective

To investigate whether the extent of cortical damage in patients with benign MS (BMS) might contribute to explain their favorable clinical status.

Methods

Forty-eight patients with BMS (Expanded Disability Status Scale [EDSS] score 3.0 and disease duration 15 years) and 96 patients with non-disabling, early relapsing–remitting (RR) MS (EDSS score 3.0 and disease duration 5 years) were studied. Brain MRI, including a DIR and a fluid-attenuated inversion recovery (FLAIR) sequence, was acquired at baseline and after 12 months. On DIR images, intracortical (ICL) and cortical-subcortical lesions (CSL) were identified and their number and volume calculated. Total white matter (WM) lesion volume was quantified on FLAIR images.

Results

Compared with early RRMS, patients with BMS had lower number of ICL at both study time points (P  0.001 for both comparisons). At one-year follow-up, a significant increase of ICL and CSL number and total volume was observed only in early patients with RRMS. The number and volume of cortical lesions was not correlated with WM lesion volume. Total ICL number at baseline, total cortical lesion volume at baseline, and total cortical lesion volume change were independent predictors of MS phenotype.

Conclusion

In patients with BMS, the selective sparing of the cortex from disease-related focal pathology might be one of the factors associated to their favorable clinical status, independently of the (possible) accrual of WM lesions.

Key Words: multiple sclerosis • cortical lesions • double inversion recovery sequence

This version was published on January 1, 2009

Multiple Sclerosis, Vol. 15, No. 1, 36-41 (2009)
DOI: 10.1177/1352458508096686


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