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Neuropsychological impairment in multiple sclerosis patients: the role of (juxta)cortical lesion on FLAIR

Department of Radiology, MS-MRI centre of the Academic Hospital, Vrije Universiteit, Amsterdam, The Netherlands

D W Langdon

Department of Clinical Neurology, The Institute of Neurology, University College, London, UK

M Filippi

Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute Ospedale San Raffaele, University of Milan, Italy

J HTM van Waesberghe

Department of Radiology, MS-MRI centre of the Academic Hospital, Vrije Universiteit, Amsterdam, The Netherlands

V L Stevenson

Department of Clinical Neurology, The Institute of Neurology, University College, London, UK

J BS Boringa

Department of Neurology, MS-MRI centre of the Academic Hospital of the Vrije Universiteit, Amsterdam, The Netherlands

D Origgi

Neuroimaging Research Unit, Department of Neuroscience, Scientific Institute Ospedale San Raffaele, University of Milan, Italy

A J Thompson

Department of Clinical Neurology, The Institute of Neurology, University College, London, UK

M Falautano

Clinical Trials Unit, Department of Neuroscience, Scientific Institute Ospedale San Raffaele, University of Milan, Italy

ChH Polman

Department of Neurology, MS-MRI centre of the Academic Hospital of the Vrije Universiteit, Amsterdam, The Netherlands

F Barkhof

Department of Radiology, MS-MRI centre of the Academic Hospital, Vrije Universiteit, Amsterdam, The Netherlands

In this study we evaluated the correlation between neuropsychological impairment (measured with the Brief Repeatable Battery Neuropsychological Tests) and (juxta)cortical lesions detected with FLAIR and the relative sensitivity of the FLAIR sequence compared to spin-echo MRI sequences in detecting (juxta)cortical MS lesions. A total of 39 patients with definite MS were evaluated by MRI with a conventional and fast spin echo sequence and fast FLAIR sequence, and neuropsychological tests of the Brief Repeatable Battery Neuropsychological tests were performed. The Z-score of all subtests were used to calculate a Cognitive Impairment Index. The results show that a high number of (juxta)cortical lesions is detected with thin slice FLAIR (30% of all lesions seen). This percentage was not superior to spin-echo, reflecting the thin slice thickness (3 mm) we used. The lesions detected with FLAIR were to a certain degree different ones than the lesions detected with the other techniques. While the number of non-cortical lesions correlated with the expanded disability status scale (r=0.32, P=0.045), the number of (juxta)cortical lesions detected with the FLAIR showed a correlation (r=0.34, P=0.035) with the Cognitive Impairment Index. Our study underlines the high number of (juxta)cortical lesions in MS and the value of thin slice FLAIR sequence to detect such lesions with MRI. It also stresses the importance of (juxta)cortical lesions on determining neuropsychological impairment.

Key Words: multiple sclerosis • magnetic resonance • FLAIR • neuropsychology

Multiple Sclerosis, Vol. 6, No. 4, 280-285 (2000)
DOI: 10.1177/135245850000600410


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