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

¹ The Multiple Sclerosis Centre of Veneto Region – First Neurology Clinic, Department of Neurosciences, University Hospital of Padua, Padua, Italy
² Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute and University, Milan, Italy
³ Neuroradiology Unit, Euganea Medica, Albignasego, Padua, Italy
⁴ CRIBI – Biotechnology Centre and Department of Biology, University of Padua, Padua, Italy

^* To whom correspondence should be addressed.

	Abstract

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

First published on August 28, 2008, doi:10.1177/1352458508096686

Multiple Sclerosis 2009;15:36.

A more recent version of this article appeared on January 1, 2009


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