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Review
. 2024 Aug;34(3):453-468.
doi: 10.1016/j.nic.2024.03.007. Epub 2024 May 19.

Decoding Gray Matter Involvement in Multiple Sclerosis via Imaging

Robert Zivadinov  1 , Ferdinand Schweser  2 , Dejan Jakimovski  3 , Niels Bergsland  3 , Michael G Dwyer  2
Affiliations
Review

Decoding Gray Matter Involvement in Multiple Sclerosis via Imaging

Robert Zivadinov et al. Neuroimaging Clin N Am. 2024 Aug.

Abstract

Multiple sclerosis (MS) is increasingly understood not only as a white matter disease but also involving both the deep and cortical gray matter (GM). GM pathology in people with MS (pwMS) includes the presence of lesions, leptomeningeal inflammation, atrophy, altered iron concentration, and microstructural changes. Studies using 7T and 3T MR imaging with optimized protocols established that GM damage is a principal driver of disease progression in pwMS. Future work is needed to incorporate the assessment of these GM imaging biomarkers into the clinical workup of pwMS and the assessment of treatment efficacy.

Keywords: 3T; 7T; Atrophy; Cortical lesions; Gray matter; Iron concentration; Leptomeningeal inflammation; Pathology.

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Conflict of interest statement

Disclosure R. Zivadinov received personal compensation from Bristol Myers Squibb, Biogen Idec, EMD Serono, Sanofi, Mapi Pharma, Filterlex, and 3D Communications for speaking and consultant fees. He received financial support for research activities from Bristol-Myers Squibb, United States, Novartis, CorEvitas, Mapi Pharma, Octave, EMD Serono, United States, and Protembis. D. Jakimovski received personal compensation from EMD Serono and AstraZeneca for consultant fees. He received financial support for research activities from ClinSTAR by NIA under award U24AG065204. M.G. Dwyer received grant support from Novartis, Bristol Myers Squibb, Mapi Pharma, Merck Serono, Keystone Heart Ltd., Protembis GmbH, V-Wave Ltd, and Filterlex Medical Ltd, and consulting fees from Bristol Myers Squibb, Merck Serono, Keystone Heart Ltd, and Mapi Pharma.

Figures

Figure 1.
Figure 1.
Identification of cortical lesion using MP2RAGE at 7T MRI in a 33-year-old pwRRMS. The lesion is seen as hypointense (white arrow). MP2RAGE – magnetization-prepared 2 rapid acquisition gradient echo, pwRRMS-patient with relapsing-remitting multiple sclerosis.
Figure 2.
Figure 2.
Identification of cortical lesions using AI-DIR (far left column), T1/T2 signal intensity ratio (middle left column), FLAIR-squared (middle right column) and FLAIR (far right column) images in a 43-year-old pwRRMS (top row), a 55-year-old pwSPMS (middle row) and a 63-year-old pwPPMS (bottom row). Cortical lesions are visible as hyperintense on AI-DIR and FLAIR-squared images, and as hypointense on T1/T2 signal intensity ratio images (white arrows). It is difficult to recognize these cortical lesions on corresponding areas of the FLAIR images (white arrows). AI-DIR – artificial intelligence derived double inversion recovery, FLAIR – fluid-attenuated inversion recovery, pwMS-patient with multiple sclerosis, RR – relapsing-remitting, SP – secondary-progressive, PP – primary-progressive.
Figure 3.
Figure 3.
Illustration of thalamic iron loss over time assessed with QSM. Susceptibility maps of a 48-year-old (at baseline) male pwRRMS is shown in the top row. Susceptibility maps of a 43-year-old female control are shown in the bottom row. Magnetic susceptibility of the pulvinar nucleus of the thalamus (arrows) progressively declined in the patient (change relative to baseline printed in red) whereas it slightly increased in the control over 6-7 years. QSM – quantitative susceptibility mapping, pwRRMS-patient with relapsing-remitting multiple sclerosis.
See this image and copyright information in PMC

References

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