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Identification of cortical lesions using DIR and FLAIR in early stages of multiple sclerosis

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Abstract

The use of non-routine MRI sequences such as DIR has highlighted the role of gray matter (GM) pathology in multiple sclerosis (MS). The aim of this study was to assess the detection and relevance of cortical lesions (CLs) using MRI in early (<5 years) MS patients. 3D DIR and 3D FLAIR images at 3T from 122 patients [93 relapsing–remitting MS (RRMS), 29 clinically isolated syndrome (CIS)] were scored for CLs by two blinded readers. Patients were divided into two groups depending on the presence or absence of CLs. For FLAIR, 51 CLs were identified, of which 13 were purely intracortical and 38 mixed CLs; for DIR, this was 60 in total and 16 and 44, respectively. In both groups, there was no difference in GM fraction. Neuropsychological testing was performed for a subgroup of 66 patients. In 22.1 % of patients CLs were identified. The number of CLs revealed an association with lower working memory scores and semantical word fluency. Overall, CLs imaged with 3D FLAIR and 3D DIR sequences are found more frequently in RRMS patients than CIS and may also be a correlate for mild neuropsychological pathology.

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Acknowledgments

F.Z. is grateful for financial support from the German Multiple Sclerosis Competence Network (KKNMS, Project B7.3) funded by the Federal Ministry for Education and Research (BMBF).

Conflicts of interest

Pierre Kolber reports no conflicts of interest and financial disclosures. Swantje Montag reports no conflicts of interest and financial disclosures. Dr. Vinzenz Fleischer reports no conflicts of interest and financial disclosures. Dr. Felix Lüssi reports no conflicts of interest and financial disclosures. Janine Wilting reports no conflicts of interest and financial disclosures. Dr. Joachim Gawehn reports no conflicts of interest and financial disclosures. Dr. Adriane Gröger reports no conflicts of interest and financial disclosures. Dr. Frauke Zipp has received research grants from Teva, Merck Serono, Novartis and Bayer as well as consultation funds from Teva, Merck Serono, Novartis, Bayer Healthcare, Biogen Idec Germany, ONO, Genzyme, Sanofi-Aventis and Octapharma. Her travel compensation has been provided for by the aforementioned companies.

Ethical standard

All patients gave their written informed consent to examinations before participating in this study, which was approved by the local ethics committee and adhered to institutional guidelines in accordance with the Declaration of Helsinki.

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    Authors and Affiliations

    1. Department of Neurology, Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany

      Pierre Kolber, Swantje Montag, Vinzenz Fleischer, Felix Luessi, Janine Wilting, Adriane Gröger & Frauke Zipp

    2. Institute of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

      Joachim Gawehn

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    Correspondence to Frauke Zipp.

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    A. Gröger and F. Zipp contributed equally.

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    Kolber, P., Montag, S., Fleischer, V. et al. Identification of cortical lesions using DIR and FLAIR in early stages of multiple sclerosis. J Neurol 262, 1473–1482 (2015). https://doi.org/10.1007/s00415-015-7724-5

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