The evaluation of multiple sclerosis by magnetic resonance imaging

Cortical injury in multiple sclerosis; the role of the immune system

The easily identifiable, ubiquitous demyelination and neuronal damage that occurs within the cerebral white matter of patients with multiple sclerosis (MS) has been the subject of extensive study. Accordingly, MS has historically been described as a disease of the white matter. Recently, the cerebral cortex (gray matter) of patients with MS has been recognized as an additional and major site of disease pathogenesis. This acknowledgement of cortical tissue damage is due, in part, to more powerful MRI that allows detection of such injury and to focused neuropathology-based investigations. Cortical tissue damage has been associated with inflammation that is less pronounced to that which is associated with damage in the white matter. There is, however, emerging evidence that suggests cortical damage can be closely associated with robust inflammation not only in the parenchyma, but also in the neighboring meninges. This manuscript will highlight the current knowledge of inflammation associated with cortical tissue injury. Historical literature along with contemporary work that focuses on both the absence and presence of inflammation in the cerebral cortex and in the cerebral meninges will be reviewed.

The callosal-septal interface lesion in multiple sclerosis: effect of sequence and imaging plane

We examined the effect of imaging plane and sequence on the demonstration of lesions at the callosal-septal interface (CSI) by magnetic resonance imaging in 20 patients with known multiple sclerosis. Variable-echo-(VE) T2- and proton density (PD) weighted images were performed in coronal axial and sagittal planes. Sagittal gradient echo (GE) T2- and PD-weighted images were also performed. Lesions at the CSI were seen in all patients and were all demonstrated on both sagittal and coronal VE images. Sagittal PD-weighted GE images were slightly less sensitive but showed good overall agreement with sagittal VE. Axial VE and sagittal T2-weighted GE images demonstrated CSI lesions poorly.