Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis

Background: Accurate classification of multiple sclerosis (MS) lesions in the brain cortex may be important in understanding their impact on cognitive impairment (CI). Improved accuracy in identification/classification of cortical lesions was demonstrated in a study combining two magnetic resonance imaging (MRI) sequences: double inversion recovery (DIR) and T1-weighted phase-sensitive inversion recovery (PSIR). Objective: To evaluate the role of intracortical lesions (IC) in MS-related CI and compare it with the role of mixed (MX), juxtacortical (JX), the sum of IC + MX and with total lesions as detected on DIR/PSIR images. Correlations between CI and brain atrophy, disease severity and disease duration were also sought. Methods: A total of 39 patients underwent extensive neuropsychological testing and were classified into normal and impaired groups. Images were obtained on a 3T scanner and cortical lesions were assessed blind to the cognitive status of the subjects. Results: Some 238 cortical lesions were identified (130 IC, 108 MX) in 82% of the patients; 39 JX lesions were also identified. Correlations between CI and MX lesions alone (p = 0.010) and with the sum of IC + MX lesions (p = 0.030) were found. A correlation between severity of CI and Expanded Disability Status Scale was also seen (p = 0.009). Conclusion: Cortical lesions play an important role in CI. However, our results suggest that lesions that remain contained within the cortical ribbon do not play a more important role than ones extending into the adjacent white matter; furthermore, the size of the cortical lesion, and not the tissue-specific location, may better explain their correlation with CI.

[1]  Jitendra Malik,et al.  Scale-Space and Edge Detection Using Anisotropic Diffusion , 1990, IEEE Trans. Pattern Anal. Mach. Intell..

[2]  B. Brownell,et al.  The distribution of plaques in the cerebrum in multiple sclerosis , 1962, Journal of neurology, neurosurgery, and psychiatry.

[3]  A. Compston,et al.  Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis , 2001, Annals of neurology.

[4]  S. Rao,et al.  On the nature of memory disturbance in multiple sclerosis. , 1989, Journal of clinical and experimental neuropsychology.

[5]  Stephen M Rao,et al.  Cognitive dysfunction in multiple sclerosis: a review of recent developments. , 2003, Current opinion in neurology.

[6]  R. He,et al.  Unified Approach for Multiple Sclerosis Lesion Segmentation on Brain MRI , 2006, Annals of Biomedical Engineering.

[7]  J. Wolinsky,et al.  Linomide in relapsing and secondary progressive MS , 2000, Neurology.

[8]  Ponnada A Narayana,et al.  Segmentation of gadolinium‐enhanced lesions on MRI in multiple sclerosis , 2007, Journal of magnetic resonance imaging : JMRI.

[9]  R. Bakshi,et al.  Frontal cortex atrophy predicts cognitive impairment in multiple sclerosis. , 2002, The Journal of neuropsychiatry and clinical neurosciences.

[10]  S. Sorbi,et al.  Neocortical volume decrease in relapsing–remitting multiple sclerosis with mild cognitive impairment , 2006, Journal of the Neurological Sciences.

[11]  P. Narayana,et al.  Improved Identification of Intracortical Lesions in Multiple Sclerosis with Phase-Sensitive Inversion Recovery in Combination with Fast Double Inversion Recovery MR Imaging , 2007, American Journal of Neuroradiology.

[12]  Stephen M. Rao.  Cognitive Function in Patients with Multiple Sclerosis: Impairment and Treatment , 2004 .

[13]  M. Lezak,et al.  Neuropsychological assessment, 4th ed. , 2004 .

[14]  P A Narayana,et al.  Volumetric analysis of white matter, gray matter, and CSF using fractional volume analysis , 1998, Magnetic resonance in medicine.

[15]  Jonathan Taylor,et al.  Statistical mapping analysis of lesion location and neurological disability in multiple sclerosis: application to 452 patient data sets , 2003, NeuroImage.

[16]  R. Kane,et al.  T1 cortical hypointensities and their association with cognitive disability in multiple sclerosis , 2010, Multiple sclerosis.

[17]  Rohit Bakshi,et al.  Bicaudate ratio as a magnetic resonance imaging marker of brain atrophy in multiple sclerosis. , 2002, Archives of neurology.

[18]  J. Hodges,et al.  Cognitive presentation of multiple sclerosis: evidence for a cortical variant , 2003, Journal of neurology, neurosurgery, and psychiatry.

[19]  Frederik Barkhof,et al.  Intracortical lesions in multiple sclerosis: improved detection with 3D double inversion-recovery MR imaging. , 2005, Radiology.

[20]  Alan J. Thompson,et al.  Disability and lesion load in MS: a reassessment with MS functional composite score and 3D fast FLAIR , 2002, Journal of Neurology.

[21]  I Litvan,et al.  Multiple memory deficits in patients with multiple sclerosis. Exploring the working memory system. , 1988, Archives of neurology.

[22]  P. Rossini,et al.  Patterns of Cognitive Impairment in Secondary Progressive Stable Phase of Multiple Sclerosis: Correlations with MRI Findings , 2001, European Neurology.

[23]  Rohit Bakshi,et al.  Prediction of neuropsychological impairment in multiple sclerosis: comparison of conventional magnetic resonance imaging measures of atrophy and lesion burden. , 2004, Archives of neurology.

[24]  F. Lublin,et al.  Linomide in relapsing and secondary progressive MS , 2000, Neurology.

[25]  Ponnada A Narayana,et al.  Global optimization of mutual information: application to three-dimensional retrospective registration of magnetic resonance images. , 2002, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[26]  M. Rovaris,et al.  Cognitive dysfunction in patients with mildly disabling relapsing–remitting multiple sclerosis: an exploratory study with diffusion tensor MR imaging , 2002, Journal of the Neurological Sciences.

[27]  K. Hasan,et al.  Phase-sensitive T1 inversion recovery imaging: a time-efficient interleaved technique for improved tissue contrast in neuroimaging. , 2005, AJNR. American journal of neuroradiology.

[28]  R. Jouvent,et al.  Cognitive function in recent-onset demyelinating diseases. , 1986, Archives of neurology.

[29]  Jayaram K. Udupa,et al.  New variants of a method of MRI scale standardization , 2000, IEEE Transactions on Medical Imaging.

[30]  G Cazzato,et al.  A longitudinal study of brain atrophy and cognitive disturbances in the early phase of relapsing-remitting multiple sclerosis , 2001, Journal of neurology, neurosurgery, and psychiatry.

[31]  A. Thompson,et al.  Neuropsychological impairment in multiple sclerosis patients: the role of (juxta)cortical lesion on FLAIR , 2000, Multiple sclerosis.

[32]  J. Wolinsky,et al.  3D MPRAGE improves classification of cortical lesions in multiple sclerosis , 2008, Multiple sclerosis.

[33]  Frederik Barkhof,et al.  Cortical lesions in multiple sclerosis: combined postmortem MR imaging and histopathology. , 2005, AJNR. American journal of neuroradiology.

[34]  R. Bakshi,et al.  Cognitive impairment is associated with subcortical magnetic resonance imaging grey matter T2 hypointensity in multiple sclerosis , 2006, Multiple sclerosis.

[35]  N. Staff,et al.  Multiple sclerosis with predominant, severe cognitive impairment. , 2009, Archives of neurology.

[36]  F. Barkhof,et al.  Cortical lesions in multiple sclerosis. , 1999, Brain : a journal of neurology.

[37]  G Luccichenti,et al.  Cognitive impairment and its relation with disease measures in mildly disabled patients with relapsing–remitting multiple sclerosis: baseline results from the Cognitive Impairment in Multiple Sclerosis (COGIMUS) study , 2009, Multiple sclerosis.

[38]  L D Blumhardt,et al.  Cognitive correlates of supratentorial atrophy on MRI in multiple sclerosis , 2001, Acta neurologica Scandinavica.

[39]  Massimo Filippi,et al.  Cortical lesions and atrophy associated with cognitive impairment in relapsing-remitting multiple sclerosis. , 2009, Archives of neurology.