More Brain lesions in people with clinically definite MS compared to CIS

Kolber P, Montag S, Fleischer V, Luessi F, Wilting J, Gawehn J, Gröger A, Zipp F. Identification of cortical lesions using DIR and FLAIR in early stages of multiple sclerosis. J Neurol. 2015 Apr 11. [Epub ahead of print]

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.

T2 weighted images make the luid look bright compared to T1 weighted images when this looks dark. In FLAIR imaging the signal of the spinal fluid is suppressed to the CSF and ventricles look dark and so lesions are easier to spot. Likewise Double inversion recovery also supresses the signal from the cerebrospinal fluid. In this study they find more grey matter lesions in MSers compared to CISers and there were more lesions in the MSers with cognitive problems. So the moral of the story again is get on top your MS as early as possible. 

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  • I was diagnosed with CIS when I had MS. Unfortunately the neurologist said they didn't have access to see my MRI scans at this appointment as they had not been sent from my previous hospital. This appointment was six months after my second relapse, so my third neurology appointment. The notes just mentioned lesions which may be demyelination. So sadly I got to begin my first DMT getting on three years from this second relapse by that time I'd had more relapses. I was the one who had to keep chasing for the scans to be sent through to my current hospital!
    Like one MSer mentioned a few days ago on this blog… it's best to get copies of your MRI scans, medical notes, examination notes, letters to patient and GP, lists of symptoms and have them in a folder with you ready to take to your neurologist appointments.
    Barriers to getting a proper diagnosis and access to DMT!

    • I do all the above, I have folders full of notes. The only person that looks after me from memory is my neurologist. Good thing really, half the time my notes haven't turned up and the computer is down.

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