Cortical lesions in primary progressive multiple sclerosis: a 2-year longitudinal MR study.
BACKGROUND
In primary progressive multiple sclerosis (PPMS), a discrepancy exists between the modest brain white matter (WM) lesion burden and the severity of neurologic disability. Double-inversion recovery (DIR) sequences have improved MRI sensitivity in the detection of cortical lesions (CLs) in patients with relapsing-onset MS.


OBJECTIVE
This 2-year longitudinal study was designed to assess the frequency, extent, and rate of formation of CLs in PPMS and their relationship with T2 lesion volume (LV), gray matter (GM) atrophy, and disability.


METHODS
Forty-eight patients with PPMS underwent clinical and magnetic resonance examinations at baseline and after 2 years. The number and volume of CLs, WM T2 LV, and GM fraction (GMf) were assessed at baseline and at follow-up.


RESULTS
At baseline, CLs were detected in 81.2% of patients with PPMS. At least one new CL was found in 28 patients during the follow-up. In patients with PPMS, CL and T2 WM LVs increased over the follow-up. At baseline, CL number and volumes were significantly correlated with T2 WM LV, GMf, disease duration, and Expanded Disability Status Scale score, as well as with increasing GM atrophy and disability during the follow-up. A multivariate analysis showed that CL volume at baseline was an independent predictor of percentage GM volume change and disability accumulation during the subsequent 2-year period.


CONCLUSIONS
Cortical lesions are a frequent finding in primary progressive multiple sclerosis. The extent of such abnormalities is associated with the extent of cortical atrophy and clinical disability, and is able to predict their changes over a medium time period.
Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute and University, Via Olgettina 60, 20132 Milan, Italy.
M
M
Calabrese
M A
MA
Rocca
M
M
Atzori
I
I
Mattisi
V
V
Bernardi
A
A
Favaretto
L
L
Barachino
C
C
Romualdi
L
L
Rinaldi
P
P
Perini
P
P
Gallo
M
M
Filippi
D000293:Adolescent; D000328:Adult; D002540:Cerebral Cortex / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000473:pathology*; D015999:Multivariate Analysis; D055815:Young Adult