title: Intracortical lesions by 3T magnetic resonance imaging and correlation with cognitive impairment in multiple sclerosis.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, University of Texas-Houston, Health Science Center, Houston, Texas, USA. flavia.m.nelson@uth.tmc.edu
authors.forename: Flavia
authors.initials: F
authors.lastname: Nelson
authors.forename: Sushmita
authors.initials: S
authors.lastname: Datta
authors.forename: Nereyda
authors.initials: N
authors.lastname: Garcia
authors.forename: Nigel L
authors.initials: NL
authors.lastname: Rozario
authors.forename: Francisco
authors.initials: F
authors.lastname: Perez
authors.forename: Gary
authors.initials: G
authors.lastname: Cutter
authors.forename: Ponnada A
authors.initials: PA
authors.lastname: Narayana
authors.forename: Jerry S
authors.initials: JS
authors.lastname: Wolinsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001284:Atrophy / Q000473:pathology / Q000503:physiopathology; D002540:Cerebral Cortex / Q000473:pathology* / Q000503:physiopathology; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology; D009483:Neuropsychological Tests