title: Lesions by tissue specific imaging characterize multiple sclerosis patients with more advanced disease.
abstract: BACKGROUND
  Cerebrospinal fluid tissue specific imaging (CSF-TSI), a newly implemented magnetic resonance imaging (MRI) technique, allows visualization of a subset of chronic black holes (cBHs) with MRI characteristics suggestive of the presence of CSF-like fluid, and representing lesions with extensive tissue destruction.
  
  
  OBJECTIVE
  To investigate the relationship between lesions in CSF-TSI and disease measures in patients with multiple sclerosis (MS).
  
  
  METHODS
  Twenty-six patients with MS were imaged at 3.0 T, obtaining T(1)-weighted (T(1)-w) and T(2)-w spin echo (SE), T(1) volumetric images and CSF-TSI images. We measured: (i) lesion volume (LV) in T(1)-w (cBH-LV) and T(2)-w SE images, and in CSF-TSI; (ii) brain parenchyma fraction (BPF). Differences between patients with and without CSF-TSI lesions were analyzed and association between clinical and MRI metrics were investigated.
  
  
  RESULTS
  cBHs were seen in 92% of the patients while lesions in CSF-TSI were seen in 40%. Patients with CSF-TSI lesions were older, with longer disease duration, higher disability scores, larger cBH-LV and T(2)-LV, and lower BPF than patients without CSF-TSI lesions (≤0.047). Partial correlation analysis correcting for T(2)-LV, cBH-LV and BPF showed an association (p < 0.0001, r = 0.753) between CSF-TSI LV and disability score.
  
  
  CONCLUSIONS
  CSF-TSI lesions characterize patients with more advanced disease and probably contribute to the progress of disability.
authors.affiliation: National Institutes of Neurological Disorders and Stroke, Building 10, Room C103, NIH, Bethesda, MD, USA. francesca.r.bagnato@vanderbilt.edu
authors.forename: Francesca
authors.initials: F
authors.lastname: Bagnato
authors.forename: Vasiliki N
authors.initials: VN
authors.lastname: Ikonomidou
authors.forename: Peter
authors.initials: P
authors.lastname: van Gelderen
authors.forename: Sungyoung
authors.initials: S
authors.lastname: Auh
authors.forename: Jailan
authors.initials: J
authors.lastname: Hanafy
authors.forename: Fredric K
authors.initials: FK
authors.lastname: Cantor
authors.forename: Joan
authors.initials: J
authors.lastname: Ohayon
authors.forename: Nancy
authors.initials: N
authors.lastname: Richert
authors.forename: Jeff
authors.initials: J
authors.lastname: Duyn
mesh_terms: D000465:Algorithms; D001921:Brain / Q000473:pathology*; D002555:Cerebrospinal Fluid; D004185:Disability Evaluation; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000473:pathology*; D012680:Sensitivity and Specificity