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AJNR - American Journal of Neuroradiology

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Cortical Lesions in Multiple Sclerosis: Combined Postmortem MR Imaging and Histopathology

Jeroen J. G. Geurts^a, Lars Bö^c, Petra J. W. Pouwels^d, Jonas A. Castelijns^a, Chris H. Polman^b and Frederik Barkhof^a

^a Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands
^b Neurology, VU University Medical Center, Amsterdam, the Netherlands
^c Pathology, Division of Neuropathology, VU University Medical Center, Amsterdam, the Netherlands
^d MS Research Center, and the Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, the Netherlands

View larger version (123K): [in a new window]   FIG 1. Example of a tissue sample and the matching area on postmortem MR images. WM lesions (WM), as well as type I lesions (I, mixed GM-WM), can be seen with relative ease on the different MR images. Intracortical lesions (IC) are difficult to detect and define, even in retrospect. A, Photomicrograph (MBP immunohistochemical stain) reveals lesions (arrowheads) in the WM and cortical GM. B, Short-echo T2-weighted SE image. Insert, a higher magnification of the intracortical lesion. C, Long-echo T2-weighted SE image. D, 3D FLAIR image.

View larger version (12K): [in a new window]   FIG 2. Lesion scores. I, type I cortical lesions; DGML indicates deep GM lesions; WML, WM lesions; total, total of all lesion categories; PA, lesions detected histopathologically; T2, lesions detected on postmortem T2SE imaging; and FLAIR, lesions detected on postmortem 3D FLAIR imaging. A, Blinded. B, After unblinding, numbers of detected lesions in all categories increased (retrospective scoring). However, a significant proportion of intracortical lesions remained undetectable.