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Dirty-appearing white matter in multiple sclerosis

Preliminary observations of myelin phospholipid and axonal loss

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Abstract

“Dirty-appearing white matter” (DAWM) in multiple sclerosis (MS) is defined as a region(s) with ill-defined borders of intermediate signal intensity between that of normal-appearing white matter (NAWM) and that of plaque on T2-weighted and proton density imaging. To delineate the histopathology of DAWM, four formalin-fixed cerebral hemisphere slices of three MS patients with DAWM were scanned with T2- weighted and proton density sequences. The myelin water fraction (MWF) was obtained by expressing the short T2 component as a fraction of the total T2 distribution. Hemispheric sections were then stained with Luxol fast blue (LFB) for myelin phospholipids, for myelin basic protein (MBP) and 2’,3’-cyclic nucleotide 3’-phosphohydrolase (CNP) for myelin; Bielschowsky silver impregnation for axons; and for glial fibrillary acidic protein (GFAP) for astrocytes. Compared to NAWM, DAWM showed reduction in MWF, corresponding to a reduction of LFB staining. DAWM also showed reduced Bielschowsky staining. Quantitatively, the change in MWF in DAWM most consistently correlated with the change in LFB staining. The findings of this preliminary study suggest that DAWM is characterized by loss of myelin phospholipids, detected by the short T2 component, and axonal reduction.

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Authors and Affiliations

  1. Dept. of Pathology and Laboratory Medicine (Neuropathology), Vancouver General Hospital, 855 West 12th Ave, Vancouver, BC, Canada, V5Z 1M9

    G. R. W. Moore MD, FRCPC

  2. University of British Columbia, British Columbia, Canada

    G. R. W. Moore MD, FRCPC & E. Leung M.Sc

  3. Dept. of Radiology, UBC Hospital and Vancouver General, Hospital and University of British Columbia, British Columbia, Canada

    A. MacKay PhD & D. K. B. Li MD, FRCPC

  4. Dept. of Physics and Astronomy, University of British Columbia, British Columbia, Canada

    C. Laule PhD & A. MacKay PhD

  5. MS/MRI Research Group, University of British Columbia, British Columbia, Canada

    C. Laule PhD, A. MacKay PhD, D. K. B. Li MD, FRCPC, G. Zhao MD, A. L. Traboulsee MD, FRCPC & D. W. Paty MD, FRCPC

  6. Dept. of Medicine (Neurology) and Multiple Sclerosis Clinic, UBC Hospital Vancouver, British Columbia, Canada

    A. L. Traboulsee MD, FRCPC & D. W. Paty MD, FRCPC

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  1. G. R. W. Moore MD, FRCPC
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  2. C. Laule PhD
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  3. A. MacKay PhD
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  4. E. Leung M.Sc
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  5. D. K. B. Li MD, FRCPC
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  6. G. Zhao MD
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  7. A. L. Traboulsee MD, FRCPC
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  8. D. W. Paty MD, FRCPC
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Correspondence to G. R. W. Moore MD, FRCPC.

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† Deceased

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Moore, G.R.W., Laule, C., MacKay, A. et al. Dirty-appearing white matter in multiple sclerosis. J Neurol 255, 1802–1811 (2008). https://doi.org/10.1007/s00415-008-0002-z

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  • DOI: https://doi.org/10.1007/s00415-008-0002-z

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