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  • Review Article
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Cortical lesions in multiple sclerosis

Abstract

Multiple sclerosis (MS) is typically considered to be a chronic inflammatory–demyelinating disease of CNS white matter. In the past decade, however, pathological and MRI studies have shown that lesions are often located in the gray matter, especially in the cerebral cortex. The histopathological characteristics of these cortical lesions differ substantially from lesions located in the white matter, which suggests location-dependent expression of the MS immunopathological process. Double inversion recovery imaging—an MRI technique that selectively images gray matter and lesions—has enabled researchers to image cortical lesions in vivo. Double inversion recovery studies have shown that cortical lesions can be detected at the earliest clinical stages of MS, and cortical lesion burden positively correlates with the severity of physical and cognitive impairments. These gray matter lesions are also independent predictors of subsequent disease evolution. This Review provides a summary of the main histopathological and MRI findings with regard to cortical lesions in MS, and indicates that increasing our understanding of cortical lesions has increased our knowledge of MS pathobiology.

Key Points

  • Four types of cortical lesion have been identified in multiple sclerosis (MS)

  • Double inversion recovery imaging detects more cortical lesions than conventional MRI

  • Cortical lesions can be identified at early clinical phases of MS, and are evident in 35–40% of patients with clinically isolated syndrome

  • Cortical lesions positively correlate with physical disability and with cognitive impairment in MS

  • Cortical lesions could be one of the pathological factors that lead to cortical atrophy in patients with MS

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Figure 1: The four types of cortical lesion identified by double inversion recovery imaging.
Figure 2: Cortical lesion identified using three-dimensional DIR imaging.

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Correspondence to Massimiliano Calabrese.

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Competing interests

M. Filippi has received honoraria from BayerScheringPharma, Biogen-Dompé, Genmab, Merck Serano and Teva for lectures and consulting. He has also received research funding from BayerScheringPharma, Biogen-Dompé, Genmab, Merck Serano and Teva. The other authors declare no competing interests.

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Calabrese, M., Filippi, M. & Gallo, P. Cortical lesions in multiple sclerosis. Nat Rev Neurol 6, 438–444 (2010). https://doi.org/10.1038/nrneurol.2010.93

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