No association between cortical lesions and leptomeningeal enhancement on 7-Tesla MRI in multiple sclerosis

Abstract

Background: Autopsy data suggest a causative link between meningeal inflammation and cortical lesions (CLs) in multiple sclerosis (MS). Objective: To use leptomeningeal enhancement (LME) and CLs on 7-Tesla (7T) magnetic resonance imaging (MRI) to investigate associations between meningeal inflammation and cortical pathology. Methods: Forty-one participants with MS underwent 7T MRI of the brain. CLs and foci of LME were quantified. Results: All MS participants had CLs; 27 (65.8%) had >1 focus of LME. Except for hippocampal CL count (ρ = 0.32 with spread/fill-sulcal pattern LME, p = 0.042), no significant correlations were seen between LME and CLs. Mean cortical thickness correlated with the number of LME foci (ρ = –0.43, p = 0.005). Participants with relapsing–remitting multiple sclerosis (RRMS) showed no correlation with neocortical CLs, but significant correlations were seen between LME and hippocampal lesion count (ρ = 0.39, p = 0.030), normalized cortical gray matter (GM) volume (ρ = –0.49, p = 0.005), and mean cortical thickness (ρ = –0.59, p < 0.001). Conclusion: This study supports a relationship between LME and cortical GM atrophy but does not support an association of LME and neocortical CLs. This may indicate that meningeal inflammation is involved with neurodegenerative inflammatory processes, rather than focal lesion development.

CSF enhancement on post-contrast fluid-attenuated inversion recovery images; a systematic review

“…Most studies were performed in cases with ischemic stroke, transient ischemic attack (TIA), and/or intracerebral hemorrhage (ICH) (n = 20) ( Villringer, 2017 , Ostwaldt, 2015 , Ostwaldt, 2014 , Warach and Latour, 2004 , Latour et al, 2004 , Choi, 2017 , Dechambre, 2000 , Forster et al, 2016 , Gupta, 2017 , Henning et al, 2008 , Hjort, 2008 , Kim, 2005 , Luby, 2019 , Nadareishvili, 2018 , Lee, 2015 , Lee, 2016 , Lee, 2018 , Rozanski, 2010 , Kidwell et al, 2011 , Jolink, et al, 2019 , Barr, 2010 ). Six studies described patients who underwent cardiovascular or intracranial vascular surgery ( Cho, 2014 , Ogami et al, 2011 , Wilkinson, 2000 , Li, 2018 , Suthiphosuwan et al, 2018 , Merino, 2013 ), nine studies patients with multiple sclerosis (MS) (one of these included stroke cases as a positive control ( Eisele, 2015 ) ( Eisele, 2015 , Absinta, 2015 , Bergsland, 2019 , Harrison, 2017 , Jonas et al, 2018 , Zivadinov, 2017 , Zivadinov, 2018 , Zurawski, 2020 , Ighani, 2020 ), four studies patients with meningitis ( Ahmad et al, 2015 , Alonso, 2015 , Fukuoka, 2010 , Splendiani, 2005 ), two studies reported on memory clinic patients and normal aging ( Freeze, 2017 , Freeze et al, 2019 ), one study on Susac syndrome and MS ( Coulette, 2019 ), one study on familial amyloid polyneuropathy ( Hirai, 2005 ), and one study included a mix of diseases, which were presented as follows: inflammatory and immune-mediated neurologic diseases (neuromyelitis optica spectrum disorder, immune-mediated encephalitis, immune-mediated cerebellar ataxia, systemic inflammatory diseases with white matter MRI abnormalities not suggestive for MS and Susac syndrome), noninflammatory neurologic diseases (small vessel disease, migraine, neurodegenerative diseases, compressive myelopathy), human T-lymphotropic virus (HTLV) infection, and human immun...…”

“…Nine studies assessed CSF enhancement in MS, of which six with non-overlapping study samples including 897 cases with a pooled mean age of 44 years ( supplemental table e-2 ) ( Zurawski, 2020 , Ighani, 2020 , Coulette, 2019 , Eisele, 2015 , Absinta, 2015 , Bergsland, 2019 ). The reported prevalence estimates within these studies ranged between 1% and 80%, with a pooled prevalence estimate of 21% (95% CI 19–24).…”

Ultra-high-field 7-T MRI in multiple sclerosis and other demyelinating diseases: from pathology to clinical practice

“…It is important to notice that the nodular pattern may be a normal variant, considering that it has been found in a great proportion of healthy controls [53]. Contradictory data exists on the relationship between LME and the presence of cortical lesions in MS. A strong relationship between the presence of cortical lesions and LME was evidenced by some authors [49], though these results were not confirmed in other works [54]. In the absence of a direct comparison between 7-T and 3-T scans in the same subjects, it is not possible to state that 7-T MRI has a higher sensitivity for leptomeningeal enhancement detection.…”

“…Without the use of an unenhanced image, it is likely that the true prevalence of LME at 3-T may be less than previously reported. LME detection modality also varies widely: some authors used subtraction techniques [54] whereas others did not [49,52]. In conclusion, further work is necessary in order to investigate the real prevalence and relevance of LME in MS and to elucidate the ideal MRI protocol to image meningeal inflammation.…”

Identifying Progression in Multiple Sclerosis: New Perspectives

“…In 2 recent 7T studies on RRMS patients, leptomeningeal enhancement was associated with cortical lesion burden 30 or cortical atrophy. 31 Leptomeningeal enhancement is also not MS-specific, being frequent in other inflammatory CNS diseases. 32 Using high-and ultrahigh-field scanners, quantitative MRI techniques improved the evaluation of cortical lesions.…”