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Magnetic Resonance Image Appearance

Frederik Barkhof, MD, PhD; Wolfgang Brück, MD, PhD; Corline J. A. De Groot, PhD; Elisabeth Bergers, MD, PhD; Sandra Hulshof, MD; Jeroen Geurts, MD; Chris H. Polman, MD, PhD; Paul van der Valk, MD, PhD

Arch Neurol. 2003;60:1073-1081.

Background  Various types of pathologic mechanisms in multiple sclerosis (MS) can alter magnetic resonance imaging (MRI) signals, and the appearance of remyelinated lesions on MRI is largely unknown.

Objective  To describe the MRI appearance of remyelinated lesions in MS.

Design  Comparison of postmortem MRI findings with histopathologic findings.

Setting  Brain donations from a general community.

Patients  Magnetic resonance images from 36 rapid autopsies yielded 161 areas that could be matched with histologic characteristics, including 149 focal T2-weighted abnormalities, with a range of signal intensities on T1-weighted images. In a subset of 49 lesions, magnetization transfer ratio could be determined.

Main Outcome Measures  An observer blinded to the MRI findings assessed the presence of remyelination using light microscopic criteria; in 25 areas, in situ hybridization was used to assess the presence of oligodendrocytes expressing proteolipid protein messenger RNA.

Results  Remyelinated areas were found in 67 lesions (42%): partial remyelination was present in 30 lesions (19%), whereas 37 lesions (23%) were fully remyelinated. Remyelinated lesions contained enhanced numbers of oligodendrocytes containing proteolipid protein messenger RNA. All areas with remyelination shown histopathologically were hyperintense on T2-weighted images. Strong hypointensity on T1-weighted images was significantly associated (² = 29.8, P<.001) with demyelinated and partially remyelinated lesions compared with fully remyelinated lesions. The magnetization transfer ratio of remyelinated lesions (mean [SD], 27.6% [41%]) differed (F = 46.3, P<.001) from both normal-appearing white matter (35.2% [32%]) and demyelinated lesions (22.3% [48%]).

Conclusions  Remyelinated lesions return an abnormal signal on T2-weighted images. Both T1-weighted images and magnetization transfer ratio may have (limited) additional value in separating lesions with and without remyelination.

From the Dutch MR-MS Center, and the Departments of Radiology (Drs Barkhof, Bergers, Geurts, and van der Valk), Pathology (Drs De Groot and Hulshof), and Neurology (Dr Polman), Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and the Department of Neuropathology, Charité Hospital, Berlin, Germany (Dr Brück).

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