Ann Neurol-MRI features can reflect the immunological pathology of multiple sclerosis

Multiple sclerosis (MS) is an inflammatory demyelinating disease of unknown etiology, which has obvious heterogeneity in clinical features, treatment response and MRI features
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In addition, when comparing the lesions of different patients, histological analysis showed huge differences

However, only mode II lesions are related to immunoglobulin and complement deposited along the myelin sheath, and are present in macrophages, suggesting that there is a mechanism of antibody- and complement-mediated demyelination
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In contrast, Mode III lesions are characterized by unclear lesion edges, the presence of apoptotic oligodendrocytes, and myelin-associated glycoprotein (MAG) is preferentially lost compared with other myelin proteins

Magnetic resonance imaging is used as a routine diagnostic tool for multiple sclerosis, and there are a wide range of magnetic resonance imaging results
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The contrast-enhancing lesions on T1-weighted MRI after contrast are considered to be a sign of blood-brain barrier destruction and may show different enhancement patterns

In this way, Imke Metz and others of the University of Göttingen retrospectively analyzed the relationship between the MRI lesion features of 161 patients with multiple sclerosis and their histopathologically defined immunopathological patterns and histologically defined lesion edge features
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They observed that ring reinforcement and low-density T2-weighted edges (T2w edges) are closely related to modes I and II, but not to mode III
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Only some patients with Mode III have ring enhancement, and this is always atypical

The ring enhancement and the T2w edge are co-located, and the ring enhancement is closely related to the macrophage edge shown by histology
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This study strongly proves that: MRI features reflect the specific morphological characteristics of the immune pattern of multiple sclerosis, ring enhancement and T2w low-density edges may be used as a valuable non-invasive biomarker to distinguish demyelination Pathological pattern
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Original source:
Metz I, Gavrilova RH, Weigand SD, Frischer JM, Popescu BF, Guo Y, Gloth M, Tobin WO, Zalewski NL, Lassmann H, Tillema JM, Erickson BJ, Parisi JE, Becker S, König FB, Brück W , Lucchinetti CF.
MRI Correlates of Multiple Sclerosis Immunopathological Patterns.
Ann Neurol.