Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis

A.M. Seewann, H. Vrenken, E.J. Kooi, P. van der Valk, D.L. Knol, C.H. Polman, P.J.W. Pouwels, F. Barkhof, J.J.G. Geurts

    Research output: Contribution to JournalArticleAcademicpeer-review

    Abstract

    Background: Cortical lesions (CLs) occur frequently in multiple sclerosis (MS), but only few CLs are observed on conventional magnetic resonance imaging (MRI). Why some CLs are visible and others are not is currently unknown. Here, we investigated whether CLs that are visible on conventional MRI differ from MRI-invisible CLs in terms of underlying histopathology and quantitative MRI (qMRI) measures.Methods: A total of 16 brain slices from 10 patients with chronic MS were analysed histopathologically and with conventional and qMRI. A region-of-interest approach was used to compare MRI-visible CLs with MRI-invisible CLs.Results: Although under-powering cannot be completely excluded in this study, MRI-visible CLs did not seem to differ from MRI-invisible CLs in terms of histopathology or qMRI measures. They were, however, significantly larger than their invisible counterparts (mean 13.3 ± 1.7 mm2 versus 6.9 ± 1.3 mm2; p = 0.001). Furthermore, the number of MRI-visible lesions correlated with the overall number of CLs in the brain slice (r = 0.96, p < 0.01) and with the overall percentage of demyelination (r = 0.78, p < 0.01) per hemispheric brain slice.Conclusion: MRI visibility of CLs is determined by lesion size, and not by any distinctive underlying pathology. Visible CLs are associated with a higher total cortical lesion load, which suggests that when CLs in patients with MS become detectable on MRI, they merely represent 'the tip of the pathological iceberg'. © SAGE Publications 2011.
    Original languageEnglish
    Pages (from-to)1202-1210
    JournalMultiple Sclerosis
    Volume17
    Issue number10
    DOIs
    Publication statusPublished - 2011

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    Multiple Sclerosis
    Magnetic Resonance Imaging
    Brain
    Ice Cover
    Demyelinating Diseases
    Publications
    Pathology

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    Seewann, A. M., Vrenken, H., Kooi, E. J., van der Valk, P., Knol, D. L., Polman, C. H., ... Geurts, J. J. G. (2011). Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis. Multiple Sclerosis, 17(10), 1202-1210. https://doi.org/10.1177/1352458511406575
    Seewann, A.M. ; Vrenken, H. ; Kooi, E.J. ; van der Valk, P. ; Knol, D.L. ; Polman, C.H. ; Pouwels, P.J.W. ; Barkhof, F. ; Geurts, J.J.G. / Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis. In: Multiple Sclerosis. 2011 ; Vol. 17, No. 10. pp. 1202-1210.
    @article{4f86c833d9d44ebb8e76f9f54513cf61,
    title = "Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis",
    abstract = "Background: Cortical lesions (CLs) occur frequently in multiple sclerosis (MS), but only few CLs are observed on conventional magnetic resonance imaging (MRI). Why some CLs are visible and others are not is currently unknown. Here, we investigated whether CLs that are visible on conventional MRI differ from MRI-invisible CLs in terms of underlying histopathology and quantitative MRI (qMRI) measures.Methods: A total of 16 brain slices from 10 patients with chronic MS were analysed histopathologically and with conventional and qMRI. A region-of-interest approach was used to compare MRI-visible CLs with MRI-invisible CLs.Results: Although under-powering cannot be completely excluded in this study, MRI-visible CLs did not seem to differ from MRI-invisible CLs in terms of histopathology or qMRI measures. They were, however, significantly larger than their invisible counterparts (mean 13.3 ± 1.7 mm2 versus 6.9 ± 1.3 mm2; p = 0.001). Furthermore, the number of MRI-visible lesions correlated with the overall number of CLs in the brain slice (r = 0.96, p < 0.01) and with the overall percentage of demyelination (r = 0.78, p < 0.01) per hemispheric brain slice.Conclusion: MRI visibility of CLs is determined by lesion size, and not by any distinctive underlying pathology. Visible CLs are associated with a higher total cortical lesion load, which suggests that when CLs in patients with MS become detectable on MRI, they merely represent 'the tip of the pathological iceberg'. {\circledC} SAGE Publications 2011.",
    author = "A.M. Seewann and H. Vrenken and E.J. Kooi and {van der Valk}, P. and D.L. Knol and C.H. Polman and P.J.W. Pouwels and F. Barkhof and J.J.G. Geurts",
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    Seewann, AM, Vrenken, H, Kooi, EJ, van der Valk, P, Knol, DL, Polman, CH, Pouwels, PJW, Barkhof, F & Geurts, JJG 2011, 'Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis' Multiple Sclerosis, vol. 17, no. 10, pp. 1202-1210. https://doi.org/10.1177/1352458511406575

    Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis. / Seewann, A.M.; Vrenken, H.; Kooi, E.J.; van der Valk, P.; Knol, D.L.; Polman, C.H.; Pouwels, P.J.W.; Barkhof, F.; Geurts, J.J.G.

    In: Multiple Sclerosis, Vol. 17, No. 10, 2011, p. 1202-1210.

    Research output: Contribution to JournalArticleAcademicpeer-review

    TY - JOUR

    T1 - Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis

    AU - Seewann, A.M.

    AU - Vrenken, H.

    AU - Kooi, E.J.

    AU - van der Valk, P.

    AU - Knol, D.L.

    AU - Polman, C.H.

    AU - Pouwels, P.J.W.

    AU - Barkhof, F.

    AU - Geurts, J.J.G.

    PY - 2011

    Y1 - 2011

    N2 - Background: Cortical lesions (CLs) occur frequently in multiple sclerosis (MS), but only few CLs are observed on conventional magnetic resonance imaging (MRI). Why some CLs are visible and others are not is currently unknown. Here, we investigated whether CLs that are visible on conventional MRI differ from MRI-invisible CLs in terms of underlying histopathology and quantitative MRI (qMRI) measures.Methods: A total of 16 brain slices from 10 patients with chronic MS were analysed histopathologically and with conventional and qMRI. A region-of-interest approach was used to compare MRI-visible CLs with MRI-invisible CLs.Results: Although under-powering cannot be completely excluded in this study, MRI-visible CLs did not seem to differ from MRI-invisible CLs in terms of histopathology or qMRI measures. They were, however, significantly larger than their invisible counterparts (mean 13.3 ± 1.7 mm2 versus 6.9 ± 1.3 mm2; p = 0.001). Furthermore, the number of MRI-visible lesions correlated with the overall number of CLs in the brain slice (r = 0.96, p < 0.01) and with the overall percentage of demyelination (r = 0.78, p < 0.01) per hemispheric brain slice.Conclusion: MRI visibility of CLs is determined by lesion size, and not by any distinctive underlying pathology. Visible CLs are associated with a higher total cortical lesion load, which suggests that when CLs in patients with MS become detectable on MRI, they merely represent 'the tip of the pathological iceberg'. © SAGE Publications 2011.

    AB - Background: Cortical lesions (CLs) occur frequently in multiple sclerosis (MS), but only few CLs are observed on conventional magnetic resonance imaging (MRI). Why some CLs are visible and others are not is currently unknown. Here, we investigated whether CLs that are visible on conventional MRI differ from MRI-invisible CLs in terms of underlying histopathology and quantitative MRI (qMRI) measures.Methods: A total of 16 brain slices from 10 patients with chronic MS were analysed histopathologically and with conventional and qMRI. A region-of-interest approach was used to compare MRI-visible CLs with MRI-invisible CLs.Results: Although under-powering cannot be completely excluded in this study, MRI-visible CLs did not seem to differ from MRI-invisible CLs in terms of histopathology or qMRI measures. They were, however, significantly larger than their invisible counterparts (mean 13.3 ± 1.7 mm2 versus 6.9 ± 1.3 mm2; p = 0.001). Furthermore, the number of MRI-visible lesions correlated with the overall number of CLs in the brain slice (r = 0.96, p < 0.01) and with the overall percentage of demyelination (r = 0.78, p < 0.01) per hemispheric brain slice.Conclusion: MRI visibility of CLs is determined by lesion size, and not by any distinctive underlying pathology. Visible CLs are associated with a higher total cortical lesion load, which suggests that when CLs in patients with MS become detectable on MRI, they merely represent 'the tip of the pathological iceberg'. © SAGE Publications 2011.

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    DO - 10.1177/1352458511406575

    M3 - Article

    VL - 17

    SP - 1202

    EP - 1210

    JO - Multiple Sclerosis

    JF - Multiple Sclerosis

    SN - 1352-4585

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    ER -

    Seewann AM, Vrenken H, Kooi EJ, van der Valk P, Knol DL, Polman CH et al. Imaging the tip of the iceberg: visualization of cortical lesions in multiple sclerosis. Multiple Sclerosis. 2011;17(10):1202-1210. https://doi.org/10.1177/1352458511406575