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Gadolinium-based MRI characterization of leptomeningeal inflammation in multiple sclerosis
Open accessAbstract
OBJECTIVE: To determine the frequency and nature of leptomeningeal contrast enhancement in multiple sclerosis (MS) via in vivo 3-tesla postcontrast T2-weighted, fluid-attenuated inversion recovery (FLAIR) MRI and 7-tesla postmortem MRI-pathology correlation. METHODS: Brain MRI, using the postcontrast T2-weighted, FLAIR technique, was prospectively collected in 299 MS cases and 37 age-matched neurologically healthy controls. Expert raters evaluated focal gadolinium enhancement in the leptomeningeal compartment. Two progressive MS cases came to autopsy after in vivo MRI characterization. Pathologic and immunohistochemical examination assessed the association of enhancement with leptomeningeal inflammation and adjacent cortical demyelination. RESULTS: Focal contrast enhancement was detected in the leptomeningeal compartment in 74 of 299 MS cases (25%) vs 1 of 37 neurologically healthy controls (2.7%; p = 0.001). Enhancement was nearly twice as frequent (p = 0.009) in progressive MS (39/118 cases, 33%) as in relapsing-remitting MS (35/181, 19%). Enhancing foci generally remained stable throughout the evaluation period (up to 5.5 years). Pathology showed perivascular lymphocytic and mononuclear infiltration in the enhancing areas in association with flanking subpial cortical demyelination. CONCLUSION: Leptomeningeal contrast enhancement occurs frequently in MS and is a noninvasive, in vivo marker of inflammation and associated subpial demyelination. It might therefore enable testing of new treatments aimed at eliminating this inflammation and potentially arresting progressive MS.
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“Similar considerations may hold with active leptomeningeal inflammation (Howell et al., 2011; Absinta et al., 2015).”
From A quantitative neuropathological assessment of translocator protein expression in multiple sclerosis (2019) · cites this paper as Absinta et al., 2015
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“15 Therefore, it is possible that the meningeal enhancement observed in our case may have been related to meningeal inflammation and subpial demyelination.”
BackgroundGadolinium-enhanced 3D-FLAIR MRI: spectrum of pial pathology and imaging pitfalls (P4.405)
Titelbaum, D. S., Engisch, R., Schwartz, E. D., & Napoli, S. Q. (2017) · Neurology · doi:10.1212/wnl.88.16_supplement.p4.405
Novel imaging approaches in multiple sclerosis
Farez, M. (2024) · Elsevier eBooks · doi:10.1016/b978-0-12-823848-6.00002-6
Multiple sclerosis: Clinical course, open questions, unmet clinical needs
Zurawski, J. D., & Weiner, H. L. (2024) · Elsevier eBooks · doi:10.1016/b978-0-12-823848-6.00001-4
Gadani, S. P., Singh, S., Kim, S., Hu, J., Smith, M. D., Calabresi, P. A., & Bhargava, P. (2024) · eLife · doi:10.7554/elife.88414.2
Self-citationUher, T., & Vaněčková, M. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-95739-7.00014-9
Immunopathogenesis of HAM/TSP and Radiological Features of Disease Progression
Stack, E. H., Mina, Y., Nair, G., & Jacobson, S. (2024) · Springer eBooks · doi:10.1007/978-3-031-68237-7_26
Self-citationUher, T. (2025) · Springer eBooks · doi:10.1007/978-3-031-98945-2_1
Gupta, K., Kesharwani, A., Rua, S., Singh, S. S., Siu, C., Jank, L., Smith, M. D., Calabresi, P. A., & Bhargava, P. (2024) · Figshare · doi:10.6084/m9.figshare.26624428
Self-citationApplication of Post-Contrast T2 FLAIR Imaging in the Diagnosis of Multiple Sclerosis
Stegura, D. S., Коновалов, Р. Н., Александровна, Б. И., Bryukhov, V. V., & Кротенкова, М. В. (2025) · Radiology - Practice · doi:10.52560/2713-0118-2025-6-13-28
Thommana, A. A., Beck, E. S., Greenwald, M. A., Norato, G., Gaitsch, H., Pham, D. L., Jacobson, S., Gaitán, M. I., Nair, G., Reich, D. S., et al. (2026) · Multiple Sclerosis Journal - Experimental Translational and Clinical · doi:10.1177/20552173251408625
“We believe that including these scans is still acceptable since LME and cortical lesions are usually persistent fi ndings, 10,32 and our sensitivity analysis of a subcohort of cases with 3T and 7T imaging within three months aligned with our fi ndings in the larger cohort.”
InfluentialSelf-citationDura mater enhancement on 3T MRI is associated with cortical lesion burden in multiple sclerosis
Zivadinov, R., Semy, M., Bartnik, A., Hildesheim, F. E., Tranquille, A., Jakimovski, D., Hojnacki, D. W., Eckert, S. P., Weinstock‐Guttman, B., Dwyer, M. G., et al. (2026) · Journal of Neurology · doi:10.1007/s00415-026-13781-6
“LME is detected in approximately 20–50% of pwMS using optimized 1.5T–3T MRI protocols [1, 8–14] and in up to 80–90% at 7T [15–20].”
InfluentialAge-related development of meningeal lymphatic vessels in children assessed by 3D T2 FLAIR MRI
Ying, J., Rao, Y., Chen, X., Chen, F., Zhang, T., Li, J., Wang, S., Lin, J., He, Y., Chen, J., et al. (2026) · Scientific Reports · doi:10.1038/s41598-026-49446-7
“11[,12 MRI sequences, such as gadolinium-enhanced 13 and dynamic contrast-enhanced (DCE) MRI 14 , have been used to visualize the structure and functionality of meningeal lymphatics in the human brain.”
The skull–meningeal axis: a new window into multiple sclerosis progression
Granberg, T. (2026) · Brain · doi:10.1093/brain/awag177
Metadata
- Authors
- Absinta, M., Vuolo, L., Rao, A., Nair, G., Sati, P., Cortese, I. C. M., Ohayon, J., Fenton, K., Reyes-Mantilla, M. I., Maric, D., Calabresi, P. A., Butman, J. A., Pardo, C. A., & Reich, D. S.
- Affiliations
- National Institutes of Health (US)
- From the Translational Neuroradiology Unit (M.A., L.V., A.R., G.N., P.S., D.S.R.), Neuroimmunology Clinic (I.C.M.C., J.O., K.F.), and Flow Cytometry Core Facility (D.M.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Neuroimaging Research Unit (M.A.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan; Department of Neurology and Radiology (L.V.), University of Florence, Italy;...
- ORCID
- Venue
- Neurology
- Published
- 2015-07-07
- Volume
- 85
- Issue
- 1
- Pages
- 18-28
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC4501940
- OpenAlex
- W2169159041
- Cited by
- 296
- References
- 36
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 32 · 2023: 30 · 2022: 27 · 2021: 32 · 2020: 32 · 2019: 31 · 2018: 28 · 2017: 27 · 2016: 26 · 2015: 6
- FWCI
- 23.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke
- Topics
- Health Sciences › Medicine › Clinical Neurology › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Oncology › Polyomavirus and related diseases
- Keywords
- multiple sclerosis, leptomeningeal inflammation, gadolinium-enhancing lesions, progressive multiple sclerosis, relapsing-remitting multiple sclerosis, perivascular lymphocytic infiltrate, cortical demyelination, MRI-pathology correlation, 7T MRI
- MeSH terms
- Gadolinium, Humans, Magnetic Resonance Imaging, Meninges, Meningitis, Multiple Sclerosis, Relapsing-Remitting
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