Guest post: gray matter lesions in MS

Gray matter lesions in MS. Part of the iceberg we haven’t been able to see. #MSBog #MSResearch

“Some of you may already know that we have joined UCL Partners an umbrella organisation that covers academic and clinical services in Central and Northeast London. This is the first of many guest posts from one of the researchers at UCL as part of our partnership.”

“These MRI images are simply stunning and begin to give you an idea what lies behind MS-related cognitive impairment and why MS is like an iceberg. We are only jut beginning to see the extent of the gray matter pathology in life.”

Dr Varun Sethi works as a clinical research associate at the Department of Neuroinflammation, UCL Institute of Neurology. His area of research is the study of grey matter lesions in MSers, using MRI. He trained as a doctor in India and after his postgraduate degree in Medicine, came to UK initially for a Masters in Clinical Neurology and is currently working towards his PhD. 
Grey matter lesions in MS

It is often thought that brain changes in people with multiple sclerosis (MS) are mostly limited to white matter (found in the centre of the brain, and containing nerve fibre bundles that are wrapped in myelin), and seeing white matter spots (lesions where the myelin has been removed) using magnetic resonance imaging (MRI) has been an important part of the investigations that help diagnose MS. However, recent work has shown that grey matter (found mostly on the outer edges of the brain, and containing nerve cells) is also affected by MS, and lesions occur there too, but are difficult to see on standard MRI scans.

Knowing that MS lesions occur in grey matter, but that they are difficult to see using standard MRI scans, different methods have been studied to improve this. One such method – Double Inversion Recovery (DIR) – has proven particularly useful to detect grey matter lesion, and has helped us to study the effects grey matter lesions have on people living with MS. However, with DIR, most grey matter lesions are still not seen, and so it is difficult to gain a true impression of how clinically important, or not, they are. In order to improve our understanding of grey matter lesions in MS, we used a previously developed MRI scan called Phase Sensitive Inversion Recovery (PSIR) to provide much more detailed scans of the brain. Using this, when compared with DIR we see about 2 to 3 times more grey matter lesions. We are now looking at whether or not this method improves our understanding of the relationship between grey matter lesions, physical and cognitive dysfunction. We will also be comparing these findings in patients with MS, with healthy controls and patients with other neurological conditions, to see if grey matter lesions can aid in the diagnosis of MS when it otherwise in doubt.

Disclosures: The NMR Research Unit is supported by the MS Society of Great Britain and Northern Ireland and the UCL UCLH Comprehensive Biomedical Research Centre; The MS Society of Great Britain and Northern Ireland has provided financial support for staff and research costs. V Sethi receives research support from Biogen Idec and Novartis. DT Chard receives research support from the Multiple Sclerosis Society of Great Britain and Northern Ireland and holds stock in GlaxoSmithKline and has received honararia for educational work and advisory board membership from Teva and Bayer.

4 thoughts on “Guest post: gray matter lesions in MS”

  1. I am impressed with these images. Makes me a bit scared about what is in my brain. Can we monitor lesions at present using this technology? Do the number of lesions correlate with cognitive impairment?

  2. Incredible improvement in being able to see what is going on – as anon 8.36 says, it's a bit scary about what is going on…

  3. Come on everyone, get behind the MS Society's Challenge60 – raising money for research!

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