Cortical Lesion Imaging in Multiple Sclerosis

Multiple sclerosis is characterised by immune-mediated demyelination affecting both white and grey matter. Cortical lesions—focal areas of demyelination within the cerebral cortex—are now recognised as key contributors to physical disability and cognitive impairment. Historically, conventional 1.5 T and 3 T MRI sequences offered limited sensitivity for cortical pathology, particularly for subpial and intracortical lesions. The development of specialised magnetisation protocols, notably double inversion recovery (DIR) and phase-sensitive inversion recovery (PSIR), has improved detection by suppressing white matter and cerebrospinal fluid signals, enhancing lesion conspicuity. Ultra-high field MRI at 7 T further refines spatial resolution and contrast, revealing lesion morphology and distribution with greater clarity. Complementary use of quantitative diffusion imaging highlights microstructural changes in both lesional and non-lesional cortex, elucidating network-level disturbances linked to cognitive deficits. Recent computational advances harness artificial intelligence to generate synthetic DIR and PSIR contrasts from standard sequences, facilitating wider clinical application. Together, these modalities offer a multidimensional view of cortical involvement—capturing lesion load, evolution and relation to functional networks. Improved imaging of cortical lesions promises to refine diagnostics, monitor progression and assess therapeutic efficacy, ultimately guiding personalised management in multiple sclerosis.

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Cortical Lesion Imaging in Multiple Sclerosis publication trend

The graph below shows the total number of articles in cortical lesion imaging in multiple sclerosis across all publications each year (not limited to Nature Index journals).

Technical terms

Cortical lesion: A focal area of myelin loss within the cerebral cortex visible on MRI.

Double inversion recovery (DIR): An MRI sequence that suppresses white matter and cerebrospinal fluid signals to enhance grey matter lesion detection.

Phase-sensitive inversion recovery (PSIR): An MRI technique that increases contrast between lesions and normal tissue by using phase information.

7 Tesla MRI (7 T MRI): Ultra-high field magnetic resonance imaging offering superior spatial resolution and contrast.

Fractional anisotropy (FA): A diffusion metric quantifying the directional coherence of water diffusion in tissue.

Mean diffusivity (MD): A diffusion metric measuring the overall magnitude of water diffusion within tissue.

Juxtacortical lesion: A demyelinating lesion abutting the cortical–white matter junction.

References

1. Multicenter Evaluation of AI-generated DIR and PSIR for Cortical and Juxtacortical Multiple Sclerosis Lesion Detection. Radiology (2023).
2. Improved Identification of Intracortical Lesions in Multiple Sclerosis with Phase-Sensitive Inversion Recovery in Combination with Fast Double Inversion Recovery MR Imaging. American Journal of Neuroradiology (2007).
3. The Parallel Analysis of Phase Sensitive Inversion Recovery (PSIR) and Double Inversion Recovery (DIR) Images Significantly Improves the Detection of Cortical Lesions in Multiple Sclerosis (MS) since Clinical Onset. PLOS ONE (2015).
4. First Clinical Study on Ultra-High-Field MR Imaging in Patients with Multiple Sclerosis: Comparison of 1.5T and 7T. American Journal of Neuroradiology (2009).
5. 7 Tesla Magnetic Resonance Imaging to Detect Cortical Pathology in Multiple Sclerosis. PLOS ONE (2014).
6. Clinical 7 Tesla magnetic resonance imaging: Impact and patient value in neurological disorders. Journal of Internal Medicine (2025).
7. The cognitive relevance of non-lesional damage to cortical networks in people with multiple sclerosis. Journal of Neurology (2024).
8. Contribution of new and chronic cortical lesions to disability accrual in multiple sclerosis. Brain Communications (2024).