Lesions by tissue specific imaging characterize multiple sclerosis patients with more advanced disease

Background: Cerebrospinal fluid tissue specific imaging (CSF-TSI), a newly implemented magnetic resonance imaging (MRI) technique, allows visualization of a subset of chronic black holes (cBHs) with MRI characteristics suggestive of the presence of CSF-like fluid, and representing lesions with extensive tissue destruction. Objective: To investigate the relationship between lesions in CSF-TSI and disease measures in patients with multiple sclerosis (MS). Methods: Twenty-six patients with MS were imaged at 3.0 T, obtaining T-1-weighted (T-1-w) and T-2-w spin echo (SE), T-1 volumetric images and CSF-TSI images. We measured: (i) lesion volume (LV) in T-1-w (cBH-LV) and T-2-w SE images, and in CSF-TSI; (ii) brain parenchyma fraction (BPF). Differences between patients with and without CSF-TSI lesions were analyzed and association between clinical and MRI metrics were investigated. Results: cBHs were seen in 92% of the patients while lesions in CSF-TSI were seen in 40%. Patients with CSF-TSI lesions were older, with longer disease duration, higher disability scores, larger cBH-LV and T-2-LV, and lower BPF than patients without CSF-TSI lesions (<= 0.047). Partial correlation analysis correcting for T-2-LV, cBH-LV and BPF showed an association (p<0.0001, r=.753) between CSF-TSI LV and disability score. Conclusions: CSF-TSI lesions characterize patients with more advanced disease and probably contribute to the progress of disability.