summary: MS is characterised by the presence of lesions in the white matter of the brain and the spinal cord. These lesions can be observed by conventional MRI techniques and are required for the diagnosis of MS. However, at the time of the onset of MS symptoms the MRI scan in some people is considered normal, without any lesion in the white matter. When this happens, the diagnosis of MS can be delayed. Although MS is a disease traditionally considered as predominantly affecting the white matter, the involvement of the grey matter has been shown to be important and related to clinical progression. The authors studied four people with symptoms suggestive of MS, who had normal MRI results, using a new MRI technique, double inversion recovery (DIR), They found that, despite having an apparently normal MRI result, all four people had lesions located in the cerebral cortex, which were shown by the DIR technique. From a pathological and diagnostic perspective, these findings may be very important.

authors: Calabrese M, Gallo P

source: Mult Scler. 2009 Aug;15(8):933-41

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