T2 Hypointensity in the Deep Gray Matter of Patients With Multiple Sclerosis

Abstract

HYPERINTENSE white matter lesions on T2-weighted magnetic resonance imaging (MRI) scans (T2WI) are useful in diagnosing multiple sclerosis (MS) in the brain¹ and spinal cord² and can assess disease activity in treatment trials.³ However, bright T2WI lesions are nonspecific in defining the wide range of pathologic changes in the white matter of patients with MS⁴ and may be insensitive to microscopic disease.⁵ While gadolinium contrast enhancement on T1-weighted images may indicate blood-brain barrier disruption, it is transient, variable, and may not accurately predict long-term sequelae.⁶ Both hyperintense and enhancing lesions show poor correlations with clinical findings in MS and provide incomplete assessments of therapies.⁷