Gray matter imaging in multiple sclerosis: the role of thalamus

Key points: 

  • GM damage in MS is common and widespread, especially in chronic MS;
  • The underlying pathological correlates of GM damage in MS are different from WM damage;
  • GM pathology is present in all stages of the disease, but is more prominent in SPMS and PPMS compared to RRMS;
  • Although a relatively non-specific measure of overall pathology, GM atrophy measurements are reliable and robust and correlate strongly with disability and cognitive impairment (more so than WM atrophy);
  • Non-neocortical GM damage is frequently detected in histopathological studies as well as on MRI; 
  • Thalamic abnormalities have been studied most extensively and were shown to correlate with clinical parameters;
Timeline of GM imaging in MS. A schematic overview of developments in the field of GM imaging in MS from the beginning of the 20th century until now. Taken from BMC Neurology 2011, 11:153  
Subcortical GM damage in MS. Subcortical atrophy in HC and MS. Above: Effect sizes of subcortical atrophy in a cohort of 120 early RRMS patients, six years post-diagnosis. Below: Two examples of segmented subcortical structures in a healthy control (HC, above) and an age-matched RRMS patient (MS, below). Taken from BMC Neurology 2011, 11:153

Representative FIRST segmentation in a 47-year-old female patient with CIS (EDSS 1.5) on the left and a 47-year-old female patient with RRMS (EDSS 2.0) on the right. The colored regions represent thalamus (green), globus pallidus (dark blue), caudate (light blue), and putamen (magenta). Taken from AJNR33: 1573-1578

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