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Open Access Highly Accessed Review

Gray matter imaging in multiple sclerosis: what have we learned?

Hanneke E Hulst12* and Jeroen JG Geurts2

Author Affiliations

1 Department of Radiology, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands

2 Department of Anatomy and Neurosciences, section of Clinical Neuroscience, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

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BMC Neurology 2011, 11:153  doi:10.1186/1471-2377-11-153

Published: 12 December 2011

Abstract

At the early onset of the 20th century, several studies already reported that the gray matter was implicated in the histopathology of multiple sclerosis (MS). However, as white matter pathology long received predominant attention in this disease, and histological staining techniques for detecting myelin in the gray matter were suboptimal, it was not until the beginning of the 21st century that the true extent and importance of gray matter pathology in MS was finally recognized. Gray matter damage was shown to be frequent and extensive, and more pronounced in the progressive disease phases. Several studies subsequently demonstrated that the histopathology of gray matter lesions differs from that of white matter lesions. Unfortunately, imaging of pathology in gray matter structures proved to be difficult, especially when using conventional magnetic resonance imaging (MRI) techniques. However, with the recent introduction of several more advanced MRI techniques, the detection of cortical and subcortical damage in MS has considerably improved. This has important consequences for studying the clinical correlates of gray matter damage. In this review, we provide an overview of what has been learned about imaging of gray matter damage in MS, and offer a brief perspective with regards to future developments in this field.