%0 Journal Article
%T Gray matter imaging in multiple sclerosis: what have we learned?
%A Hanneke E Hulst
%A Jeroen JG Geurts
%J BMC Neurology
%D 2011
%I BioMed Central
%R 10.1186/1471-2377-11-153
%X For many years, focal inflammatory demyelination in the white matter (WM) was considered the most important pathological 'hallmark' of multiple sclerosis (MS). However, demyelination in the cerebral cortex was already observed in early pathology studies by Sander (1898), Dinkler (1904), Schob (1907) and Dawson (1916) [1-4]. After these initial, largely casuistic, descriptions of demyelination in the gray matter (GM) of MS patients, the topic was largely disregarded. This was mostly due to difficulties involved with the visualization of cortical GM lesions in the post mortem setting, in which conventional histochemical staining procedures were applied, as well as to a predominant attention for the generally more conspicuous process of inflammatory WM demyelination.However, by the start of the 21st century, the focus within MS research slowly shifted back from WM to GM. In 2003, when new immunohistochemical staining techniques that improved the ex vivo detection of GM damage had become available, the presence and extent of GM demyelination was described in detail and pathophysiological processes causing GM damage, as well as its visualization with modern magnetic resonance imaging (MRI) techniques, became central issues in MS research (see Figure 1).This review will focus on what has been learned in the past decade of imaging GM pathology in MS. As will be shown, visualization of GM demyelination was difficult at first, but improved upon technical developments in the field. An important question that now remains is whether MRI visualization of GM pathology in MS is sufficient, or whether further improvement is still needed.After the first pivotal reports of GM damage in MS in the early 20th century, it was not until 1962 that Brownell and Hughes reported that 26% of the macroscopically visible lesions found in their post mortem material of 22 MS patients were (partly) located in or around the cortical and subcortical GM [5]. Extensive involvement of the cortex in MS p
%U http://www.biomedcentral.com/1471-2377/11/153