Patterns of Tissue Damage in Multiple Sclerosis Lesions: Insights from Advanced Diffusion Imaging

Using our in-house diffusion tensor imaging (DTI) analysis techniques, we investigated how tissue damage evolves differently in the core versus periphery of chronic MS lesions, uncovering distinct patterns that provide new insights into disease mechanisms.

Key Findings:

• Distinct Damage Patterns: We identified a previously unrecognized pattern where lesion rims show predominantly myelin damage, while core regions exhibit more severe tissue destruction and axonal loss
• Rim Characteristics: The peripheral regions of lesions maintain relatively constant width regardless of lesion size, suggesting a preserved zone that may be more amenable to therapeutic intervention
• Core Dynamics: Central lesion areas demonstrate more severe tissue disruption with equal increases in both axial and radial diffusivity, indicating extensive structural breakdown

Clinical Implications:

• The preserved lesion rim may represent an optimal target for emerging remyelination therapies
• Understanding these distinct patterns could help develop more sensitive measures for monitoring treatment effects
• The findings suggest different therapeutic approaches may be needed for lesion cores versus rims

Why It Matters:

This research reveals for the first time how tissue damage evolves differently across MS lesions. By demonstrating that the lesion rim maintains structural integrity while showing primarily myelin loss, we’ve identified a potential therapeutic window where remyelination treatments might be most effective. This insight could fundamentally change how we approach treatment and monitoring of MS lesions.