A method designed to classify and estimate the severity of T1-weighted hypointensities (persistent black and gray holes) within multiple sclerosis (MS) can add information to conventional imaging, a recent study found. 38 MS patients contributed images to the study. Intensities of lesions on T1-weighted scans were assessed relative to cerebrospinal fluid intensity using commercial software. Magnetization transfer imaging, diffusion tensor imaging, and clinical testing were performed to assess associations with T1w intensity-based measures. Researchers found:

• Intensity-based assessments of T1w hypointensities were reproducible and achieved >90% concordance with expert rater determinations of “black” and “gray” holes.
• Intensity ratio values correlated with magnetization transfer ratios (R=0.473) and diffusion tensor imaging metrics (R values ranging from 0.283 to −0.531) that have been associated with demyelination and axon loss.
• Intensity ratio values incorporated into T1w hypointensity volumes correlated with clinical measures of cognition.