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Background  Neocortical lesions (NLs) are an important pathological component of multiple sclerosis (MS), but their visualization by magnetic resonance imaging (MRI) remains challenging.    Objectives  We aimed at assessing the sensitivity of multi echo gradient echo (ME-GRE) T 2   * -weighted MRI at 7.0 Tesla in depicting NLs compared to myelin and iron staining.    Methods  Samples from two MS patients were imaged  post mortem  using a whole body 7T MRI scanner with a 24-channel receive-only array. Isotropic 200 micron resolution images with varying T 2   *  weighting were reconstructed from the ME-GRE data and converted into R 2   *  maps. Immunohistochemical staining for myelin (proteolipid protein, PLP) and diaminobenzidine-enhanced Turnbull blue staining for iron were performed.    Results  Prospective and retrospective sensitivities of MRI for the detection of NLs were 48% and 67% respectively. We observed MRI maps detecting only a small portion of 20 subpial NLs extending over large cortical areas on PLP stainings. No MRI signal changes suggestive of iron accumulation in NLs were observed. Conversely, R 2   *  maps indicated iron loss in NLs, which was confirmed by histological quantification.    Conclusions  High-resolution  post mortem  imaging using R 2   *  and magnitude maps permits detection of focal NLs. However, disclosing extensive subpial demyelination with MRI remains challenging.

7 Tesla Magnetic Resonance Imaging to Detect Cortical Pathology in Multiple Sclerosis