Multi-contrast Imaging Research Articles

Comparison of Intensity- and Polarization-based Contrast in Amyloid-beta Plaques as Observed by Optical Coherence Tomography

One key hallmark of Alzheimer’s disease (AD) is the accumulation of extracellular amyloid-beta protein in cortical regions of the brain. For a definitive diagnosis of AD, post-mortem histological analysis, including sectioning and staining of different brain regions, is required. Here, we present optical coherence tomography (OCT) as a tissue-preserving imaging modality for the visualization of amyloid-beta plaques and compare their contrast in intensity- and polarization-sensitive (PS) OCT. Human brain samples of eleven patients diagnosed with AD were imaged. Three-dimensional PS-OCT datasets were acquired and plaques were manually segmented in 500 intensity and retardation cross-sections per patient using the freely available ITK-SNAP software. The image contrast of plaques was quantified. Histological staining of tissue sections from the same specimens was performed to compare OCT findings against the gold standard. Furthermore, the distribution of plaques was evaluated for intensity-based OCT, PS-OCT and the corresponding histological amyloid-beta staining. Only 5% of plaques were visible in both intensity and retardation segmentations, suggesting that different types of plaques may be visualized by the two OCT contrast channels. Our results indicate that multicontrast OCT imaging might be a promising approach for a tissue-preserving visualization of amyloid-beta plaques in AD.

Plaque components segmentation in carotid artery on simultaneous non-contrast angiography and intraplaque hemorrhage imaging using machine learning

PurposeThis study sought to determine the feasibility of using Simultaneous Non-contrast Angiography and intraPlaque Hemorrhage (SNAP) to detect the lipid-rich/necrotic core (LRNC), and develop a machine learning based algorithm to segment plaque components on SNAP images. MethodsSixty-eight patients (age: 58±9 years, 24 males) with carotid artery atherosclerotic plaque were imaged on a 3 T MR scanner with both traditional multi-contrast vessel wall MR sequences (TOF, T1W, and T2W) and 3D SNAP sequence. The manual segmentations of carotid plaque components including LRNC, intraplaque hemorrhage (IPH), calcification (CA) and fibrous tissue (FT) on traditional multi-contrast images were used as reference. By utilizing the intensity and morphological information from SNAP, a machine learning based two steps algorithm was developed to firstly identify LRNC (with or without IPH), CA and FT, and then segmented IPH from LRNC. Ten-fold cross-validation was used to evaluate the performance of proposed method. The overall pixel-wise accuracy, the slice-wise sensitivity & specificity & Youden's index, and the Pearson's correlation coefficient of the component area between the proposed method and the manual segmentation were reported. ResultsIn the first step, all tested classifiers (Naive Bayes (NB), Support Vector Machine (SVM), Random Forest (RF), Gradient Boosting Decision Tree (GBDT) and Artificial Neural Network (ANN)) had overall pixel-wise accuracy higher than 0.88. For RF, GBDT and ANN classifiers, the correlation coefficients of areas were all higher than 0.82 (p < 0.001) for LRNC and 0.79 for CA (p < 0.001), and the Youden's indexes were all higher than 0.79 for LRNC and 0.76 for CA, which were better than that of NB and SVM. In the second step, the overall pixel-wise accuracy was higher than 0.78 for the five classifiers, and RF achieved the highest Youden's index (0.69) with the correlation coefficients as 0.63 (p < 0.001). ConclusionsThe RF is the overall best classifier for our proposed method, and the feasibility of using SNAP to identify plaque components, including LRNC, IPH, CA, and FT has been validated. The proposed segmentation method using a single SNAP sequence might be a promising tool for atherosclerotic plaque components assessment.

Molecular and Nonmolecular Magnetic Resonance Coronary and Carotid Imaging.

Atherosclerosis is the leading cause of cardiovascular morbidity and mortality. Over the past 2 decades, increasing research attention is converging on the early detection and monitoring of atherosclerotic plaque. Among several invasive and noninvasive imaging modalities, magnetic resonance imaging (MRI) is emerging as a promising option. Advantages include its versatility, excellent soft tissue contrast for plaque characterization and lack of ionizing radiation. In this review, we will explore the recent advances in multicontrast and multiparametric imaging sequences that are bringing the aspiration of simultaneous arterial lumen, vessel wall, and plaque characterization closer to clinical feasibility. We also discuss the latest advances in molecular magnetic resonance and multimodal atherosclerosis imaging.

Human-Compatible Multi-Contrast Mammographic Prototype System.

In the past decade, grating-based x-ray multi-contrast imaging has demonstrated potential advantages for breast imaging, including reduced anatomical noise, sharper tumor boundary and improved visibility of microcalcifications. However, most of the studies have been performed on benchtop-based systems. The experimental conditions including the dose, scanning time and system geometry may not meet clinical standards. Therefore, to evaluate true clinical benefits of grating-based multi-contrast breast imaging, in-vivo imaging should be performed, which requires a human-compatible system. The purpose of this paper is to report the development of a human-compatible prototype multi-contrast imaging system. In particular, this work focuses on several key challenges in building the prototype system. Regarding the challenge of patient safety, the mean glandular dose (MGD) and the scatter radiation were evaluated for the prototype system. Regarding the challenge of the limited field-of-view (FOV), the origin of the problem and corresponding technical solutions are presented. Finally, imaging results of several test phantoms are presented and strategies to improve the image quality are discussed.

Evaluation of focal damage in the retinal pigment epithelium layer in serous retinal pigment epithelium detachment

The purpose of this study was to evaluate focal damage in the retinal pigment epithelium (RPE) layer in serous retinal pigment epithelium detachment (PED) with multi-contrast optical coherence tomography (OCT), which is capable of simultaneous measurement of OCT angiography, polarization-sensitive OCT and standard OCT images. We evaluated 37 eyes with age-related macular degeneration that had serous PED. Focal RPE damage was indicated by hyper-transmission beneath the RPE-Bruch’s membrane band in standard OCT images. Distribution of RPE melanin was calculated using the dataset from multi-contrast OCT. Twenty-four points with hyper-transmission were detected in 21 of the 37 eyes. Standard OCT images failed to show disruption of the RPE-Bruch’s membrane band at 5 of the 24 hyper-transmission points. Conversely, multi-contrast OCT images clearly showed melanin defects in the RPE-Bruch’s membrane band at all points. Areas of melanin defects with disruption of the RPE-Bruch’s membrane band were significantly larger than those without disruption. The volume of intraretinal hyper-reflective foci was significantly larger in eyes with hyper-transmission than that in eyes without hyper-transmission. Multi-contrast OCT is more sensitive than standard OCT for displaying changes at the RPE-Bruch’s membrane band when there are small areas of RPE damage.

Brain tissue segmentation based on MP2RAGE multi-contrast images in 7 T MRI.

We proposed a method for segmentation of brain tissues—gray matter, white matter, and cerebrospinal fluid—using multi-contrast images, including a T1 map and a uniform T1-weighted image, from a magnetization-prepared 2 rapid acquisition gradient echoes (MP2RAGE) sequence at 7 Tesla. The proposed method was evaluated with respect to the processing time and the similarity of the segmented masks of brain tissues with those obtained using FSL, FreeSurfer, and SPM12. The processing time of the proposed method (28 ± 0 s) was significantly shorter than those of FSL and SPM12 (444 ± 4 s and 159 ± 2 s for FSL and SPM12, respectively). In the similarity assessment, the tissue mask of the brain obtained by the proposed method showed higher consistency with those obtained using FSL than with those obtained using SPM12. The proposed method misclassified the subcortical structures and large vessels since it is based on the intensities of multi-contrast images obtained using MP2RAGE, which uses a similar segmentation approach as FSL but is not based on a template image or a parcellated brain atlas, which are used for FreeSurfer and SPM12, respectively. However, the proposed method showed good segmentation in the cerebellum and white matter in the medial part of the brain in comparison with the other methods. Thus, because the proposed method using different contrast images of MP2RAGE sequence showed the shortest processing time and similar segmentation ability as the other methods, it may be useful for both neuroimaging research and clinical diagnosis.

Image Synthesis in Multi-Contrast MRI With Conditional Generative Adversarial Networks.

Acquiring images of the same anatomy with multiple different contrasts increases the diversity of diagnostic information available in an MR exam. Yet, the scan time limitations may prohibit the acquisition of certain contrasts, and some contrasts may be corrupted by noise and artifacts. In such cases, the ability to synthesize unacquired or corrupted contrasts can improve diagnostic utility. For multi-contrast synthesis, the current methods learn a nonlinear intensity transformation between the source and target images, either via nonlinear regression or deterministic neural networks. These methods can, in turn, suffer from the loss of structural details in synthesized images. Here, in this paper, we propose a new approach for multi-contrast MRI synthesis based on conditional generative adversarial networks. The proposed approach preserves intermediate-to-high frequency details via an adversarial loss, and it offers enhanced synthesis performance via pixel-wise and perceptual losses for registered multi-contrast images and a cycle-consistency loss for unregistered images. Information from neighboring cross-sections are utilized to further improve synthesis quality. Demonstrations on T1- and T2- weighted images from healthy subjects and patients clearly indicate the superior performance of the proposed approach compared to the previous state-of-the-art methods. Our synthesis approach can help improve the quality and versatility of the multi-contrast MRI exams without the need for prolonged or repeated examinations.

Echo planar time-resolved imaging (EPTI).

To develop an efficient distortion- and blurring-free multi-shot EPI technique for time-resolved multiple-contrast and/or quantitative imaging. EPI is a commonly used sequence but suffers from geometric distortions and blurring. Here, we introduce a new multi-shot EPI technique termed echo planar time-resolved imaging (EPTI), which has the ability to rapidly acquire distortion- and blurring-free multi-contrast data set. The EPTI approach performs encoding in ky -t space and uses a new highly accelerated spatio-temporal CAIPI sampling trajectory to take advantage of signal correlation along these dimensions. Through this acquisition and a B0 -informed parallel imaging reconstruction, hundreds of "time-resolved" distortion- and blurring-free images at different TEs across the EPI readout window can be created at sub-millisecond temporal increments using a small number of EPTI shots. Moreover, a method for self-estimation and correction of shot-to-shot B0 variations was developed. Simultaneous multi-slice acquisition was also incorporated to further improve the acquisition efficiency. We evaluated EPTI under varying simulated acceleration factors, B0 -inhomogeneity, and shot-to-shot B0 variations to demonstrate its ability to provide distortion- and blurring-free images at multiple TEs. Two variants of EPTI were demonstrated in vivo at 3T: (1) a combined gradient- and spin-echo EPTI for quantitative mapping of T2 , T2* , proton density, and susceptibility at 1.1 × 1.1 × 3mm3 whole-brain in 28 s (0.8 s/slice), and (2) a gradient-echo EPTI, for multi-echo and quantitative T2* fMRI at 2 × 2 × 3mm3 whole-brain at a 3.3 s temporal resolution. EPTI is a new approach for multi-contrast and/or quantitative imaging that can provide fast acquisition of distortion- and blurring-free images at multiple TEs.

Time and Mechanism of Nanoparticle Functionalization by Macromolecular Ligands during Pulsed Laser Ablation in Liquids.

Laser ablation of gold in liquids with nanosecond laser pulses in aqueous solutions of inorganic electrolytes and macromolecular ligands for gold nanoparticle size quenching is probed inside the laser-induced cavitation bubble by in situ X-ray multicontrast imaging with a Hartmann mask (XHI). It is found that (i) the in situ size quenching power of sodium chloride (NaCl) in comparison to the ablation in pure water can be observed by the scattering contrast from XHI already inside the cavitation bubble, while (ii) for polyvinylpyrrolidone (PVP) as a macromolecular model ligand an in situ size quenching cannot be observed. Complementary ex situ characterization confirms the overall size quenching ability of both additive types NaCl and PVP. The macromolecular ligand as well as its monomer N-vinylpyrrolidone (NVP) are mainly effective for growth quenching of larger nanoparticles on later time scales, leading to the conclusion of an alternative interaction mechanism with ablated nanoparticles compared to the electrolyte NaCl, probably outside of the cavitation bubble, in the surrounding liquid phase. While monomer and polymer have similar effects on the particle properties, with the polymer being slightly more efficient, only the polymer is effective against hydrodynamic aggregation.

A miniature multi-contrast microscope for functional imaging in freely behaving animals

Neurovascular coupling, cerebrovascular remodeling and hemodynamic changes are critical to brain function, and dysregulated in neuropathologies such as brain tumors. Interrogating these phenomena in freely behaving animals requires a portable microscope with multiple optical contrast mechanisms. Therefore, we developed a miniaturized microscope with: a fluorescence (FL) channel for imaging neural activity (e.g., GCaMP) or fluorescent cancer cells (e.g., 9L-GFP); an intrinsic optical signal (IOS) channel for imaging hemoglobin absorption (i.e., cerebral blood volume); and a laser speckle contrast (LSC) channel for imaging perfusion (i.e., cerebral blood flow). Following extensive validation, we demonstrate the microscope’s capabilities via experiments in unanesthetized murine brains that include: (i) multi-contrast imaging of neurovascular changes following auditory stimulation; (ii) wide-area tonotopic mapping; (iii) EEG-synchronized imaging during anesthesia recovery; and (iv) microvascular connectivity mapping over the life-cycle of a brain tumor. This affordable, flexible, plug-and-play microscope heralds a new era in functional imaging of freely behaving animals.

MR-PET head motion correction based on co-registration of multicontrast MR images.

Head motion is a major source of image artefacts in neuroimaging studies and can lead to degradation of the quantitative accuracy of reconstructed PET images. Simultaneous magnetic resonance-positron emission tomography (MR-PET) makes it possible to estimate head motion information from high-resolution MR images and then correct motion artefacts in PET images. In this article, we introduce a fully automated PET motion correction method, MR-guided MAF, based on the co-registration of multicontrast MR images. The performance of the MR-guided MAF method was evaluated using MR-PET data acquired from a cohort of ten healthy participants who received a slow infusion of fluorodeoxyglucose ([18-F]FDG). Compared with conventional methods, MR-guided PET image reconstruction can reduce head motion introduced artefacts and improve the image sharpness and quantitative accuracy of PET images acquired using simultaneous MR-PET scanners. The fully automated motion estimation method has been implemented as a publicly available web-service.

Using 3D Thin-Layer Model with in Vivo Patient-Specific Vessel Material Properties to Assesse Carotid Atherosclerotic Plaque Vulnerability

Image-based computational models have been introduced to calculate plaque stress/strain conditions and investigate their association with plaque progression and rupture [Tang, Yang, Zheng, et al. (2004)]. However, the accuracy of the computational results is heavily dependent on the data and assumptions used by those models. Patient-specific vessel material properties are in general lacking in image-based computational models, limiting the accuracy of their stress/strain calculations. A noninvasive approach of combining in vivo 3D multi-contrast and Cine magnetic resonance imaging (MRI) and computational modeling was used to quantify patient-specific carotid plaque material properties for potential plaque model improvements [Wang, Canton, Guo, et al. (2017)]. The stress-based plaque vulnerability index (SPVI) was proposed to combine mechanical analysis, plaque morphology and composition for more complete carotid plaque vulnerability assessment.

Association Between Incomplete Circle of Willis and Carotid Vulnerable Atherosclerotic Plaques.

Objective- Carotid high-risk plaque, characterized by intraplaque hemorrhage, fibrous cap rupture, and large lipid-rich necrotic core, is associated with cerebrovascular events. This study sought to investigate the relationship between high-risk carotid plaque and an incomplete circle of Willis (COW). Approach and Results- Patients were recruited from a multicenter study, Chinese Atherosclerosis Risk Evaluation (CARE-II) and underwent 3-dimensional time-of-flight magnetic resonance angiography for intracranial arteries and 2-dimensional multicontrast magnetic resonance vessel wall imaging for carotid arteries on a 3.0T magnetic resonance scanner. The integrity of the COW in anterior and posterior portions was evaluated. Characteristics of carotid plaques were assessed. Correlation between incomplete COW and carotid plaque features was determined. Of 482 eligible patients, patients with carotid intraplaque hemorrhage showed significantly higher prevalence of an incomplete anterior COW (52.7% versus 38.5%; P=0.022) compared with those without. An incomplete anterior COW was associated with intraplaque hemorrhage before (odds ratio, 1.781; 95% CI, 1.083-2.931; P=0.023) and after adjusted for clinical risk factors (odds ratio, 1.945; 95% CI, 1.139-3.321; P=0.015). The unilateral carotid artery stenosis showed no correlation with incomplete anterior COW and posterior COW (all P>0.025). No significant associations were found between other plaque features and any type of incomplete COW (all P>0.025). Conclusions- An incomplete COW is independently associated with intraplaque hemorrhage of carotid atherosclerotic plaques. Clinical Trial Registration- URL: http://www.clinicaltrials.gov . Unique identifier: NCT02017756.

X-ray dark-field imaging of the human lung-A feasibility study on a deceased body.

Disorders of the lungs such as chronic obstructive pulmonary disease (COPD) are a major cause of chronic morbidity and mortality and the third leading cause of death in the world. The absence of sensitive diagnostic tests for early disease stages of COPD results in under-diagnosis of this treatable disease in an estimated 60–85% of the patients. In recent years a grating-based approach to X-ray dark-field contrast imaging has shown to be very sensitive for the detection and quantification of pulmonary emphysema in small animal models. However, translation of this technique to imaging systems suitable for humans remains challenging and has not yet been reported. In this manuscript, we present the first X-ray dark-field images of in-situ human lungs in a deceased body, demonstrating the feasibility of X-ray dark-field chest radiography on a human scale. Results were correlated with findings of computed tomography imaging and autopsy. The performance of the experimental radiography setup allows acquisition of multi-contrast chest X-ray images within clinical boundary conditions, including radiation dose. Upcoming clinical studies will have to demonstrate that this technology has the potential to improve early diagnosis of COPD and pulmonary diseases in general.

Mobile-phone-based Rheinberg microscope with a light-emitting diode array.

Mobile phone technology has led to implementation of portable and inexpensive microscopes. Light-emitting diode (LED) array microscopes support various multicontrast imaging by flexible illumination patterns of the LED array that can be achieved without changing the optical components of the microscope. Here, we demonstrate a mobile-phone-based LED array microscope to realize multimodal imaging with bright-field, dark-field, differential phase-contrast, and Rheinberg illuminations using as few as 37 LED bulbs. Using this microscope, we obtained high-contrast images of living cells. Furthermore, by changing the color combinations of Rheinberg illumination, we were able to obtain images of living chromatic structures with enhanced or diminished contrast. This technique is expected to be a foundation for high-contrast microscopy used in modern field studies.

Middle Cerebral Artery Atherosclerosis and Deep Subcortical Infarction: A 3T Magnetic Resonance Vessel Wall Imaging Study

BackgroundDeep subcortical infarction is a major subtype of stroke in middle cerebral artery (MCA) territory. This study aims to evaluate the relationship between characteristics of MCA plaque and features of deep subcortical infarction. MethodsPatients with recent acute ischemic stroke and deep subcortical infarction were prospectively enrolled. Both multicontrast brain sequences and 3D high-resolution vessel wall imaging (VWI) sequences were scanned for all patients. MCA plaque characteristics, including plaque presence, location, maximum vessel wall thickness (Max WT), signal intensity and luminal stenosis, and deep subcortical infarction features, including lowest infarct layer index (LILI), area, volume, maximum area, and infarct quantity were evaluated. Infarct feature differences were compared between MCA plaque+ group and MCA plaque− group. The correlations between MCA plaque characteristics and deep subcortical infarction features were analyzed. ResultsOf all 50 patients included in this study, 30 (60%) had MCA plaques. All deep subcortical infarction was single lesion for patients without MCA plaque. The average number of deep subcortical infarction for patients with MCA plaque was 3.10 ± 4.44. The LILI (P = .036) and infarct quantity (P = .030) showed significant differences between 2 groups. Max WT (P = .025) and stenosis degree (P = .023) were negatively correlated with LILI. Intraplaque hemorrhage was positively correlated with maximum area (P = .029) and infarct volume (P = .030). ConclusionsMCA plaque characteristics were correlated with deep subcortical infarct features. Magnetic resonance VWI may provide more information for etiological evidence of deep subcortical infarction.

Small near-infrared photochromic protein for photoacoustic multi-contrast imaging and detection of protein interactions in vivo

Photoacoustic (PA) computed tomography (PACT) benefits from genetically encoded probes with photochromic behavior, which dramatically increase detection sensitivity and specificity through photoswitching and differential imaging. Starting with a DrBphP bacterial phytochrome, we have engineered a near-infrared photochromic probe, DrBphP-PCM, which is superior to the full-length RpBphP1 phytochrome previously used in differential PACT. DrBphP-PCM has a smaller size, better folding, and higher photoswitching contrast. We have imaged both DrBphP-PCM and RpBphP1 simultaneously on the basis of their unique signal decay characteristics, using a reversibly switchable single-impulse panoramic PACT (RS-SIP-PACT) with a single wavelength excitation. The simple structural organization of DrBphP-PCM allows engineering a bimolecular PA complementation reporter, a split version of DrBphP-PCM, termed DrSplit. DrSplit enables PA detection of protein–protein interactions in deep-seated mouse tumors and livers, achieving 125-µm spatial resolution and 530-cell sensitivity in vivo. The combination of RS-SIP-PACT with DrBphP-PCM and DrSplit holds great potential for noninvasive multi-contrast deep-tissue functional imaging.

Accelerated MR parameter mapping with a union of local subspaces constraint.

A new reconstruction method for multi-contrast imaging and parameter mapping based on a union of local subspaces constraint is presented. Subspace constrained reconstructions use a predetermined subspace to explicitly constrain the relaxation signals. The choice of subspace size impacts the approximation error vs noise-amplification tradeoff associated with these methods. A different approach is used in the model consistency constraint (MOCCO) framework to leverage the subspace model to enforce a softer penalty. Our proposed method, MOCCO-LS, augments the MOCCO model with a union of local subspaces (LS) approach. The union of local subspaces model is coupled with spatial support constraints and incorporated into the MOCCO framework to regularize the contrast signals in the scene. The performance of the MOCCO-LS method was evaluated in vivo on T1 and T2 mapping of the human brain and with Monte-Carlo simulations and compared against MOCCO and the explicit subspace constrained models. The results demonstrate a clear improvement in the multi-contrast images and parameter maps. We sweep across the model order space to compare the different reconstructions and demonstrate that the reconstructions have different preferential operating points. Experiments on T2 mapping show that the proposed method yields substantial improvements in performance even when operating at very high acceleration rates. The use of a union of local subspace constraints coupled with a sparsity promoting penalty leads to improved reconstruction quality of multi-contrast images and parameter maps.

Pixel-wise segmentation of severely pathologic retinal pigment epithelium and choroidal stroma using multi-contrast Jones matrix optical coherence tomography

Tissue segmentation of retinal optical coherence tomography (OCT) is widely used in ophthalmic diagnosis. However, its performance in severe pathologic cases is still insufficient. We propose a pixel-wise segmentation method that uses the multi-contrast measurement capability of Jones matrix OCT (JM-OCT). This method is applicable to both normal and pathologic retinal pigment epithelium (RPE) and choroidal stroma. In this method, "features," which are sensitive to specific tissues of interest, are synthesized by combining the multi-contrast images of JM-OCT, including attenuation coefficient, degree-of-polarization-uniformity, and OCT angiography. The tissue segmentation is done by simple thresholding of the feature. Compared with conventional segmentation methods for pathologic maculae, the proposed method is less computationally intensive. The segmentation method was validated by applying it to images from normal and severely pathologic cases. The segmentation results enabled the development of several types of en face visualizations, including melano-layer thickness maps, RPE elevation maps, choroidal thickness maps, and choroidal stromal attenuation coefficient maps. These facilitate close examination of macular pathology. The melano-layer thickness map is very similar to a near infrared fundus autofluorescence image, so the map can be used to identify the source of a hyper-autofluorescent signal.

Detection and clinical correlation of leukocortical lesions in pediatric-onset multiple sclerosis on multi-contrast MRI

Objective: To determine the frequency of cortical lesions (CLs) in patients with pediatric-onset multiple sclerosis (POMS) using multi-contrast magnetic resonance imaging (MRI), and the relationship between frontal CL load and upper limb dexterity assessed with the Nine-Hole Peg Test (9-HPT). Methods: Participants completed the 9-HPT and were imaged on a 3T MRI scanner to collect T1-weighted three-dimensional (3D) magnetization prepared rapid gradient echo (MPRAGE), proton density–weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR) images. CLs were manually segmented using all MRI contrasts. Results: We enrolled 24 participants with POMS (mean (standard deviation) age at first symptom: 13.3 (±2.7) years; mean age at scan: 18.8 (±3) years; mean disease duration of 5 (±3.2) years). A total of 391 CLs (mean, 16.3 ± 27.2; median, 7) were identified in 19 of 24 POMS patients (79%). The total number of CLs was positively associated with white matter lesion volume (p = 0.04) but not with thalamic volume, age at the time of the scan, or disease duration. The number of frontal CLs was associated with slower performance on the 9-HPT (p = 0.05). Conclusion: Multi-contrast 3T MRI led to a high rate of CL detection, demonstrating that cortical pathology occurs even in pediatric-onset disease. Frontal lobe CL count was associated with reduced manual dexterity, indicating that these CLs are clinically relevant.