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<meta name="DC.Title" content="Dynamic Expansion and Contraction of Multiple Sclerosis T2-weighted Hyperintense Lesions are Present Below the Threshold of Visual Perception" />
<meta name="DC.Identifier" content="10.3174/ajnr.A8453" />
<meta name="DC.Date" content="2024-08-16" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The study of T2-weighted hyperintense lesions resulting from autoimmune inflammatory injury and associated volumes within the CNS remains fundamental to the diagnosis and disease surveillance of multiple sclerosis (MS). We investigated the dynamic changes of individual T2-weighted hyperintense MS lesions on MRI and hypothesized that variations may be present below the threshold of visual perception when evaluating longitudinal data.

MATERIALS AND METHODS: A retrospective study was performed of people with MS, incorporating data from three consecutive MRI time points acquired within a single academic center. All included MRI studies lacked formal imaging interpretations of newly enlarging or contracting T2-weighted hyperintensities. Well defined, non-coalescing, individual T2-weighted hyperintense lesions were targeted. A total of 8-12 lesions were randomly selected in a blinded fashion at MRI time point 1 and 3-dimensional lesion volumes followed over MRI time points 2 and 3. The impact of treatment on lesion expansion and relationship to brain MRI advancement, patient-reported progression of disease, and physician-identified progression was also studied.

RESULTS: The study cohort was comprised of 115 people (81 (70.4%) female; mean disease duration of 6.62 years(y) (standard deviation: 6.68y)) who were primarily White (79.1%). A total of 1,426 focal T2-weighted hyperintense MS lesions were identified on MRI time point 1 and longitudinally followed over MRI time points 2 and 3. In the evaluation of raw changes in individual T2-weighted hyperintense lesion volumes from MRI time point 1 to MRI time point 2, a similar number of individuals were observed with predominantly expanding (49/115; 42.6%) or contracting (51/115; 44.3%) lesions. However, the majority of lesions expanded in volume (48/115; 41.7%) versus those that contracted (45/115; 39.1%) when evaluating MRI time point 3 to time point 1. Those individuals not on active treatment had a 67.15% reduction in the odds of more individual lesions predominantly contracting in volume relative to those on low-efficacy disease modifying therapy treatment (95% CI=[-83.89, -33.01], p=0.0008) and 74.02% reduction for those on high-efficacy treatment (95% CI=[-87.37%,-46.56%], p&lt;0.0001).

CONCLUSIONS: Dynamic changes in T2-weighted hyperintense lesions are abundant, occurring below the threshold of visual perception and are present more frequently in untreated individuals.

ABBREVIATIONS: MS = multiple sclerosis; DMT = disease modifying therapy; 2D = 2-dimensional; 3D = 3-dimensional; LMS = Lambda, Mu, and Sigma" />
<meta name="DC.Contributor" content="Darin T. Okuda" />
<meta name="DC.Contributor" content="Tatum M. Moog" />
<meta name="DC.Contributor" content="Morgan McCreary" />
<meta name="DC.Contributor" content="Kevin Shan" />
<meta name="DC.Contributor" content="Kasia Zubkow" />
<meta name="DC.Contributor" content="Braeden D. Newton" />
<meta name="DC.Contributor" content="Alexander D. Smith" />
<meta name="DC.Contributor" content="Mahi A. Patel" />
<meta name="DC.Contributor" content="Katy W. Burgess" />
<meta name="DC.Contributor" content="Christine Lebrun-Frénay" />
<meta name="article:published_time" content="2024-08-16" />
<meta name="article:section" content="ORIGINAL RESEARCH" />
<meta name="citation_title" content="Dynamic Expansion and Contraction of Multiple Sclerosis T2-weighted Hyperintense Lesions are Present Below the Threshold of Visual Perception" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;ABSTRACT&lt;/h3&gt;
&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The study of T2-weighted hyperintense lesions resulting from autoimmune inflammatory injury and associated volumes within the CNS remains fundamental to the diagnosis and disease surveillance of multiple sclerosis (MS). We investigated the dynamic changes of individual T2-weighted hyperintense MS lesions on MRI and hypothesized that variations may be present below the threshold of visual perception when evaluating longitudinal data.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A retrospective study was performed of people with MS, incorporating data from three consecutive MRI time points acquired within a single academic center. All included MRI studies lacked formal imaging interpretations of newly enlarging or contracting T2-weighted hyperintensities. Well defined, non-coalescing, individual T2-weighted hyperintense lesions were targeted. A total of 8-12 lesions were randomly selected in a blinded fashion at MRI time point 1 and 3-dimensional lesion volumes followed over MRI time points 2 and 3. The impact of treatment on lesion expansion and relationship to brain MRI advancement, patient-reported progression of disease, and physician-identified progression was also studied.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;The study cohort was comprised of 115 people (81 (70.4%) female; mean disease duration of 6.62 years(y) (standard deviation: 6.68y)) who were primarily White (79.1%). A total of 1,426 focal T2-weighted hyperintense MS lesions were identified on MRI time point 1 and longitudinally followed over MRI time points 2 and 3. In the evaluation of raw changes in individual T2-weighted hyperintense lesion volumes from MRI time point 1 to MRI time point 2, a similar number of individuals were observed with predominantly expanding (49/115; 42.6%) or contracting (51/115; 44.3%) lesions. However, the majority of lesions expanded in volume (48/115; 41.7%) versus those that contracted (45/115; 39.1%) when evaluating MRI time point 3 to time point 1. Those individuals not on active treatment had a 67.15% reduction in the odds of more individual lesions predominantly contracting in volume relative to those on low-efficacy disease modifying therapy treatment (95% CI=[-83.89, -33.01], p=0.0008) and 74.02% reduction for those on high-efficacy treatment (95% CI=[-87.37%,-46.56%], p&amp;lt;0.0001).&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Dynamic changes in T2-weighted hyperintense lesions are abundant, occurring below the threshold of visual perception and are present more frequently in untreated individuals.&lt;/p&gt;&lt;p&gt;ABBREVIATIONS: MS = multiple sclerosis; DMT = disease modifying therapy; 2D = 2-dimensional; 3D = 3-dimensional; LMS = Lambda, Mu, and Sigma&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2024/08/16" />
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<meta name="citation_full_html_url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/08/16/ajnr.A8453.full" />
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<meta name="citation_section" content="ORIGINAL RESEARCH" />
<meta name="citation_author" content="Darin T. Okuda" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Tatum M. Moog" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Morgan McCreary" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Kevin Shan" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Kasia Zubkow" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Braeden D. Newton" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Alexander D. Smith" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Mahi A. Patel" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Katy W. Burgess" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="citation_author" content="Christine Lebrun-Frénay" />
<meta name="citation_author_institution" content="From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France" />
<meta name="twitter:title" content="Dynamic Expansion and Contraction of Multiple Sclerosis T2-weighted Hyperintense Lesions are Present Below the Threshold of Visual Perception" />
<meta name="twitter:card" content="summary" />
<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The study of T2-weighted hyperintense lesions resulting from autoimmune inflammatory injury and associated volumes within the CNS remains fundamental to the diagnosis and disease surveillance of multiple sclerosis (MS). We investigated the dynamic changes of individual T2-weighted hyperintense MS lesions on MRI and hypothesized that variations may be present below the threshold of visual perception when evaluating longitudinal data.

MATERIALS AND METHODS: A retrospective study was performed of people with MS, incorporating data from three consecutive MRI time points acquired within a single academic center. All included MRI studies lacked formal imaging interpretations of newly enlarging or contracting T2-weighted hyperintensities. Well defined, non-coalescing, individual T2-weighted hyperintense lesions were targeted. A total of 8-12 lesions were randomly selected in a blinded fashion at MRI time point 1 and 3-dimensional lesion volumes followed over MRI time points 2 and 3. The impact of treatment on lesion expansion and relationship to brain MRI advancement, patient-reported progression of disease, and physician-identified progression was also studied.

RESULTS: The study cohort was comprised of 115 people (81 (70.4%) female; mean disease duration of 6.62 years(y) (standard deviation: 6.68y)) who were primarily White (79.1%). A total of 1,426 focal T2-weighted hyperintense MS lesions were identified on MRI time point 1 and longitudinally followed over MRI time points 2 and 3. In the evaluation of raw changes in individual T2-weighted hyperintense lesion volumes from MRI time point 1 to MRI time point 2, a similar number of individuals were observed with predominantly expanding (49/115; 42.6%) or contracting (51/115; 44.3%) lesions. However, the majority of lesions expanded in volume (48/115; 41.7%) versus those that contracted (45/115; 39.1%) when evaluating MRI time point 3 to time point 1. Those individuals not on active treatment had a 67.15% reduction in the odds of more individual lesions predominantly contracting in volume relative to those on low-efficacy disease modifying therapy treatment (95% CI=[-83.89, -33.01], p=0.0008) and 74.02% reduction for those on high-efficacy treatment (95% CI=[-87.37%,-46.56%], p&lt;0.0001).

CONCLUSIONS: Dynamic changes in T2-weighted hyperintense lesions are abundant, occurring below the threshold of visual perception and are present more frequently in untreated individuals.

ABBREVIATIONS: MS = multiple sclerosis; DMT = disease modifying therapy; 2D = 2-dimensional; 3D = 3-dimensional; LMS = Lambda, Mu, and Sigma" />
<meta name="og-title" property="og:title" content="Dynamic Expansion and Contraction of Multiple Sclerosis T2-weighted Hyperintense Lesions are Present Below the Threshold of Visual Perception" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/early/2024/08/16/ajnr.A8453" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The study of T2-weighted hyperintense lesions resulting from autoimmune inflammatory injury and associated volumes within the CNS remains fundamental to the diagnosis and disease surveillance of multiple sclerosis (MS). We investigated the dynamic changes of individual T2-weighted hyperintense MS lesions on MRI and hypothesized that variations may be present below the threshold of visual perception when evaluating longitudinal data.

MATERIALS AND METHODS: A retrospective study was performed of people with MS, incorporating data from three consecutive MRI time points acquired within a single academic center. All included MRI studies lacked formal imaging interpretations of newly enlarging or contracting T2-weighted hyperintensities. Well defined, non-coalescing, individual T2-weighted hyperintense lesions were targeted. A total of 8-12 lesions were randomly selected in a blinded fashion at MRI time point 1 and 3-dimensional lesion volumes followed over MRI time points 2 and 3. The impact of treatment on lesion expansion and relationship to brain MRI advancement, patient-reported progression of disease, and physician-identified progression was also studied.

RESULTS: The study cohort was comprised of 115 people (81 (70.4%) female; mean disease duration of 6.62 years(y) (standard deviation: 6.68y)) who were primarily White (79.1%). A total of 1,426 focal T2-weighted hyperintense MS lesions were identified on MRI time point 1 and longitudinally followed over MRI time points 2 and 3. In the evaluation of raw changes in individual T2-weighted hyperintense lesion volumes from MRI time point 1 to MRI time point 2, a similar number of individuals were observed with predominantly expanding (49/115; 42.6%) or contracting (51/115; 44.3%) lesions. However, the majority of lesions expanded in volume (48/115; 41.7%) versus those that contracted (45/115; 39.1%) when evaluating MRI time point 3 to time point 1. Those individuals not on active treatment had a 67.15% reduction in the odds of more individual lesions predominantly contracting in volume relative to those on low-efficacy disease modifying therapy treatment (95% CI=[-83.89, -33.01], p=0.0008) and 74.02% reduction for those on high-efficacy treatment (95% CI=[-87.37%,-46.56%], p&lt;0.0001).

CONCLUSIONS: Dynamic changes in T2-weighted hyperintense lesions are abundant, occurring below the threshold of visual perception and are present more frequently in untreated individuals.

ABBREVIATIONS: MS = multiple sclerosis; DMT = disease modifying therapy; 2D = 2-dimensional; 3D = 3-dimensional; LMS = Lambda, Mu, and Sigma" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node109946--7" data-node-nid="109946" id="top-node-109946--81894239279" data-pisa="ajnr;ajnr.A8453v1" data-pisa-master="ajnr;ajnr.A8453" data-apath="/ajnr/early/2024/08/16/ajnr.A8453.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">ORIGINAL RESEARCH</span></span></div>
  
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      <h1 class="highwire-cite-title" id="page-title">Dynamic Expansion and Contraction of Multiple Sclerosis T2-weighted Hyperintense Lesions are Present Below the Threshold of Visual Perception</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Darin T. Okuda</span>, <span class="highwire-citation-author" data-delta="1">Tatum M. Moog</span>, <span class="highwire-citation-author" data-delta="2">Morgan McCreary</span>, <span class="highwire-citation-author" data-delta="3">Kevin Shan</span>, <span class="highwire-citation-author" data-delta="4">Kasia Zubkow</span>, <span class="highwire-citation-author" data-delta="5">Braeden D. Newton</span>, <span class="highwire-citation-author" data-delta="6">Alexander D. Smith</span>, <span class="highwire-citation-author" data-delta="7">Mahi A. Patel</span>, <span class="highwire-citation-author" data-delta="8">Katy W. Burgess</span> and <span class="highwire-citation-author" data-delta="9">Christine Lebrun-Frénay</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2024,  </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8453; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A8453 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-109946--81894239279" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Darin T. Okuda </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Darin%2BT.%2BOkuda%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Okuda%20DT&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ADarin%2BT.%2BOkuda%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Tatum M. Moog </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Tatum%2BM.%2BMoog%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Moog%20TM&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ATatum%2BM.%2BMoog%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Morgan McCreary </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Morgan%2BMcCreary%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=McCreary%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AMorgan%2BMcCreary%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Kevin Shan </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Kevin%2BShan%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Shan%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKevin%2BShan%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">Kasia Zubkow </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Kasia%2BZubkow%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zubkow%20K&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKasia%2BZubkow%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">Braeden D. Newton </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Braeden%2BD.%2BNewton%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Newton%20BD&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ABraeden%2BD.%2BNewton%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">Alexander D. Smith </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Alexander%2BD.%2BSmith%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Smith%20AD&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AAlexander%2BD.%2BSmith%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">Mahi A. 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Burgess </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Katy%2BW.%2BBurgess%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Burgess%20KW&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKaty%2BW.%2BBurgess%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">Christine Lebrun-Frénay </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Christine%2BLebrun-Fr%C3%A9nay%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lebrun-Fr%C3%A9nay%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AChristine%2BLebrun-Fr%25C3%25A9nay%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">Darin T. Okuda</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-2"><span class="name">Tatum M. Moog</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-3"><span class="name">Morgan McCreary</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-4"><span class="name">Kevin Shan</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-5"><span class="name">Kasia Zubkow</span><a id="xref-aff-1-5" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-6"><span class="name">Braeden D. Newton</span><a id="xref-aff-1-6" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-7"><span class="name">Alexander D. Smith</span><a id="xref-aff-1-7" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-8"><span class="name">Mahi A. Patel</span><a id="xref-aff-1-8" class="xref-aff" href="#aff-1"></a>, </li><li class="contributor" id="contrib-9"><span class="name">Katy W. Burgess</span><a id="xref-aff-1-9" class="xref-aff" href="#aff-1"></a> and </li><li class="last" id="contrib-10"><span class="name">Christine Lebrun-Frénay</span><a id="xref-aff-1-10" class="xref-aff" href="#aff-1"></a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address>From the Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute (DTO, TMM, MM, MAP, KWB), Dallas Texas, USA; The University of Texas Southwestern Medical Center, School of Medicine (KS), Dallas, Texas, USA; Division of Neurology, University of Saskatchewan (KZ), Saskatoon, SK, Canada; Division of Neurosurgery, University of Saskatchewan (BDN), Saskatoon, SK, Canada; Texas Tech University Health Sciences Center, School of Medicine (ADS), Lubbock, Texas, USA; Université Nice Cote d’Azur (CLF), CRCSEP, Nice, France</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Darin T. Okuda, M.D., M.Sc., F.A.A.N., F.A.N.A., Department of Neurology, Neuroinnovation Program, Multiple Sclerosis and Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Peter O’Donnell Jr. Brain Institute, 5323 Harry Hines Blvd., Dallas, Texas 75390-8806, U.S.A.; <span class="em-link"><span class="em-addr">darin.okuda{at}utsouthwestern.edu</span></span>.</li></ol></div></div></div>  </div>

  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8453; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8453 </span></div>
  
  
  
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      <div class="highwire-cite-title">Dynamic Expansion and Contraction of Multiple Sclerosis T2-weighted Hyperintense Lesions are Present Below the Threshold of Visual Perception</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Darin T.</span> <span class="nlm-surname">Okuda</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Tatum M.</span> <span class="nlm-surname">Moog</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Morgan</span> <span class="nlm-surname">McCreary</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Kevin</span> <span class="nlm-surname">Shan</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">Kasia</span> <span class="nlm-surname">Zubkow</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">Braeden D.</span> <span class="nlm-surname">Newton</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">Alexander D.</span> <span class="nlm-surname">Smith</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">Mahi A.</span> <span class="nlm-surname">Patel</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">Katy W.</span> <span class="nlm-surname">Burgess</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">Christine</span> <span class="nlm-surname">Lebrun-Frénay</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2024, </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">ajnr.A8453; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A8453 </span></div>
  
  
  
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