MRI Subtypes in Multiple Sclerosis: Discovery from Imaging Studies
The study identified four MRI subtypes in multiple sclerosis: lesion-led, cortex-led, tract-led, and deep gray matter/cerebellar-led. Cortex-led and deep gray matter/cerebellar-led subtypes are more common in progressive disease, while lesion-led and tract-led are frequent in relapsing-remitting cases. Higher disability scores were more prevalent in the progressive subtypes. Cognitive performance declined with advancing SuStaIn stages within each subtype.
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Why it matters
These findings provide insight into the different biological behaviors and disabled profiles of multiple sclerosis, which may aid in understanding disease progression and tailoring future research. However, it does not prove direct causation of disability effects due to these MRI subtypes.
What this does not prove
The study does not establish causation between MRI subtypes and clinical outcomes, nor does it clarify how broadly these findings apply beyond the studied population.
Next milestone
No next milestone was established from the available source.
Study facts
- Study design
- Not reported
- Participants / samples
- Not reported
- Randomised
- Not reported
- Controlled
- Not reported
- Primary endpoint met
- Not reported
- Relevant MS type
- Not reported
- Publication date
- 2026-09-23
- Evidence reviewed
- Abstract only
- Regulatory approval
- Not reported
- Research areas
- Not classified
Original sources
- Primary evidenceImaging subtypes reveal distinct biological substrates and disability profiles in multiple sclerosis. ↗DOI: 10.1093/brain/awag320
Supporting passages (8)
findingsSuStaIn identified four MRI subtypes: lesion-led (44%), cortex-led (23%), tract-led (23%), and deep gray matter/cerebellar-led (10%).
findingsCortex-led and deep gray matter/cerebellar-led subtypes were enriched in progressive disease (47% and 56%), whereas lesion-led and tract-led subtypes were predominantly relapsing-remitting disease (66% and 71%) (p<0.001).
findingsCortex-led and deep gray matter/cerebellar-led subtypes were enriched in progressive disease (47% and 56%), whereas lesion-led and tract-led subtypes were predominantly relapsing-remitting disease (66% and 71%) (p<0.001).
findingsTract-led subtype was overrepresented in pediatric-onset disease (38%) and underrepresented in adult-onset disease (19%); lesion-led subtype predominated in adult-onset disease (48%), and deep gray matter/cerebellar-led subtype was more frequent in late-onset disease (14%) (p<0.001).
findingsExpanded Disability Status Scale scores ≥4.0 and ≥6.0 were more frequent in cortex-led and deep gray matter/cerebellar-led disease than in lesion-led or tract-led disease (45.3% and 55.6% versus 34.3% and 31.9%, and 27.8% and 29.3% versus 20.0% and 18.7%; p<0.001).
findingsCognitive performance and genetic risk scores for multiple sclerosis severity did not differ across subtypes, but within each subtype advancing SuStaIn stage was associated with worse global and domain-specific cognitive performance (all p≤0.030).
publication datePublication date: 2026-09-23
limitationsTitle: Imaging subtypes reveal distinct biological substrates and disability profiles in multiple sclerosis.
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