7T imaging and the commensurate T1-lenghtening have the potential to increase lesion sensitivity at the expense of their specificity in patients with multiple sclerosis. In our work we demonstrate that (1) T1-hypontense lesions detected on T1-w MPRAGE reflect both remyelinated and chronic demyelinated lesions as measured by histology and that (2) associations between black hole lesion load and measures of physical and cognitive disability are weak. At 7T, the increased sensitivity to lesion penalizes the T1-w MPRAGE specificity to areas with higher water content and tissue destruction seen at lower field strength.
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