In multiple sclerosis (MS), cortical atrophy could result from extensive axonal transection from distant white matter lesion and/or local cortical demyelination. The destructive potential of MS white matter lesions, however, seem to differ across lesion types, being higher for chronic active lesions detectable on susceptibility weighted images by their characteristic paramagnetic rim. Using 7T MRI that has shown increased sensitivity to cortical lesions and modern machine learning algorithms, we demonstrate that both white matter and cortical lesions are main determinants of cortical thinning. Despite their destructive capacity, chronic active lesions are not major contributors of cortical tissue loss.
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