Evolution Of Different MRI Measures In Patients With Active Relapsing/Remitting Multiple Sclerosis Over 2 And 5 Years: A Case-Control Study
Horakova D, Cox JL, Havrdova E, Hussein S, Dolezal O, Cookfair D, Dwyer MG, Seidl Z, Bergsland N, Vaneckova M, Zivadinov R
J Neurol NeuroSurg Psychiatry 2008 Apr;79(4):407-14
Charles University in Prague, First Faculty of Medicine, Department of Neurology, Prague, Czech Republic
There is growing evidence for the concept of Multiple Sclerosis (MS) as an Inflammatory NeuroDegenerative Disease, with a different pattern of Atrophy evolution in Gray Matter (GM) and White Matter (WM) tissue compartments.
We aimed to investigate the evolution of different MRI measures in early Relapsing/Remitting patients with MS and in Normal Controls (NCs) over 2 years.
We also evaluated the progression of these MRI measures in a subset of patients who were followed for up to 5 years.
Included in this study were 147 patients who participated in the combination ASA (Avonex Steroids Azathioprine) study and completed full treatment, clinical and MRI assessment at 0, 12 and 24 months.
A subgroup of 66 patients was followed for 36 months, 51 patients for 48 months and 43 patients for 60 months.
Mean age at baseline was 30.7 years, mean disease duration was 5.5 years, mean EDSS was 1.8 and mean annualised relapse rate before study entry was 1.7.
MRI scans were performed on a 1.5T scanner every 2 months for the first 2 years and thereafter once yearly for up to 5 years.
In addition to the MS group, 27 NCs were examined at months 0, 12 and 24 using the same MRI protocol.
Percentage Brain Volume Change (PBVC), GM Volume (GMV), WM Volume (WMV) and Peripheral Gray Volume (PGV) were measured annually using SIENA/X software.
T2-HyperIntense lesion volume (LV), Lateral Ventricle Volume (LVV) and Third Ventricle Width (3VW) were also assessed annually.
Over the period of 0-24 months, patients with MS lost significantly more GMV (-2.6% vs -0.72%, p < 0.001), PGV (-2.4% vs -1.03%, p < 0.001) and PBVC (-1.2% vs -0.22%, p < 0.001), and increased in LVV (+16.6% vs +0.55%, p < 0.003) and 3VW (+9.3% vs 0%, p = 0.003), when compared with NCs.
Within-person change in MRI measures for patients with MS over 5 years was -4.2% for PBVC, -6.2% for GMV, -5.8% for PGV, -0.5% for WMV (all p < 0.001), +68.7 for LVV (p < 0.001), +4% for 3VW (p < 0.001) and +42% for T2-LV (p < 0.001).
Our study confirmed a different pattern of GM, WM and Central Atrophy progression over 2 years between patients with MS and NCs.
The study showed a different evolution of tissue compartment Atrophy measures in patients with MS, with faster decline in Cortical and deep GM regions, as well as PeriVentricular WM regions, over a 5-year period.
Mesaros S, Rocca MA, Absinta M, Ghezzi A, Milani N, Moiola L, Veggiotti P, Comi G, Filippi M
Neurology 2008 Mar 25;70(13 Pt 2):1107-12
Scientific Institute and University Hospital San Raffaele,NeuroImaging Research Unit, Via Olgettina 60, 20132 Milan, Italy
We used Voxel-Based Morphometry (VBM) to assess the pattern of Regional Gray Matter (GM) loss in patients with pediatric Multiple Sclerosis (MS).
And its relation with the Expanded Disability Status Scale (EDSS) score, disease duration, and the extent of T2 Lesion Load (LL).
From 28 patients with pediatric Relapsing/Remitting MS (16 girls; mean age = 14.4 years, range = 7 to 16 years) and 21 matched controls, dual-echo and three-dimensional T1-weighted Magnetization prepared rapid acquisition gradient echo sequences were acquired.
T2 LL was measured using a local thresholding segmentation technique. Data were analyzed using an optimized VBM analysis and statistical parametric mapping.
In pediatric patients with MS, mean Brain T2 LL was 7.8 mL +/- 11.3. IntraCranial Volume did not differ between patients and controls.
Compared to controls, patients with pediatric MS had significant GM loss in the Thalamus, bilaterally, which was significantly correlated with T2 LL (r = -0.80 for the Right Thalamus, r = -0.74 for the left Thalamus, p < 0.05, corrected for multiple comparisons).
No correlation was found between Thalamic GM loss, disease duration, and disability.
In patients with pediatric Multiple Sclerosis (MS), differently from what happens in adult-onset MS, Gray Matter (GM) Atrophy seems to involve the Thalamus only, with sparing of the Cortex and other deep GM Nuclei.
The correlation found between Atrophy and T2 lesion load suggests TransSynaptic and Wallerian Degeneration as the most likely substrate of tissue loss in the Thalamus of these patients.
A Voxel-Based Morphometry Study Of Gray Matter Loss In MS Patients With Different Clinical Phenotypes
Ceccarelli A, Rocca MA, Pagani E, Colombo B, Martinelli V, Comi G, Filippi M
NeuroImage 2008 Aug 1;42(1):315-22
Scientific Institute and University Ospedale San Raffaele, NeuroImaging Research Unit, Milan, Italy
To assess Regional Gray Matter (GM) changes in a large cohort of Multiple Sclerosis (MS) patients with different clinical phenotypes, using Voxel-Based Morphometry (VBM) and their correlation with the extent of global and Regional T2 Lesion Volumes (LV).
We acquired conventional MRI scans from 71 MS patients with different clinical phenotypes:
- 26 with Relapsing/Remitting [RR] MS,
- 27 with Secondary/Progressive [SP] MS and
- 18 with Primary/Progressive [PP] MS),
- 28 patients with a Clinically Isolated Syndrome (CIS) suggestive of MS, and
- 21 controls
No GM loss was found in CIS patients.
Compared to CIS patients, those with RRMS had a significant GM loss in the Right Pre and PostCentral Gyri.
Compared to RRMS, SPMS patients had a significant GM loss in several regions of the Fronto-Parieto-Temporo-Occipital Lobes, the Cerebellum and Superior and Inferior Colliculus, bilaterally, and deep GM structures.
Compared to PPMS, SPMS patients had a significant GM loss in the Postcentral Gyrus, the Cuneus, the Middle Occipital Gyrus, the Thalamus, the Cerebellum, and the Superior and Inferior Colliculi.
In all MS groups, regional GM loss was strongly/moderately correlated with Brain T2 LV.
In SPMS and PPMS patients, a correlation was found between Cortical regional GM loss and T2 LV of the corresponding or adjacent lobes.
In MS patients, GM Volume Loss follows different patterns of regional distribution according to the clinical phenotype of the disease.
It is likely secondary to the presence and topography of focal WM Inflammatory-DeMyelinating lesions, and is more evident in the Progressive forms of the disease.