To assess in a large population of patients with clinically isolated syndrome (CIS) the relevance of brain lesion location and frequency in predicting 1-year conversion to multiple sclerosis (MS).
In this multicenter, retrospective study, clinical and MRI data at onset and clinical follow-up at 1 year were collected for 1,165 patients with CIS. On T2-weighted MRI, we generated lesion probability maps of white matter (WM) lesion location and frequency. Voxelwise analyses were performed with a nonparametric permutation-based approach (p < 0.05, cluster-corrected).
In CIS patients with hemispheric, multifocal, and brainstem/cerebellar onset, lesion probability map clusters were seen in clinically eloquent brain regions. Significant lesion clusters were not found in CIS patients with optic nerve and spinal cord onset. At 1 year, clinically definite MS developed in 26% of patients. The converting group, despite a greater baseline lesion load compared with the nonconverting group (7 ± 8.1 cm3 vs. 4.6 ± 6.7 cm3, p < 0.001), showed less widespread lesion distribution (18% vs. 25% of brain voxels occupied by lesions). High lesion frequency was found in the converting group in projection, association, and commissural WM tracts, with larger clusters being in the corpus callosum, corona radiata, and cingulum.
Higher frequency of lesion occurrence in clinically eloquent WM tracts can characterize CIS subjects with different types of onset. The involvement of specific WM tracts, in particular those traversed by fibers involved in motor function and near the corpus callosum, seems to be associated with a higher risk of clinical conversion to MS in the short term.
[Show abstract][Hide abstract] ABSTRACT: Clinically isolated syndrome (CIS) describes a first symptomatic neurologic episode that is consistent with multiple sclerosis (MS), lasts at least 24 hours, occurs in the absence of fever or infection, and presents without encephalopathy.(1) Its cause is inflammation or demyelination in one (i.e., monofocal episode) or multiple areas (i.e., multifocal episode) of the CNS. Symptoms are those commonly found in MS and include, for example, optic neuritis, sensory or motor signs, partial myelitis, and bladder or bowel dysfunction.(1).
[Show abstract][Hide abstract] ABSTRACT: White matter atrophy occurs independently of lesions in multiple sclerosis. In contrast to lesion detection, the quantitative assessment of white matter atrophy in individual patients has been regarded as a major challenge. We therefore tested the hypothesis that white matter atrophy (WMA) is present at the very beginning of multiple sclerosis (MS) and in virtually each individual patient. To find a new sensitive and robust marker for WMA we investigated the relationship between cortical surface area, white matter volume (WMV), and whole-brain-surface-averaged rectified cortical extrinsic curvature. Based on geometrical considerations we hypothesized that cortical curvature increases if WMV decreases and the cortical surface area remains constant.
[Show abstract][Hide abstract] ABSTRACT: Atrophy of the corpus callosum is a recognized characteristic of multiple sclerosis (MS). We describe a new reliable method for measuring corpus callosum atrophy and correlate this with global cerebral atrophy measures.
Whole brain 3T MRI was performed in 38 relapsing-remitting MS subjects and 21 healthy controls (HC). Brain global gray and white matter volumes were segmented with SPM8. The contour of the corpus callosum was outlined on the midline of 3-D T1-weighted images by a semiautomated edge-detection technique to determine the corpus callosum area (CCA). Normalized CCA was correlated with other brain atrophy measures in MS subjects.
CCA was disproportionately lower in MS subjects vs. HC (20.1% mean decrease; P < .001), with a large effect size (d = .62) when compared with global atrophy measures. In MS subjects, CCA correlated with brain parenchymal fraction (r = .55; P < .001) and gray matter fraction (r = .45; P = .005) but not white matter fraction (r = .18; P = .29). An inverse correlation with FLAIR hyperintense lesion volume (r = -.40; P = .01) was detected for CCA.
Measurement of atrophy of the corpus callosum can have sensitivity as a useful imaging biomarker in patients with MS, even in patients with low disability levels. Both gray and white matter involvement in MS contribute to corpus callosum atrophy.
Journal of neuroimaging: official journal of the American Society of Neuroimaging 05/2014; 25(1). DOI:10.1111/jon.12124 · 1.73 Impact Factor
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