The predictive value of gray matter atrophy in clinically isolated syndromes

Multiple Sclerosis Centre of Veneto Region, First Neurology Clinic, Department of Neurosciences, University Hospital of Padova, Via Giustiniani 5, 35128 Padova, Italy.
Neurology (Impact Factor: 8.3). 05/2011; 77(3):257-63. DOI: 10.1212/WNL.0b013e318220abd4
Source: PubMed

ABSTRACT Although gray matter (GM) atrophy is recognized as a common feature of multiple sclerosis (MS), conflicting results have been obtained in patients with clinically isolated syndromes (CIS). Methodologic and clinical constraints may take account for literature discrepancies.
A total of 105 patients presenting with CIS and 42 normal controls (NC) were studied. At baseline, 65/105 patients with CIS met the criterion of dissemination in space of lesions (DIS+). All patients were clinically assessed by means of the Expanded Disability Status Scale every 6 months and underwent MRI evaluation at study entry and then annually for 4 years. Global and regional cortical thickness and deep GM atrophy were assessed using Freesurfer.
No significant reduction in GM atrophy was observed between the entire CIS group and the NC, excepting for the cerebellum cortical volume. When the 59 patients with CIS (46 DIS+, 13 DIS-) who converted to MS during the follow-up were compared to the NC, a significant atrophy in the precentral gyrus, superior frontal gyrus, thalamus, and putamen was observed (p ranging from 0.05 to 0.001). The multivariate analysis identified the atrophy of superior frontal gyrus, thalamus, and cerebellum as independent predictors of conversion to MS. CIS with atrophy of such areas had a double risk of conversion compared to DIS+ (odds ratio 9.6 vs 5.0).
Selective GM atrophy is relevant in patients with CIS who convert early to MS. The inclusion of GM analysis in the MS diagnostic workup is worthy of further investigation.

1 Follower
  • Source
    • "Determination of CL number and CL volume on DIR images and of volume of T2 WM lesions (T2WMLV) on FLAIR images was achieved by consensus of two experienced observers blind to patient identity and to the date of image acquisition, as previously described in detail (Calabrese et al., 2010) and in agreement with the recent MAGNIMS Study Group's recommendations (Geurts et al., 2011). Global and regional cortical thickness (CTh) (mean of right and left hemispheres) was performed on the volumetric FFE data sets by means of Freesurfer image analysis suite, as described in detail elsewhere (Calabrese et al., 2011). Spinal cord MRI included T1, T2, STIR and contrast enhancing T1 sequences. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The cerebrospinal fluid levels of interleukin-1 beta and structural magnetic resonance parameters of cortical damage, i.e., cortical lesion number and volume, and global cortical thickness, were analysed in multiple sclerosis patients at clinical onset. Cerebrospinal fluid interleukin-1 beta levels strongly correlated with cortical lesion load and cortical thickness, while correlation with white matter lesion load was modest. Interleukin-1 beta, intrathecally produced by infiltrating lymphocytes and activated microglia, may constitute a possible link between inflammation and neurodegeneration in multiple sclerosis.
    Journal of neuroimmunology 05/2014; DOI:10.1016/j.jneuroim.2014.02.014 · 2.79 Impact Factor
  • Source
    • "GM atrophy having a predictive value for development of MS after clinically isolated syndromes (CIS) (Batista et al., 2012; Ceccarelli et al., 2008; Houtchens et al., 2007; Khaleeli et al., 2007; Mesaros et al., 2011; Neema et al., 2009; Rocca et al., 2010; Vercellino et al., 2009; Zivadinov et al., 2012). It has been shown, for example , that selective GM atrophy is relevant in patients with CIS who convert early to MS (Calabrese et al., 2011). Despite the fast-paced development of imaging techniques there is still a lack of robust association between relapses, clinical symptoms, and sites of lesion location (Svendsen et al., 2011). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Various types of multiple sclerosis (MS) related pain have been discussed. One concept is that deafferentation secondary to lesions in the spino-thalamo-cortical network can cause central pain. However, this hypothesis is somehow limited by a lack of a robust association between pain episodes and sites of lesion location. We tested the hypothesis that temporary tissue alterations in the thalamus that are not detectable by conventional magnetic resonance imaging (T1w, FLAIR) can potentially explain a focal, paroxysmal central pain episode of a patient with MS. For microstructural tissue assessment we employed ten longitudinal diffusion tensor imaging (DTI) examinations. We could demonstrate an abnormal, unilateral temporary increase of the fractional anisotropy (FA) in the thalamus contralateral to the affected body side. Before the pain episode and after pain relief the FA reached completely normal values as seen in identically investigated age and gender matched 100 healthy control subjects. THESE FINDINGS SUGGEST THAT: i.) frequently applied and quantitatively evaluated DTI could be used as a sensitive imaging technique for detection of pathological processes associated with MS not detectable with conventional imaging strategies, ii.) temporary pathological processes in the "normal-appearing" thalamus may explain waxing and waning symptoms like episodes of central pain, and iii.) cross-sectional case examinations on (MS) patients with central pain should be performed to investigate how often thalamic alterations occur together with central pain.
    01/2013; 2:258-62. DOI:10.1016/j.nicl.2013.01.008
  • Source
    • "Some of the processes in the cortex even precede changes in WM and are probably more responsible for development of irreversible clinical disability [15–19, 22–24]. Very few longitudinal studies explored the relationship between cortical atrophy development and WM lesion burden accumulation and disability progression in early RRMS [11] [18]. erefore, another aim of this study was to investigate the effect of cortical atrophy development on disability progression, using bimonthly serial MRI assessments. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the evolution of cortical atrophy in patients with early relapsing-remitting (RR) multiple sclerosis (MS) and its association with lesion volume (LV) accumulation and disability progression. 136 of 181 RRMS patients who participated in the Avonex-Steroids-Azathioprine study were assessed bimonthly for clinical and MRI outcomes over 2 years. MS patients with disease duration (DD) at baseline of ≤24 months were classified in the early group (DD of 1.2 years, n = 37), while patients with DD > 24 months were classified in the late group (DD of 7.1 years, n = 99). Mixed effect model analysis was used to investigate the associations. Significant changes in whole brain volume (WBV) (P < 0.001), cortical volume (CV) (P < 0.001), and in T2-LV (P < 0.001) were detected. No significant MRI percent change differences were detected between early and late DD groups over 2 years, except for increased T2-LV accumulation between baseline and year 2 in the early DD group (P < 0.01). No significant associations were found between changes in T2-LV and CV over the followup. Change in CV was related to the disability progression over the 2 years, after adjusting for DD (P = 0.01). Significant cortical atrophy, independent of T2-LV accumulation, occurs in early RRMS over 2 years, and it is associated with the disability progression.
    01/2013; 2013:231345. DOI:10.1155/2013/231345
Show more