Bi-caudate ratio as a MRI marker of white matter atrophy in multiple sclerosis and ischemic leukocencephalopathy

Abstract

Background: Brain atrophy measurement is now a cornerstone in basic neuro-imaging science. While assessment of white matter atrophy by visual inspection is subjective, volumetric approaches are time-consuming and not often feasible. Bi-caudate ratio represents a linear surrogate parameter of brain volume that can be derived from standard imaging sequences. This study highlights the value of the bi-caudate ratio (BCR) as a MRI marker of white matter atrophy in patients with multiple sclerosis and ischemic leukoencephalopathy and set a cut-off value to differentiate between patients with white matter atrophy and normal subjects. Results: A total of 115 patients (54 males and 61 females) diagnosed with white matter leukoencephalopathy (MS in 51 patients and ischemic leukoencephalopathy in 64 patients) were included. Another group of 60 subjects with a normal white matter signal was recruited as a control group. BCR for the patient group ranged from 0.13 to 0.27 (mean (± SD) = 0.16 ± 0.02), while for the control group, it ranged from 0.05 mm to 0.13 (mean (± SD) = 0.09 ± 0.01). The difference between the two groups was statistically significant (P value < 0.001). A cut-off value of 0.13 was used to differentiate between the BCR in both patients and control groups with sensitivity, specificity, and accuracy of 99.2%, 100%, and 99%, respectively. The difference in BCR for patients diagnosed with MS and ischemic leukoencephalopathy was also statistically significant (P value < 0.001). Conclusion: The bi-caudate ratio represents a linear measurement of subcortical atrophy that can be useful as a surrogate marker of global supra-tentorial white matter atrophy instead of the usually performed visual and therefore subjective assessment. It is an easily obtained measure that can be performed without complex time-consuming volumetric studies. Our findings also revealed that the BCR is higher in patients with ischemic leukoencephalopathy than in patients with MS.

Differences in Brain Atrophy Pattern between People with Multiple Sclerosis and Systemic Diseases with Central Nervous System Involvement Based on Two-Dimensional Linear Measures

“…However, there are no data concerning the impact of age on BCR in SDCNS patients. Thus, based on the accepted interpretation that BCR reflects deep frontal subcortical white matter atrophy [28,[33][34][35]49], our findings highlight a relationship between age and this process not only in MS but also in SDCNS patients. Another 2DLM commonly used to assess brain atrophy is 3VW.…”

“…Additionally, 3V enlargement was also associated with higher T1LV and T2LV only in the MS group. Again, these observations might suggest that deep frontal subcortical white matter atrophy (measured by BCR) as well as central brain atrophy (represented by 3V enlargement) [28,[33][34][35]49,50] are significantly dependent on inflammatory and/or degenerative processes represented by focal white matter pathology in MS but not in SDCNS patients.…”

Neurocognitive functions and brain volume in patients with endogenous cushing's syndrome before and after curative surgery

“…We found that there was a significant ( P < 0.01) reduction in the diameter of both these parameters, suggesting that curative surgery in patients with CS leads to a reversal of structural changes of the brain. [ 40 41 ] However, studies with long term follow-up are required to know that these changes are completely reversed and neuropsychiatric manifestations revert to normal after structural changes normalized.…”

Predictive value of brain atrophy, serum biomarkers and information processing speed for early disease progression in multiple sclerosis

“…Another promising but non-specific biomarker is chitinase-3-like-1 precursor (CHI3L1); CHI3L1 serum and CSF levels were found to be increased as the disease progressed. CHI3L1 is also associated with conversion from CIS to RRMS and is correlated with a higher relapse rate ( 16 ). Although some studies reported that the levels of osteopontin (OPN) were higher in the blood and CSF of MS patients and correlated with relapse rate and disease severity ( 17 , 18 ), others did not confirm these findings.…”

“…To meet the need for simple but reliable measures of brain atrophy, linear atrophy parameters such as the bicaudate ratio (BCR) and the third ventricle width (TVW) were proposed ( 15 ). BCR is a surrogate marker of global supra-tentorial white matter atrophy ( 16 ), and the TVW corresponds with thalamic atrophy ( 17 ). Recently, it was shown that these two-dimensional parameters, which are easy and quick to measure in everyday practice, may be useful in the prognosis of disease progression ( 18 ).…”