Cerebral Blood Flow Changes in Multiple Sclerosis and Neuromyelitis Optica and Their Correlations With Clinical Disability

Abstract

Distinguishing relapsing-remitting multiple sclerosis (RRMS) and neuromyelitis optica (NMO) is clinically important because they differ in prognosis and treatment. This study aimed to identify perfusion abnormalities in RRMS and NMO and their correlations with gray matter volume (GMV) atrophy and clinical parameters. Structural and arterial spin labeling MRI scans were performed in 39 RRMS patients, 62 NMO patients, and 73 healthy controls. The gray matter cerebral blood flow (CBF) values were voxel-wisely compared among the three groups with and without GMV correction. The regional CBF changes were correlated with the Expanded Disability Status Scale scores in the corresponding patient groups. Although multiple brain regions showed CBF differences among the three groups without GMV correction, only three of these regions remained significant after GMV correction. Specifically, both the RRMS and NMO groups showed reduced CBF in the occipital cortex and increased CBF in the right putamen compared to the control group. The RRMS group had increased CBF only in the medial prefrontal cortex compared to the other two groups. The occipital CBF was negatively correlated with clinical disability in the NMO group; however, the CBF in the right putamen was positively correlated with clinical disability in both patient groups. These findings suggest that there are perfusion alterations independent of GMV atrophy in RRMS and NMO patients. The regional CBF in the occipital cortex and putamen could be used as imaging features to objectively assess clinical disability in these patients.

Alterations in the retinal vasculature occur in multiple sclerosis and exhibit novel correlations with disability and visual function measures

“…Indeed, support for a possible uncoupling between neurodegeneration and hypoperfusion in MS includes brain imaging studies suggesting that gray matter perfusion is reduced even in regions without evidence of atrophy. 29 Finally, regardless of whether vascular abnormalities in PwMS are a primary contributor to the pathophysiology of the disease, there is accumulating evidence that co-morbidities that are traditionally considered to be cardiovascular risk factors may play a role in modifying the clinical course of PwMS. 30–34 Thus, the potential to provide information on the combined effects of neurodegeneration and vasculopathy makes OCTA an attractive avenue of investigation in MS.…”

Arterial Spin Labeling Applications in Pediatric and Adult Neurologic Disorders

“…In longstanding inflammatory disorders, such as relapsing-remitting multiple sclerosis (MS), hypoperfusion may extend to involve normalappearing white matter and deep gray matter with decreased CVR and disrupted functional connectivity. 99 Toxic-Metabolic ASL features of toxic-metabolic encephalopathy are highly dependent on etiology and time course (Fig. 15a,d).…”

Hemodynamic Alterations in Multiple Sclerosis

“…However another one observed increased CBV and CBF in RRMS, in patients with high inflammatory lesion load, underlining the role of global modified microcirculation prior to leakage of the blood-brain barrier in the pathophysiology of MS [56]. The perfusion alterations in RRMS seem to be independent of GM volume atrophy, which presents in all types of MS [57]. Hemodynamic changes in both WM and GM seem to occur even at the earliest stages of MS. Interestingly, a greater reduction of NAWM CBF was found in PPMS compared to RRMS [47,49].…”