Choroid Plexus Enlargement in Inflammatory Multiple Sclerosis: 3.0-T MRI and Translocator Protein PET Evaluation

Ricigliano, Vito A. G.; Morena, Emanuele; Colombi, A; Tonietto, Mattéo; Hamzaoui, Mariem; Poirion, Émilie; Bottlaender, Michel; Gervais, Philippe; Louapre, Céline; Bodini, Benedetta; Stankoff, Bruno

doi:10.1148/radiol.2021204426

Cited by 82 publications

(129 citation statements)

References 39 publications

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“…Our results are in line with other MRI studies 9 but not all. 15 The enlargement of the choroid plexus in MS vs HCs was more pronounced in a previous study 9 than in our study.…”

Section: Discussionsupporting

confidence: 94%

“…Our results are in line with other MRI studies 9 but not all. 15 The enlargement of the choroid plexus in MS vs HCs was more pronounced in a previous study 9 than in our study. In that study 9 , the choroid plexus volume adjusted for TIV was 35% larger in MS than in HCs compared with 21% in our study.…”

Section: Discussionsupporting

confidence: 94%

“…TIV and lateral ventricle volume were measured using FreeSurfer ( surfer.nmr.mgh.harvard.edu/ ) on white matter lesion–filled T1-weighted MPRAGE sequences. Similar to a previously published study, 9 we reported the choroid plexus volume also relative to the TIV.…”

Section: Methodssupporting

confidence: 91%

“…In that study 9 , the choroid plexus volume adjusted for TIV was 35% larger in MS than in HCs compared with 21% in our study. 9 This might be due to the inclusion of less active MS patients in our study. In our MS group, 33% of the patients with RRMS had a relapse in the 2 years before the MRI, and only 2 of 180 patients with MS had gadolinium enhancement in contrast to 80% and 32%, respectively, in the aforementioned study.…”

Section: Discussioncontrasting

confidence: 68%

“… 15 The enlargement of the choroid plexus in MS vs HCs was more pronounced in a previous study 9 than in our study. In that study 9 , the choroid plexus volume adjusted for TIV was 35% larger in MS than in HCs compared with 21% in our study. 9 This might be due to the inclusion of less active MS patients in our study.…”

Section: Discussioncontrasting

confidence: 47%

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Choroid Plexus Volume in Multiple Sclerosis vs Neuromyelitis Optica Spectrum Disorder

Müller

Sinnecker²,

Wendebourg³

et al. 2022

Neurol Neuroimmunol Neuroinflamm

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Background and ObjectivesThe choroid plexus has been shown to play a crucial role in CNS inflammation. Previous studies found larger choroid plexus in multiple sclerosis (MS) compared with healthy controls. However, it is not clear whether the choroid plexus is similarly involved in MS and in neuromyelitis optica spectrum disorder (NMOSD). Thus, the aim of this study was to compare the choroid plexus volume in MS and NMOSD.MethodsIn this retrospective, cross-sectional study, patients were included by convenience sampling from 4 international MS centers. The choroid plexus of the lateral ventricles was segmented fully automatically on T1-weighted MRI sequences using a deep learning algorithm (Multi-Dimensional Gated Recurrent Units). Uni- and multivariable linear models were applied to investigate associations between the choroid plexus volume, clinically meaningful disease characteristics, and MRI parameters.ResultsWe studied 180 patients with MS and 98 patients with NMOSD. In total, 94 healthy individuals and 47 patients with migraine served as controls. The choroid plexus volume was larger in MS (median 1,690 µL, interquartile range [IQR] 648 µL) than in NMOSD (median 1,403 µL, IQR 510 µL), healthy individuals (median 1,533 µL, IQR 570 µL), and patients with migraine (median 1,404 µL, IQR 524 µL; all p < 0.001), whereas there was no difference between NMOSD, migraine, and healthy controls. This was also true when adjusted for age, sex, and the intracranial volume. In contrast to NMOSD, the choroid plexus volume in MS was associated with the number of T2-weighted lesions in a linear model adjusted for age, sex, total intracranial volume, disease duration, relapses in the year before MRI, disease course, Expanded Disability Status Scale score, disease-modifying treatment, and treatment duration (beta 4.4; 95% CI 0.78–8.1; p = 0.018).DiscussionThis study supports an involvement of the choroid plexus in MS in contrast to NMOSD and provides clues to better understand the respective pathogenesis.

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“…Our results are in line with other MRI studies 9 but not all. 15 The enlargement of the choroid plexus in MS vs HCs was more pronounced in a previous study 9 than in our study.…”

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 94%

Section: Methodssupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 68%

Section: Discussioncontrasting

confidence: 47%

See 3 more Smart Citations

Choroid Plexus Volume in Multiple Sclerosis vs Neuromyelitis Optica Spectrum Disorder

Müller

Sinnecker²,

Wendebourg³

et al. 2022

Neurol Neuroimmunol Neuroinflamm

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Choroid plexus volume in multiple sclerosis predicts expansion of chronic lesions and brain atrophy

Klistorner

Barnett

Parratt

et al. 2022

Ann Clin Transl Neurol

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Objectives Recent studies suggested that the expansion of long‐standing multiple sclerosis (MS) lesions and an enlargement of choroid plexus may be linked to chronic inflammation and microglial activation. We investigated the potential association between plexus volume and subsequent lesion expansion in patients with relapsing‐remitting MS. Methods Pre‐ and post‐gadolinium 3D‐T1, 3D FLAIR and diffusion tensor images were acquired from 49 patients. Choroid plexus (CP) volume (normalised by Total Intracranial Volume, TIV) and lesion activity were analysed between baseline and 48 months. In addition, plexus volume was measured in 40 healthy controls of similar age and gender. Results Baseline CP/TIV ratio was significantly larger in RRMS patients compared to normal controls (p < 0.001). CP/TIV ratio remained stable in RRMS patients during follow‐up period. There was a strong correlation between baseline CP/TIV ratio and subsequent rate of chronic lesion expansion (p < 0.001), which was stronger in close proximity to CSF. A cut‐off of 98 × 10−5 CP/TIV ratio predicted future lesion expansion with a sensitivity of 85% and specificity of 76%. CP/TIV ratio larger than a cut‐off was associated with >8‐fold increased risk of chronic lesion expansion. Baseline CP/TIV ratio was also associated with change in Mean Diffusivity (MD) inside of chronic lesions. Furthermore, baseline CP/TIV ratio significantly correlated with central brain atrophy. There was, however, no correlation between CP/TIV ratio and volume of new lesions. Interpretation Our data demonstrate that baseline CP/TIV ratio predicts subsequent expansion of chronic periventricular MS lesions and associated tissue damage within and outside of chronic lesions.

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Choroid Plexus Enlargement Exacerbates White Matter Hyperintensity Growth through Glymphatic Impairment

Zhou

Zhong

et al. 2023

Annals of Neurology

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Objective: Choroid plexus (CP) is a key regulator in cerebrospinal fluid production, but its contribution to glymphatic clearance function and association with white matter hyperintensity (WMH) remains unclear. Methods: This retrospective study included 2 prospective 3.0-T magnetic resonance imaging (MRI) cohorts. In cohort 1, patients with indications for lumbar puncture underwent 3-dimensional T1-weighted sequence (3D-T1) before and at 39 hours after intrathecal administration of contrast agent (glymphatic MRI). In cohort 2, patients with WMH were enrolled from the CIRCLE study and had a median follow-up time of 1.4 years. WMH and CP of the lateral ventricles were automatically segmented on T2 fluid-attenuated inversion recovery (FLAIR) and 3D-T1, respectively. CP volume was expressed as a ratio to intracranial volume. Glymphatic clearance was measured as signal percentage change from baseline to 39 hours at 8 brain locations based on glymphatic MRI in the first cohort, or as noninvasive diffusion tensor image analysis along the perivascular space (DTI-ALPS) index based on DTI in the second cohort. Results: In cohort 1, a total of 52 patients were included. Higher CP volume was correlated with slower glymphatic clearance rate in all brain locations. In cohort 2, a total of 197 patients were included. Baseline CP volume was positively associated with WMH volume and its growth. Furthermore, DTI-ALPS index partially mediated the association of CP with both WMH load and growth. Interpretations: Enlarged CP volume could be an indicator for larger growth of WMH, potentially involving impaired glymphatic clearance function. The exploration of CP may provide a novel perspective to clarify the mechanism of WMH pathogenesis, as well as other glymphatic-related disorders.

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Choroid Plexus Enlargement in Inflammatory Multiple Sclerosis: 3.0-T MRI and Translocator Protein PET Evaluation

Cited by 82 publications

References 39 publications

Choroid Plexus Volume in Multiple Sclerosis vs Neuromyelitis Optica Spectrum Disorder

Choroid Plexus Volume in Multiple Sclerosis vs Neuromyelitis Optica Spectrum Disorder

Choroid plexus volume in multiple sclerosis predicts expansion of chronic lesions and brain atrophy

Choroid Plexus Enlargement Exacerbates White Matter Hyperintensity Growth through Glymphatic Impairment

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