Magnetic resonance imaging characteristics of children and adults with paediatric-onset multiple sclerosis

Abstract

The purpose of this study was to compare the clinical and quantitative magnetic resonance imaging metrics of paediatric-onset multiple sclerosis to adult-onset multiple sclerosis. It was a prospective comparison of clinical and magnetic resonance imaging characteristics of two paediatric onset multiple sclerosis and two adult onset multiple sclerosis groups that were matched for disease duration. The paediatric-onset-C group consisted of children with paediatric-onset multiple sclerosis with mean disease duration of 2.7 years, whereas the paediatric onset-A group consisted of adults with mean disease duration of 20 years. The adult onset multiple sclerosis-1 and adult onset multiple sclerosis-2 groups were matched to the paediatric onset-C and paediatric onset-A groups. The brain magnetic resonance imaging measures included: T(1)-, T(2)- and gadolinium contrast-enhancing volumes and the T(2)-lesion volume relative magnetization transfer ratio, global and tissue specific white and grey matter brain atrophy and normal appearing grey and white matter magnetization transfer ratio. Regression analyses were employed for magnetic resonance imaging measures. The paediatric onset multiple sclerosis-C (n = 17) and adult onset multiple sclerosis-1 (n = 81) groups had mean disease duration values of 2.7 +/- standard deviation 2.0 and 2.6 +/- 1.1 years, respectively. The paediatric onset multiple sclerosis-A group (n = 33) and adult onset multiple sclerosis-2 group (n = 300) had mean disease durations of 20 +/- standard deviation 10.9 and 20 +/- 9.3 years, respectively. In regression analysis, the T(2)- lesion volume of the paediatric onset multiple sclerosis-C and adult onset multiple sclerosis-1 groups were similar but there was a trend toward higher T(1)- lesion volume (P = 0.028) in the paediatric onset group. The brain parenchymal fraction and grey matter fraction in the paediatric-onset multiple sclerosis-C group were higher than those for the adult onset multiple sclerosis-1 group (both P < 0.001). The frequency of progressive multiple sclerosis in the paediatric onset multiple sclerosis-A group (27.3%) trended lower (odds ratio = 0.43, P = 0.042) than that in the adult onset multiple sclerosis-2 group (46.3%). The Expanded Disability Status Scale (median; inter-quartile range) in the paediatric onset multiple sclerosis-A group (2.25; 2.5) trended lower (P = 0.058) compared with the adult onset multiple sclerosis-2 group (3.5; 4.0). There was a trend toward lower magnetization transfer ratio values in T(2)-lesions, normal appearing grey matter and normal appearing white matter and higher grey matter fraction in the paediatric onset multiple sclerosis-A group compared with the adult onset multiple sclerosis-2 group. There was no evidence for differences on T(2)-lesion volume, T(1)-lesion volume, brain parenchymal fraction or white matter fraction. Paediatric-onset multiple sclerosis is characterized by a significant disease burden both early and later in the disease course. Despite this, disability is slower to accrue i...

Subcortical and Cortical Gray Matter Atrophy in a Large Sample of Patients with Clinically Isolated Syndrome and Early Relapsing-Remitting Multiple Sclerosis

“…Before we used the T1-weighted 3D spoiled gradient-recalled for subsequent analysis, it was modified by using an in-house-developed in-painting technique to avoid the impact of WM lesions on GM volume measurements 26 as previously described. 27 Consequently, for each subject, we obtained NBV, NGMV, NCV, NWMV, NLVV, and a volumetric scaling factor, by using SIENAX (Version 2.6; FMRIB Software Library, http://www.fmrib.ox.ac.uk/fsl/). 27 Absolute tissue volumes for the thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, and nucleus accumbens were estimated from the in-painted T1-weighted 3D spoiled gradient-recalled with FIRST (Version 1.2, FMRIB Software Library), a model-based segmentation/registration tool.…”

“…27 Consequently, for each subject, we obtained NBV, NGMV, NCV, NWMV, NLVV, and a volumetric scaling factor, by using SIENAX (Version 2.6; FMRIB Software Library, http://www.fmrib.ox.ac.uk/fsl/). 27 Absolute tissue volumes for the thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, and nucleus accumbens were estimated from the in-painted T1-weighted 3D spoiled gradient-recalled with FIRST (Version 1.2, FMRIB Software Library), a model-based segmentation/registration tool. 28 Normalized SDGM volumes were thus obtained by multiplying the estimated volumes from FIRST by the volumetric scaling factor from SIENAX.…”

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

“…As mentioned above, pediatric patients with MS tend to have a more inflammatory course within the first 2 years of onset [11], manifesting with more frequent clinical relapses and a higher brain T2-and T1-weighted lesion volume [31][32][33][34]. Patients with pediatric-onset MS generally maintain good recovery from relapses with minimal-to-no progression in disability within the first 10 years of disease onset; however, irreversible disability and secondary progression ultimately occur at a much earlier age than in adult-onset MS [35].…”

Iron Deposition on SWI-Filtered Phase in the Subcortical Deep Gray Matter of Patients with Clinically Isolated Syndrome May Precede Structure-Specific Atrophy

“…fmrib.ox.ac.uk/fsl/feeds/doc/index.html) was used for brain extraction and tissue segmentation, with correction for T1-hypointensity misclassification. 36 As described previously, 37 we acquired the following volume measures: NBV, NGMV, NWMV, and NLVV. T2-and Gd-LVs and numbers were measured using a semiautomated edge detection contouring/thresholding technique, as described previously.…”