MRI characteristics of patients with antiphospholipid syndrome and multiple sclerosis

Abstract

MRI findings of primary anti-phospholipid antibody syndrome (PAPLS) are difficult to distinguish from those of multiple sclerosis (MS). Only a few previous studies have compared conventional and non-conventional MRI findings in MS and PAPLS patients. In addition, MRI differences between anti-phospholipid antibody (APLA) positive (+) and APLA negative (-) MS patients have not been reported. Therefore, the aim of this study was to investigate the differences in MRI measures among patients with PAPLS, MS and normal control (NC) subjects. We also explored non-conventional MRI measures in APLA+ and APLA- MS patients. Forty-nine (49) consecutive MS patients among whom 39 had relapsing-remitting (RR) and 10 secondary-progressive (SP) disease course, 30 patients with PAPLS and 49 NC were enrolled. Twenty-eight (28) MS patients were APLA+. MRI measures of T1- and T2-lesion volumes (LV) and brain atrophy, including fractions of whole brain (BPF), gray matter (GMF) and white matter (WMF), were evaluated. The magnetization transfer ratio (MTR) of T2- and T1-LVs and different normal-appearing brain tissue (NABT) compartments as well as diffusion-weighted imaging of whole brain mean parenchyma diffusivity (MPD) were obtained. MS patients differed significantly from NC in all MRI measures. PAPLS patients differed from NC in their T2-LV, in MTR measures and in MPD. When MS patients were compared to PAPLS patients, they showed significantly higher T2- and T1-LVs and T2-LV MTR, lower BPF and GMF and higher MPD. APLA+ RR and SPMS (all APLA+) patients showed significantly higher T2-LV, lower GMF, lower normal-appearing gray matter MTR and higher MPD when compared to APLA- patients. The results indicate that brain abnormalities can be detected in PAPLS patients with non-conventional MRI. MRI reveals more profound injury in patients with MS versus PAPLS. APLA mediates heterogeneous cerebral pathology that remains to be further investigated.

Autoantibodies and Sjogren’s Syndrome in Multiple Sclerosis, a Reappraisal

“…Our data is in agreement with studies [3]–[4], [6]–[7], [9], [10], [13], [22], [24] that have identified no association with clinical severity. Of note, two recent studies have suggested that MRI measurements of disease burden, including T2 lesion volume, may be associated with the presence of antiphospholipid autoantibodies in patients with MS. [5], [8] Further data is needed to confirm the significance of this finding.…”

“…Some but not all previous studies have suggested an association between clinical phenotype, frequency of exacerbations or severity of disability, and the detection of autoantibodies. [4], [8], [12], [14], [15] It is possible that potential inclusion of NMO/NMOSD patients may have influenced these results. Our data is in agreement with studies [3]–[4], [6]–[7], [9], [10], [13], [22], [24] that have identified no association with clinical severity.…”

Brain Parenchymal Fraction in Healthy Adults—A Systematic Review of the Literature

“…As an example, the ICV could be defined as either the intracranial cavity measured directly [42] or as the sum of the volumes of GM, WM and CSF [43]. Only studies having included the complete intracranial space in the assessment of ICV were included in the aggregated statistical calculations.…”

Antiphospholipid syndrome and the brain in pediatric and adult patients

“…The severity of these lesions predicted the number and type of cognitive domains impaired during neuropsychology evaluation 24. Neuroimaging studies utilizing volumetric assessments, Magnetization Transfer Imaging (MTI), and Diffusion Weighted Imaging (DWI) reveal micro-structural changes in primary APS patients even without previous CNS events 25, 26. These “novel” modalities appear to differentiate APS patients from those diagnosed with Multiple Sclerosis and who have more pronounced atrophy, higher lesion load, and abnormal diffusivity 25…”