MRI evaluation of thalamic volume differentiates MS from common mimics

Abstract

Objective:To determine whether MRI evaluation of thalamic volume differentiates MS from other disorders that cause MRI white matter abnormalities.Methods:There were 40 study participants: 10 participants with MS without additional comorbidities for white matter abnormalities (MS − c); 10 participants with MS with additional comorbidities for white matter abnormalities (MS + c); 10 participants with migraine, MRI white matter abnormalities, and no additional comorbidities for white matter abnormalities (Mig − c); and 10 participants previously incorrectly diagnosed with MS (Misdx). T1-magnetization-prepared rapid gradient-echo and T2-weighted three-dimensional fluid attenuation inversion recovery sequences were acquired on a Phillips Achieva d-Stream 3T MRI, and scans were randomly ordered and de-identified for a blinded reviewer who performed MRI segmentation using LesionTOADS.Results:Mean normalized thalamic volume differed among the 4 cohorts (analysis of variance, p = 0.005) and was smaller in the 20 MS participants compared with the 20 non-MS participants (p < 0.001), smaller in MS − c compared with Mig − c (p = 0.03), and smaller in MS + c compared with Misdx (p = 0.006). The sensitivity and specificity were both 0.75 for diagnosis of MS with a thalamic volume <0.0077.Conclusions:MRI volumetric evaluation of the thalamus, but not other deep gray-matter structures, differentiated MS from other diseases that cause white matter abnormalities and are often mistaken for MS. Evaluation for thalamic atrophy may improve accuracy for diagnosis of MS as an adjunct to additional radiologic criteria. Thalamic volumetric assessment by MRI in larger cohorts of patients undergoing evaluation for MS is needed, along with the development of automated and easily applied volumetric assessment tools for future clinical application.Classification of evidence:This study provides Class III evidence that MRI evaluation of thalamic volume differentiates MS from other diseases that cause white matter abnormalities.

Altered Coupling of Psychological Relaxation and Regional Volume of Brain Reward Areas in Multiple Sclerosis

“…In addition to the two VBM analyses presented in the main text, four supplementary VBM analyses were conducted. The first tested volume differences between PwMS and HCs and identified loss of GM volume in PwMS in thalamic areas (which is consistent with findings on MS-induced atrophy) and, to a lesser degree, in MTG (42,43). However, these areas characterized by GM volume loss in PwMS turned out to be of limited importance for relaxationrelated tissue alterations in PwMS because a repetition of the two VBM analyses presented in the main text constrained to the coordinates found in the first supplementary VBM analysis in supplementary VBM analysis 2 did not reveal any significant associations.…”

Tremor in multiple sclerosis is associated with cerebello-thalamic pathology

“…This study investigated the involvement of the cerebello-thalamic tract in the pathogenesis of unilateral MS upper limb tremor. The thalamus was of particular interest as thalamic atrophy had been correlated with worse prognosis in MS patients (Rocca et al 2010 ), is present in the very early stages of MS (Azevedo et al 2015 ; Bergsland et al 2012 ), and has been shown to allow differentiation from other MRI white matter pathologies (Solomon et al 2017 ). We found that contra- and ipsilateral thalamic volumes and ipsilateral SCP area inversely correlated with increased unilateral tremor severity scores.…”

Urgent challenges in quantification and interpretation of brain grey matter atrophy in individual MS patients using MRI

“…Also, significant GM volume loss occurred in the right precuneus in relapsing-remitting MS patients with progressive disability ( Hofstetter et al, 2014 ). Moreover, atrophy of specific DGM structures, most notably the thalamus, also occurs in MS patients ( Bishop et al, 2017 ; Houtchens et al, 2007 ; Schoonheim et al, 2015 ; Solomon et al, 2017 ). Atrophy of the thalamus appears to occur especially early and prominently, to be worse in men, and to be associated with cognitive decline ( Schoonheim et al, 2015 ).…”