Reduced grey matter perfusion without volume loss in early relapsing-remitting multiple sclerosis

Debernard, Laëtitia; Melzer, Tracy R.; Stockum, Saskia van; Graham, Charlotte; Wheeler‐Kingshott, Claudia A. M.; Dalrymple‐Alford, John C.; Miller, David H.; Mason, Deborah

doi:10.1136/jnnp-2013-305612

Cited by 74 publications

(98 citation statements)

References 38 publications

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“…3,8,12,[25][26][27][28] Only 1 report identified an overall increased WM perfusion in 60 patients with MS with mixed phenotypes, but heterogeneous WM perfusion.…”

Section: Perfusion In Normal-appearing Tissuementioning

confidence: 99%

“…Hence, perfusion changes may constitute a clinically relevant biomarker in early MS, especially because they could precede detectable structural atrophy. 26,30 Using DCE-MR imaging, a more recent study with high projected statistical power based on calculation using means and SDs derived from a Monte Carlo simulation found much lower CBF and CBV values than the aforementioned reports, with no difference in CBF, CBV, or mean transit time between 16 controls and 24 patients with RRMS.…”

mentioning

confidence: 96%

“…3 Decreased perfusion has also been observed in deep and cortical gray matter of patients with MS compared with healthy controls. 26,27,[29][30][31][32][33] In early RRMS, reduced perfusion but no atrophy was described in multiple cortical areas and deep gray matter structures including the thalamus, caudate, putamen, and hippocampus. 26,30 Moreover, Debernard et al 26 found that these findings correlated to visual and verbal memory impairment in 25 patients with early RRMS.…”

mentioning

confidence: 99%

“…26,27,[29][30][31][32][33] In early RRMS, reduced perfusion but no atrophy was described in multiple cortical areas and deep gray matter structures including the thalamus, caudate, putamen, and hippocampus. 26,30 Moreover, Debernard et al 26 found that these findings correlated to visual and verbal memory impairment in 25 patients with early RRMS. Hence, perfusion changes may constitute a clinically relevant biomarker in early MS, especially because they could precede detectable structural atrophy.…”

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confidence: 99%

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What Have We Learned from Perfusion MRI in Multiple Sclerosis?

Lapointe¹,

Traboulsee³

et al. 2018

AJNR Am J Neuroradiol

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SUMMARY: Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified. ABBREVIATIONS:ASL ϭ arterial spin-labeling; DCE ϭ dynamic contrast-enhanced; NAWM ϭ normal-appearing white matter; RRMS ϭ relapsing-remitting MS

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“…3,8,12,[25][26][27][28] Only 1 report identified an overall increased WM perfusion in 60 patients with MS with mixed phenotypes, but heterogeneous WM perfusion.…”

Section: Perfusion In Normal-appearing Tissuementioning

confidence: 99%

mentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

What Have We Learned from Perfusion MRI in Multiple Sclerosis?

Lapointe¹,

Traboulsee³

et al. 2018

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

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“…3 MR perfusion demonstrates a hypoperfusion of white and gray matter, and the parameters involved are cerebral blood volume, cerebral blood flow, and mean transit time, but not cerebral venous blood outflow (CVF). 4,5 Disorders involving the cerebral venous system may result in CVF insufficiency, elevation of venous pressure, and an increase of intracranial pressure and may lead to parenchymal abnormalities. Compliance of the venous system depends on anatomic variants and the onset timing of venous pathologies.…”

mentioning

confidence: 99%

A Sonographic Quantitative Cutoff Value of Cerebral Venous Outflow in Neurologic Diseases: A Blinded Study of 115 Subjects

Monti

Menci

Piu

et al. 2014

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The autonomic nervous system maintains constant cerebral venous blood outflow in changing positions. Alterations in cerebral autoregulation can be revealed by postural changes at quantitative color Doppler sonography. The aim of this study was to reach an optimal cutoff value of the difference between the cerebral venous blood outflow in the supine and seated positions that can discriminate healthy controls from patients with multiple sclerosis and those with other neurologic diseases and to evaluate its specificity, sensitivity, and diagnostic accuracy.

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Identifying the Distinct Cognitive Phenotypes in Multiple Sclerosis

et al. 2021

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IMPORTANCECognitive impairment is a common and disabling feature of multiple sclerosis (MS), but a precise characterization of cognitive phenotypes in patients with MS is lacking.OBJECTIVES To identify cognitive phenotypes in a clinical cohort of patients with MS and to characterize their clinical and magnetic resonance imaging (MRI) features. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cross-sectional study consecutively screened clinically stable patients with MS and healthy control individuals at 8 MS centers in Italy from January 1, 2010, to October 31, 2019. Patients with MS and healthy control individuals who were not using psychoactive drugs and had no history of other neurological or medical disorders, learning disability, severe head trauma, and alcohol or drug abuse were enrolled. MAIN OUTCOMES AND MEASURES Participants underwent a neurological examination and a cognitive evaluation with the Rao Brief Repeatable Battery and Stroop Color and Word Test. A subgroup of participants also underwent a brain MRI examination. Latent profile analysis was used on cognitive test z scores to identify cognitive phenotypes. Linear regression and mixed-effects models were used to define clinical and MRI features of each phenotype. RESULTS A total of 1212 patients with MS (mean [SD] age, 41.1 [11.1] years; 784 women [64.7%]) and 196 healthy control individuals (mean [SD] age, 40.4 [8.6] years; 130 women [66.3%]) were analyzed in this study. Five cognitive phenotypes were identified: preserved cognition (n = 235 patients [19.4%]), mild-verbal memory/semantic fluency (n = 362 patients [29.9%]), mild-multidomain (n = 236 patients [19.5%]), severe-executive/attention (n = 167 patients [13.8%]), and severe-multidomain (n = 212 patients [17.5%]) involvement. Patients with preserved cognition and mild-verbal memory/semantic fluency were younger (mean [SD] age, 36.5 [9.8] years and 38.2 [11.1] years) and had shorter disease duration (mean [SD] 8.0 [7.3] years and 8.3 [7.6] years) compared with patients with mild-multidomain (mean [SD] age, 42.6 [11.2] years; mean [SD] disease duration, 12.8 [9.6] years; P < .001), severe-executive/attention (mean [SD] age, 42.9 [11.7] years; mean [SD] disease duration, 12.2 [9.5] years; P < .001), and severe-multidomain (mean [SD] age, 44.0 [11.0] years; mean [SD] disease duration , 13.3 [10.2] years; P < .001) phenotypes. Severe cognitive phenotypes prevailed in patients with progressive MS. At MRI evaluation, compared with those with preserved cognition, patients with mild-verbal memory/semantic fluency exhibited decreased mean (SE) hippocampal volume (5.42 [0.68] mL vs 5.13 [0.68] mL; P = .04), patients with the mild-multidomain phenotype had decreased mean (SE) cortical gray matter volume (687.69 [35.40] mL vs 662.59 [35.48] mL; P = .02), patients with severe-executive/ attention had higher mean (SE) T2-hyperintense lesion volume (51.33 [31.15] mL vs 99.69 [34.07] mL; P = .04), and patients with the severe-multidomain phenotype had extensive brain damage, with decreased volume in a...

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Reduced grey matter perfusion without volume loss in early relapsing-remitting multiple sclerosis

Cited by 74 publications

References 38 publications

What Have We Learned from Perfusion MRI in Multiple Sclerosis?

What Have We Learned from Perfusion MRI in Multiple Sclerosis?

A Sonographic Quantitative Cutoff Value of Cerebral Venous Outflow in Neurologic Diseases: A Blinded Study of 115 Subjects

Identifying the Distinct Cognitive Phenotypes in Multiple Sclerosis

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