The Relationship between Normal Cerebral Perfusion Patterns and White Matter Lesion Distribution in 1,249 Patients with Multiple Sclerosis

Holland, Christopher M.; Charil, Arnaud; Csapo, Istvan; Liptak, Zsuzsanna; Ichise, Masanori; Khoury, Samia J.; Bakshi, Rohit; Weiner, Howard L.; Guttmann, Charles R.G.

doi:10.1111/j.1552-6569.2011.00585.x

Cited by 77 publications

(61 citation statements)

References 34 publications

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“…However, it is worth pointing out that based on the lesion probability maps shown in this manuscript (Fig. 6) and published literature [Holland et al, 2012] on large cohorts, the juxtacortical lesion load is significantly lower than the deep WM lesion load.…”

Section: Table V Multivariate Regression On Cortical Thickness With mentioning

confidence: 52%

Effect of in‐painting on cortical thickness measurements in multiple sclerosis: A large cohort study

Govindarajan¹,

Datta²,

Hasan³

et al. 2015

Human Brain Mapping

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A comprehensive analysis of the effect of lesion in-painting on the estimation of cortical thickness using magnetic resonance imaging was performed on a large cohort of 918 relapsing-remitting multiple sclerosis patients who participated in a phase III multicenter clinical trial. An automatic lesion in-painting algorithm was developed and implemented. Cortical thickness was measured using the FreeSurfer pipeline with and without in-painting. The effect of in-painting was evaluated using FreeSurfer's paired analysis pipeline. Multivariate regression analysis was also performed with field strength and lesion load as additional factors. Overall, the estimated cortical thickness was different with in-painting than without. The effect of in-painting was observed to be region dependent, more significant in the left hemisphere compared to the right, was more prominent at 1.5 T relative to 3 T, and was greater at higher lesion volumes. Our results show that even for data acquired at 1.5 T in patients with high lesion load, the mean cortical thickness difference with and without in-painting is ~2%. Based on these results, it appears that in-painting has only a small effect on the estimated regional and global cortical thickness.

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Section: Table V Multivariate Regression On Cortical Thickness With mentioning

confidence: 52%

Effect of in‐painting on cortical thickness measurements in multiple sclerosis: A large cohort study

Govindarajan¹,

Datta²,

Hasan³

et al. 2015

Human Brain Mapping

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“…6 The retinal hypoperfusion is in alignment with the observation of cerebral hypoperfusion in NAWGM in MS. 27,28 The cerebral hypoperfusion is considered a major step that induces a status defined as energy failure in MS. 29 According to a recent large scale clinical study on 1249 patients, MS lesions tend to occur in areas with lower perfusion. 30 …”

Section: Discussionmentioning

confidence: 99%

Impaired retinal microcirculation in multiple sclerosis

et al. 2016

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Background The transparent ocular structure enables quantitative analysis of microvasculature of retina, a neuronal tissue affected by multiple sclerosis. Objective To determine whether the retinal blood flow velocity and flow volume at the macula are impaired in patients with relapsing remitting multiple sclerosis (RRMS). Methods Seventeen RRMS patients and 17 age- and gender-matched healthy subjects were assessed. A Retinal Function Imager was used to measure the blood flow velocity of retinal arterioles and venules, and to calculate the total perifoveal blood flow volume. Results The blood flow velocities of the retinal arterioles (3.34 ± 0.89 mm/s) and venules (2.61 ± 0.6 mm/s) were significantly lower in MS patients than normal subjects (arteriole: 4.10 ± 0.87 mm/s; venule: 3.22 ± 0.65 mm/s, both P = 0.01). In addition, the total perifoveal blood flow volume in arterioles (3.74 ± 1.64 nl/s) and venules (3.81 ± 1.60 nl/s) were significantly lower in MS patients than in normal subjects (arteriole: 4.87 ± 1.41 nl/s, P = 0.02; venule: 4.71 ± 1.64 nl/s, P = 0.04). Conclusion The impaired retinal microcirculation in RRMS patients indicates microvascular dysfunction in MS.

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“…Many studies, using magnetic resonance imaging approaches, have found an impairment of about 50%, or more, of blood flow through NAWM of MS patients [29–34]. Furthermore, the probability of developing MS lesions is greater in NAWM with the lowest perfusion rates [34]. One could argue that in MS, large areas of white matter may not function normally, thereby accounting for the reduced blood flow.…”

Section: Evidence For Hypoxia In Early Ms Lesionsmentioning

confidence: 99%

The Evidence for Hypoperfusion as a Factor in Multiple Sclerosis Lesion Development

Juurlink

2013

Multiple Sclerosis International

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The evidence that hypoxia is a precipitating factor in causing early MS lesions includes increased protein levels of hypoxia-inducible factor-1α; presence of the D-110 hypoxia-inducible protein; increased expression of hypoxia-inducible genes in lesions as well as in adjacent normal-appearing white matter (NAWM); loss of myelin-associated glycoprotein in myelin of early MS lesions; a 50% reduction of blood flow through NAWM with areas of lowest blood flow having the greatest probability of lesion development. Why MS-like lesions develop following hypoxemic insults in some individuals but not in others is likely dependent upon the presence of immune predisposing factors that are governed genetically. Hypoperfusion may be due to decreased arterial supply, restricted venous return, or a combination of these. There are clinical trials ongoing or planned to treat chronic cerebrospinal venous insufficiency (CCSVI) through angioplasty. I suggest that it is important that clinical trials addressing vascular issues in MS should examine how the vascular intervention affects white matter perfusion and determine whether the extent of perfusion recovery and maintenance of this recovery is related to functional recovery and maintenance of functional recovery. Consideration should also be given to the possibility of arterial problems playing a role in hypoperfusion in some MS patients.

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The Relationship between Normal Cerebral Perfusion Patterns and White Matter Lesion Distribution in 1,249 Patients with Multiple Sclerosis

Abstract: Chronic plaques were more prevalent in WM regions with lower relative perfusion. Lesions in more highly perfused regions were more commonly observed in early RR MS and therefore, may be more likely to successfully remyelinate and resolve.

Cited by 77 publications

References 34 publications

Effect of in‐painting on cortical thickness measurements in multiple sclerosis: A large cohort study

Effect of in‐painting on cortical thickness measurements in multiple sclerosis: A large cohort study

Impaired retinal microcirculation in multiple sclerosis

The Evidence for Hypoperfusion as a Factor in Multiple Sclerosis Lesion Development

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