A comparison of brain magnetic resonance imaging lesions in multiple sclerosis by race with reference to disability progression

Abstract

BackgroundWe compared the magnetic resonance imaging (MRI) features between Japanese and Caucasian patients with multiple sclerosis (MS), and identified the relationships between MRI features and disability.MethodsFrom the baseline data of phase II fingolimod trials, 95 Japanese and 246 Caucasian relapsing-remitting MS patients were enrolled. The number, volume, and distribution of brain MRI lesions were evaluated using T2-weighted (T2W) images. Cross-sectional total normalized brain volume (NBV), normalized cortical gray matter volume, normalized deep gray matter volume (NDGMV), normalized white matter volume (NWMV), and normalized thalamic volume were measured.ResultsJapanese patients had significantly lower Expanded Disability Status Scale (EDSS) scores than Caucasian patients (mean 2.0 vs. 2.3, p = 0.008), despite a similar disease duration. Japanese patients showed a trend towards fewer T2W-lesions (median 50 vs. 65, p = 0.08) and significantly lower frequencies of cerebellar and parietal lobe lesions (p = 0.02 for both) than Caucasian patients. There were no differences in T2W-lesion volume between races, whereas Japanese patients had a significantly larger T2W-lesion volume per lesion compared with Caucasian patients (median 140 mm3 vs. 85 mm3, p < 0.0001). T2W-lesion volumes were positively correlated with EDSS scores in Japanese patients (p < 0.0001). In both races, NBV, normalized cortical gray matter volume, NDGMV, and thalamic volume were negatively correlated with disease duration and EDSS scores (p < 0.01 for all). NWMV was negatively correlated with disease duration and EDSS scores only in Caucasian patients (p = 0.03 and p = 0.004, respectively). NBV, NDGMV, NWMV, and thalamic volume were consistently smaller in Japanese compared with Caucasian patients throughout the entire examined disease duration (p = 0.046, p = 0.01, p = 0.005, and p = 0.04, respectively). Japanese patients had a significantly faster reduction in NDGMV (p = 0.001), particularly for thalamic volume (p = 0.001), with disease duration compared with Caucasian patients.ConclusionsGray matter atrophy is a common denominator for disability in Japanese and Caucasian patients. Additional contributory factors for disability include T2W-lesion volume in Japanese patients and white matter atrophy in Caucasian patients. Less frequent parietal and cerebellar involvement with fewer T2W-lesions may underlie milder disability in Japanese patients.

Magnetic resonance imaging diagnosis of demyelinating diseases: An update

“…47 Ring enhancement is also frequently seen, and the ring is often discontinuous (open-ring sign; Fig. 52 Further studies with a larger number of patients might be required to clarify the details and mechanisms of brain atrophy processes in Japanese MS patients. 47,48 Enhancement of each lesion disappears within 6 months.…”

“…21 A recent report stated that the speed of decrease in whole brain volume is slower in Japanese patients, 49 but another recent report stated that the speed of decrease in deep gray matte volume was faster in Japanese patients than in Caucasian patients. 52 Further studies with a larger number of patients might be required to clarify the details and mechanisms of brain atrophy processes in Japanese MS patients.…”

IgG Index Revisited: Diagnostic Utility and Prognostic Value in Multiple Sclerosis

“…With an extremely low prevalence of 1.39 per 100,000 among the Chinese population, the diagnosis for MS is always a challenge (14). Furthermore, MS in the Asian population may present with different clinical patterns from the Caucasian patients with less disseminated baseline MRI lesions, a more benign disease course and a lower rate of OCB positivity (21%-60% in Asians vs. 89.8% in Caucasians) (15)(16)(17)(18)(19)(20)(21). Delays in diagnosis and treatment are not uncommon.…”

Two susceptible HLA-DRB1 alleles for multiple sclerosis differentially regulate anti-JC virus antibody serostatus along with fingolimod

“…Finally, our study was a cross-sectional study enrolling a relatively small number of MS patients because of the rarity of MS in Japanese. The low median EDSS scores in this study cohort might reflect the milder disability of Japanese patients with MS compared with European patients with a similar disease duration and age [ 49 , 50 ]. Therefore, we think that the relatively low EDSS scores in our patients are not necessarily related to selection bias.…”