Choroid Plexus Volume Change—A Candidate for a New Radiological Marker of MS Progression

Abstract

(1) Background: Multiple sclerosis (MS) is an auto-immune, chronic, neuroinflammatory, demyelinating disease that affects mainly young patients. This progressive inflammatory process causes the chronic loss of brain tissue and results in a deterioration in quality of life. To monitor neuroinflammatory process activity and predict the further development of disease, it is necessary to find a suitable biomarker that could easily be used. In this research, we verify the usability of choroid plexus (CP) volume, a new MS biomarker, in the monitoring of the progression of multiple sclerosis disease. (2) Methods: A single-center, prospective study with three groups of patients was conducted based on the following groups: MS patients who received experimental cellular therapy (Treg), treatment-naïve MS patients and healthy controls. (3) Results: This study concludes that there is a correlation between the CPV/TIV (choroid plexus/total intracranial volume) ratio and the progress of multiple sclerosis disease—patients with MS (MS + Treg) had larger volumes of choroid plexuses. CPV/TIV ratios in MS groups were constantly and significantly growing. In the Treg group, patients with relapses had larger plexuses in comparison to the group with no relapses of MS. A similar correlation was observed for the GD+ group (patients with postcontrast enhancing plaques) compared against the non-GD group (patients without postcontrast enhancing plaques). (4) Conclusion: Choroid plexus volume, due to its immunological function, correlates with the inflammatory process in the central nervous system. We consider it to become a valuable radiological biomarker of MS activity.

The Time Trajectory of Choroid Plexus Enlargement in Multiple Sclerosis

“…Fleischer and colleagues, on the other hand, demonstrated a significant correlation between CP enlargement and clinical disability (EDSS score) in a cohort of CIS and RRMS individuals, both cross-sectionally and longitudinally, after 4-year follow-ups, supporting the clinical relevance of plexus volumetric analysis, among others [5,23,30]. Cognitive impairment, measured with the Symbol Digit Modalities Test (SDMT) score, was also associated with plexus enlargement [23].…”

“…Similarly, Ricigliano and colleagues did not find an association between the enlarged and inflamed CP and the severity of clinical disability, as measured by the EDSS score, but the plexus volume was markedly associated with the annual relapse rate in the RRMS group [15]. Jankowska et al also confirmed that CP enlargement was connected to relapses in RRMS individuals, but it should be mentioned that it was a relatively small group (14 people) [30].…”

“…Specifically, the annual rate of CPV increase was 1.4% ± 1.2%/year [31]. Jankowska and colleagues also reported a subtle but constant increase in plexus volume during at the one-year follow-up in RRMS individuals [30]. Other studies found that CPV remained stable during the follow-up period [19,20,32].…”

“…Potential mechanisms of CP enlargement during active inflammation in MS are depicted in Figure 2. Taken together, the significant relationship arising between CPV and the degree of apparent (acute) inflammation in brain tissue (for example, gadolinium-enhancing lesions, 18 F-DPA uptake in NAWM, thalami) opens the perspective to use plexus volume analysis as a promising MRI biomarker for MS disease activity, especially in the early MS stages, with a strong inflammatory component [15,16,23,30]. However, the temporal evolution of CPV over the course of the disease and its association with chronic inflammation, along with MS-related brain atrophy and neurodegeneration remain relatively poorly understood.…”

The diagnosis of multiple sclerosis: what has changed in diagnostic criteria?

“…For example, in our recent study we observed that the choroid plexus volume correlates with the activity of the inflammatory process in the CNS in MS patients. We proposed that it could become a valuable radiological biomarker of MS activity [ 34 ].…”