Extent of cerebellum, subcortical and cortical atrophy in patients with MS

Ramasamy, Deepa P.; Benedict, Ralph H. B.; Cox, Jennifer L.; Fritz, David; Abdelrahman, Nadir; Hussein, Sara; Minagar, Alireza; Dwyer, Michael G.; Zivadinov, Robert

doi:10.1016/j.jns.2008.12.034

Cited by 129 publications

(137 citation statements)

References 60 publications

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“…Our findings suggest, therefore, that future studies should concentrate more on understanding the pathogenetic mechanisms leading to selective SDGM rather than to cortical GM damage in patients with early RRMS. Central atrophy development in early RRMS (10% larger NLVV than that in patients with CIS) emphasizes the need for better understanding of pathogenetic mechanisms leading to selective central and SDGM atrophy.The disparate findings of GM atrophy in patients with CIS between different studies [7][8][9]11,14,16,21 point to the heterogeneity of the disease in patients with CIS and the inclusion criteria for the studies in which they are enrolled. A recent study revealed significant global GM volumetric differences in contrast to our own between patients with CIS and RRMS 16 ; however, patients with CIS did not have to fulfill the oligoclonal bands criterion.…”

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confidence: 99%

“…[5][6][7] More recently, research has focused on determining the extent of GM pathology at the first clinical event in patients presenting with CIS [8][9][10][11][12][13][14][15][16] or on its evolution with conversion to clinically definite MS. [17][18][19][20] It has been reported that global GM volume measures are not sensitive enough to detect GM atrophy at the time of the initial attack.…”

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confidence: 99%

“…11 Consequently, GM atrophy studies in patients with CIS have increasingly turned to regional segmentation techniques to identify specific structures with a stronger predilection for disease susceptibility and conversion to clinically definite MS. [8][9][10][11]13,14,16,17,19,21 The aim of this study was to investigate differences in the extent of SDGM and cortical atrophy in a large sample of patients with CIS and early RRMS. Another goal was to explore the relationship between SDGM and cortical atrophy and other MR imaging and clinical outcomes in these disease subtypes.…”

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confidence: 99%

“…[5][6][7] Other nonconventional MR imaging techniques have also contributed to determining the extent of GM damage in patients with MS. 2 The role of GM pathology in MS has come under increasingly close scrutiny, especially after it was shown that GM atrophy predicts clinical outcomes better than WM damage. [5][6][7] More recently, research has focused on determining the extent of GM pathology at the first clinical event in patients presenting with CIS [8][9][10][11][12][13][14][15][16] or on its evolution with conversion to clinically definite MS. [17][18][19][20] It has been reported that global GM volume measures are not sensitive enough to detect GM atrophy at the time of the initial attack. 11 Consequently, GM atrophy studies in patients with CIS have increasingly turned to regional segmentation techniques to identify specific structures with a stronger predilection for disease susceptibility and conversion to clinically definite MS. [8][9][10][11]13,14,16,17,19,21 The aim of this study was to investigate differences in the extent of SDGM and cortical atrophy in a large sample of patients with CIS and early RRMS.…”

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confidence: 99%

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Subcortical and Cortical Gray Matter Atrophy in a Large Sample of Patients with Clinically Isolated Syndrome and Early Relapsing-Remitting Multiple Sclerosis

Bergsland

Horáková²,

Dwyer

et al. 2012

AJNR Am J Neuroradiol

141

134

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BACKGROUND AND PURPOSE:Recent studies have shown that selective regional, but not global, GM atrophy occurs from clinical onset to conversion to clinically definite MS. Our aim was to investigate the difference in the extent of SDGM and cortical atrophy in a large sample of patients with CIS and early RRMS and to explore the relationship between SDGM and cortical atrophy and other MR imaging and clinical outcomes. MATERIALS AND METHODS:Two hundred twelve patients with CIS recruited at the first clinical event (mean age, 29.3 years; median EDSS, 1.5; median disease duration, 3 months) and 177 patients with early RRMS (mean age, 30.7 years; median EDSS, 2.0; median disease duration, 47 months) were imaged on a 1.5T scanner by using a high-resolution 3D T1 spoiled gradient-recalled sequence. Volumetric data for SDGM structures were obtained by using FSL FIRST, while whole-brain, GM, white matter, cortical, and lateral ventricle volumes were estimated by using SIENAX software. Comparisons between the groups were adjusted for age and sex. RESULTS:Patients with early RRMS showed significantly lower SDGM but not cortical volumes compared with patients with CIS. The most apparent SDGM differences were evident in the caudate and thalamus (P Ͻ .0001), total SDGM (P ϭ .0001), and globus pallidus (P ϭ .01). Patients with CIS with a median T2 lesion volume Ͼ4.49 mL showed lower total SDGM, caudate, thalamus (P Ͻ .001), globus pallidus (P ϭ .007), hippocampus (P ϭ .004), and putamen (P ϭ .01) volumes and higher lateral ventricle volume (P ϭ .001) than those with a median T2 lesion volume Ͻ4.49 mL. Decreased thalamic volume showed the most consistent relationship with MR imaging outcomes (P Ͻ .0001) in patients with CIS.CONCLUSIONS: Significant SDGM, but not cortical, atrophy develops during the first 4 years of the RRMS. GM atrophy is relevant for disease progression from the earliest clinical stages.ABBREVIATIONS: ASA ϭ Avonex-Steroid-Azathioprine; CIS ϭ clinically isolated syndrome; EDSS ϭ Expanded Disease Status Scale; FSL ϭ FMRIB Software Library; GM ϭ gray matter; NBV ϭ normalized brain volume; NCV ϭ normalized cortical volume; NGMV ϭ normalized gray matter volume; NLVV ϭ normalized lateral ventricle volume; NWMV ϭ normalized white matter volume; RRMS ϭ relapsing remitting MS; SDGM ϭ subcortical deep gray matter; SET ϭ Study of Early Interferon ␤ 1a Treatment in High Risk Subjects after CIS M R imaging is a vital tool enabling clinicians to diagnose, monitor, and predict the progression of MS. Conventional MR imaging has proved to be very sensitive for detecting focal changes in the WM, yet it is relatively insensitive to involvement of the GM in MS. GM pathology in MS is quite different from that in WM, with only mild blood-brain barrier disruption and little-to-no inflammation due to minimal Tcell infiltration.1 Hence, the difference between lesion and normal GM relaxation times on MR imaging is less than that seen between lesion and normal white matter. 2In the past decade, continuous effort has been made to develop n...

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confidence: 99%

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confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Subcortical and Cortical Gray Matter Atrophy in a Large Sample of Patients with Clinically Isolated Syndrome and Early Relapsing-Remitting Multiple Sclerosis

Bergsland

Horáková²,

Dwyer

et al. 2012

AJNR Am J Neuroradiol

141

134

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“…Atrophy has been found to be associated with impaired neurologic and neurocognitive performance. [7][8][9][10] More recently, research revealed that deep GM atrophy specifically plays an important role in the characterization, course, and progression of AD [11][12][13][14][15][16][17] and in other diseases like MS [18][19][20] and Parkinson disease. [21][22][23] Measurements of deep GM atrophy could therefore be of importance in the evaluation of neuroprotective treatment (eg, in investigating drug efficacy).…”

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confidence: 99%