Multiple sclerosis and depressive manifestations: can diffusion tensor MR imaging help in the detection of microstructural white matter changes?

Abstract

Background: Multiple sclerosis is one of the commonest causes of neurological disability in middle-aged and young adults. Depression in MS patients can compromise cognitive functions, lead to suicide attempts, impair relationships and reduce compliance with disease-modifying treatments. The aim of this study was to investigate and compare the microstructural changes in the white matter tracts of the limbic system in MS patients with and those without depressive manifestations using a diffusion tensor imaging (DTI) technique. Methods: This study included 40 patients who were divided into three groups. Group 1 comprised of 20 patients with relapsing-remitting MS with depressive symptoms and group 2 comprised 10 MS patients without symptoms of depression. The third group is a control group that included 10 age-matched healthy individuals. All patients underwent conventional MRI examinations and DTI to compare the fractional anisotropy (FA) values in the white matter tracts of the limbic system. Results: We compared the DTI findings in MS patients with and those without depressive symptoms. It was found that patients with depression and MS exhibited a significant reduction in the FA values of the cingulum (P < 0.0111 on the right and P < 0.0142 on the left), uncinate fasciculus (P < 0.0001 on the right and P < 0.0076 on the left) and the fornix (P < 0.0001 on both sides). No significant difference was found between the FA values of the anterior thalamic radiations in both groups. Conclusion: Patients with depression and MS showed more pronounced microstructural damage in the major white matter connections of the limbic pathway, namely, the uncinate fasciculus, cingulum and fornix. These changes can be detected by DTI as decreased FA values in depressed MS patients compared to those in non-depressed patients.

Comparative study between double inversion recovery (DIR) and fluid-attenuated inversion recovery (FLAIR) MRI sequences for detection of cerebral lesions in multiple sclerosis

“…The main pathological hallmarks of the disease are demyelination, inflammation, and axonal damage, giving the characteristic multifocal lesions particularly targeting the periventricular, juxta cortical regions, brainstem, optic nerves, and spinal cord. However, considerable gray matter (GM) involvement is seen in many patients [1,2].…”

Brain connectivity changes underlying depression and fatigue in relapsing-remitting multiple sclerosis: a systematic review

“…Changes in choline levels within the AAC and frontal lobe have been observed in MDD and might be a potential marker for treatment outcomes in depressed patients (98,159,160). 2019) observed structural connectivity changes in RRMS patients with depression in the WM pathways within the fronto-limbic network, i.e., the cingulum, fornix and uncinate fasciculus (133). The uncinate fasciculus connects the temporal lobe (containing the hippocampus and amygdala) and PFC (161).…”

Comparative between Double Inversion Recovery and Fluid-Attenuated Inversion Recovery Sequences for Detection of Brain Multiple Sclerosis

“…Multiple sclerosis is the utmost common chronic inflammatory demyelinating disease of the central nervous system (CNS), affecting mainly the white matter but also parts of the gray matter. [1] The diagnosis of MS and the observation of the disease are essentially based on magnetic resonance imaging (MRI), which lets an early diagnosis of MS be based on diagnostic criteria. [1,2] According to recent studies, the degree of cortical damage is closely linked to the advancement of the patient's disease progress, the depth of cognitive impairment, and the degree of physical handicap.…”

“…[1] The diagnosis of MS and the observation of the disease are essentially based on magnetic resonance imaging (MRI), which lets an early diagnosis of MS be based on diagnostic criteria. [1,2] According to recent studies, the degree of cortical damage is closely linked to the advancement of the patient's disease progress, the depth of cognitive impairment, and the degree of physical handicap. [3] T2-weighted, fluidattenuated inversion recovery (FLAIR), before and after contrast T1-weighted sequences are used in multi-sequence MR imaging for the diagnosis of MS. [4] According to the anatomic site of the inflammatory brain lesions, the pulse sequences have varying sensitivity in detecting them.…”