White matter and deep gray matter hemodynamic changes in multiple sclerosis patients with clinically isolated syndrome

Abstract

The dynamic susceptibility contrast magnetic resonance imaging perfusion technique was used to investigate possible hemodynamic changes in normal appearing white matter and deep gray matter (DGM) of 30 patients with clinically isolated syndrome (CIS) and 30 patients with relapsing-remitting multiple sclerosis. Thirty normal volunteers were studied as controls. Cerebral blood volume, cerebral blood flow (CBF), and mean transit time values were estimated. Normalization was achieved for each subject with respect to average values of CBF and mean transit time of the hippocampi's dentate gyrus. Measurements concerned three regions of normal white matter of normal volunteers, normal appearing white matter of CIS and patients with relapsing-remitting multiple sclerosis, and DGM regions, bilaterally. All measured normal appearing white matter and DGM regions of the patients with CIS had significantly higher cerebral blood volume and mean transit time values, while averaged DGM regions had significantly lower CBF values, compared to those of normal volunteers (P < 0.001). Regarding patients with relapsing-remitting multiple sclerosis, all measured normal appearing white matter and DGM regions showed lower CBF values than those of normal volunteers and lower cerebral blood volume and CBF values compared to patients with CIS (P < 0.001). These data provide strong evidence that hemodynamic changes--affecting both white and DGM--may occur even at the earliest stage of multiple sclerosis, with CIS patients being significantly different than relapsing-remitting multiple sclerosis patients.

Neuropsychiatric lupus or not? Cerebral hypoperfusion by perfusion-weighted MRI in normal-appearing white matter in primary neuropsychiatric lupus erythematosus

“…Such lesions were detected only in 5% of our patients with primary NPSLE. Inflammatory activity has been related to increased perfusion due to inflammation-mediated vasodilation 44. Our findings of diffuse hypoperfusion, along with the rarity of inflammatory-like lesions on conventional MRI, suggest that in most cases primary NPSLE is characterised by chronic widespread decreased perfusion and ischaemia due to microvasculopathy and subsequent neuronal loss in the absence of high-grade inflammation.…”

Hypoperfusion and T1-hypointense lesions in white matter in multiple sclerosis

“…Perfusion studies based on multiple imaging modalities reported reduced cerebral blood flow (CBF) in MS. 4–5 In some patients, new focal lesions were observed with reduced mean diffusivity (MD) on diffusion MRI, similar to that observed in acute ischemic lesions. 6–8 To better explain aspects of the observed pathological features of MS it was postulated that hypoperfusion plays a critical role in the pathogenesis of MS. 9 …”

Cerebral Hypoperfusion: A New Pathophysiologic Concept in Multiple Sclerosis?

“…[16][17][18] Similar observations were made in the deep gray matter of clinically isolated syndromes suggestive for MS and relapsing-remitting MS patients. 19 These results suggest that cerebral hypoperfusion, regardless of the clinical subtype, is an early and integral part of MS pathology.…”