Magnetic resonance imaging perfusion is associated with disease severity and activity in multiple sclerosis
The utility of perfusion-weighted imaging in multiple sclerosis (MS) is not well investigated. The purpose of this study was to compare baseline normalized perfusion measures in subgroups of newly diagnosed MS patients. We wanted to test the hypothesis that this method can differentiate between groups defined according to disease severity and disease activity at 1 year follow-up.
Baseline magnetic resonance imaging (MRI) including a dynamic susceptibility contrast perfusion sequence was performed on a 1.5-T scanner in 66 patients newly diagnosed with relapsing-remitting MS. From the baseline MRI, cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were generated. Normalized (n) perfusion values were calculated by dividing each perfusion parameter obtained in white matter lesions by the same parameter obtained in normal-appearing white matter. Neurological examination was performed at baseline and at follow-up approximately 1 year later to establish the multiple sclerosis severity score (MSSS) and evidence of disease activity (EDA).
Baseline normalized mean transit time (nMTT) was lower in patients with MSSS >3.79 (p = 0.016), in patients with EDA (p = 0.041), and in patients with both MSSS >3.79 and EDA (p = 0.032) at 1-year follow-up. Baseline normalized cerebral blood flow and normalized cerebral blood volume did not differ between these groups.
Lower baseline nMTT was associated with higher disease severity and with presence of disease activity 1 year later in newly diagnosed MS patients. Further longitudinal studies are needed to confirm whether baseline-normalized perfusion measures can differentiate between disease severity and disease activity subgroups over time.
KeywordsDisease activity Disease severity Magnetic resonance imaging Mean transit time Multiple sclerosis Perfusion-weighted imaging
Cerebral blood flow
Cerebral blood volume
Evidence of disease activity
Expanded disability status scale
Magnetic resonance imaging
Multiple sclerosis severity score
Mean transit time
Normal-appearing white matter
No evidence of disease activity
Partial volume effect
White matter lesions
The authors would like to thank Paulina Due-Tønnessen, Soheil Damangir, Gabriela Spulber and Kyrre Emblem for assistance.
Compliance with ethical standards
This study was funded by South-Eastern Norway Regional Health Authority (Grant nr 39569). MRI scans and clinical tests were performed within a previous project financed by the same institution (Grant nr 2011059).
Conflict of interest
PS has received speaker honoraria from Novartis, Genzyme and Biogen. GON has received unrestricted research grants from Novartis Norway and from the Odd Fellow’s Foundation for Multiple Sclerosis Research. AB consults for NordicNeuroLab AS, Bergen, Norway. EGC has received support for travelling and speaker honoraria from Biogen, Genzyme, Merck, Novartis, Sanofi-Aventis and Teva, and unrestricted research grants from Biogen, Genzyme and Novartis. HFH has received an unrestricted research grant from Novartis, and support for travelling and speaker honoraria from Biogen, Novartis, Sanofi-Aventis and Teva. MKB has received speaker honoraria from Novartis and Biogen.
All procedures involving human participants performed in this study were in accordance with the ethical standards of the institutional and national research committee (data inspectorate representative at the hospital and the Regional Committee for Medical and Health Research Ethics for South-Eastern Norway) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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