The role of 7T MRI to assess atrophy of the subcortical deep gray matter in relapsing-remitting multiple sclerosis

Abstract:

Background: Deep gray matter (DGM) atrophy and lesions are important elements of multiple sclerosis (MS) pathogenesis.

Objective: To optimize automated segmentation for 7T DGM volume quantitation and assess its sensitivity for atrophy detection and relationship to DGM lesions and disability in relapsing-remitting (RR) MS.

Methods: 30 RRMS subjects [mean age 44.0 years, median Expanded Disability Status Scale (EDSS) score 2] and 14 age-/sex-matched healthy controls underwent 7T MRI with 3D magnetization-prepared 2 rapid gradient-echoes (MP2RAGE) and fluid-attenuated inversion recovery with 0.7 mm3 isotropic voxels. Applying a freely available automated pipeline to assess DGM structure volumes required pre-processing combining two MP2RAGE inversion times and uniform T1-weighted images, and noise-suppressed reconstruction. DGM volumes were then normalized. Brain DGM lesions and white matter T2 lesion volume (T2LV) were expert-quantified. Group differences (two-sample t-tests) and Spearman correlations were assessed.

Results: Total DGM volumes were lower in MS vs. controls (43.5 vs. 46.3 mL, p=0.034), varying by region, most pronounced in the caudate (9.0 vs. 9.9 mL, p=0.008). DGM volumes inversely correlated with EDSS (total DGM: r=-0.45, p=0.014; GP: r=-0.42, p=0.023; putamen: r=-0.44, p=0.016; caudate: r=-0.37, p=0.047) and T2LV (total DGM: r=-0.64, p<0.001; putamen: r=-0.48, p=0.009; thalamus: r=-0.76, p<0.001). DGM lesions were found in 77% (n=23) of MS subjects and no controls, with thalamic lesions most prevalent (73%). Thalamic lesion volume correlated inversely with thalamic volume (r=-0.38, p=0.045). Conclusion: 7T MRI shows a link between DGM atrophy and both white matter lesions and physical disability in RRMS. Furthermore, thalamic lesions are associated with thalamic atrophy.   References Audoin B, Zaaraoui W, Reuter F, et al. Atrophy mainly affects the limbic system and the deep grey matter at the first stage of multiple sclerosis. J Neurol Neurosurg Psychiatry 2010;81:690-5. 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