1H-MRSI evidence for cortical gray matter pathology that is independent of cerebral white matter lesion load in patients with secondary progressive multiple sclerosis

Background Fatigue is one of the most frequent and disturbing symptoms in multiple sclerosis (MS), directly affecting the patient’s quality of life. However, many questions remain unclear regarding the anatomic brain correlate of MS-related fatigue. Objective To assess the relationship between fatigue and white matter lesion location and gray matter atrophy. Methods In this study, 60 patients with MS were evaluated with the Modified Fatigue Impact Scale and magnetic resonance imaging. Location of white matter lesion was analyzed using a voxel-by-voxel lesion probability mapping approach and gray matter atrophy degree and location using an optimized voxel-based morphometry method. Results We found a correlation between lesion load and fatigue score (T2 lesion load: r = 0.415, P = 0.001; T1 lesion load r = 0.328, P = 0.011). Moreover, fatigue correlated with lesions in the right parietotemporal (periatrial area, juxtaventricular white matter deep in the parietal lobe and callosal forceps) and left frontal (middle-anterior corpus callosum, anterior cingulum and centrum semiovale of the superior and middle frontal gyri) white matter regions ( P < 0.001 in all cases). Finally, fatigue score significantly correlated with gray matter atrophy in frontal regions, specifically, the left superior frontal gyrus and bilateral middle frontal gyri ( P < 0.001 in all cases). Conclusion Our results suggest that the symptom of fatigue is associated with a disruption of brain networks involved in cognitive/attentional processes.

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An Autopsy Confirmed Neuromyelitis Optica Spectrum Disorder with Extensive Brain White Matter Lesion and Optic Neuritis but Intact Spinal Cord, Clinically Mimicking a Secondary Progressive Multiple Sclerosis-like Course

Internal Medicine ◽

10.2169/internalmedicine.7635-21 ◽

2022 ◽

Author(s):

Fumika Azuma ◽

Kazuya Nokura ◽

Tetsuharu Kako ◽

Mari Yoshida ◽

Shinsui Tatsumi

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

White Matter ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

White Matter Lesion ◽

Progressive Multiple Sclerosis ◽

Neuromyelitis Optica Spectrum Disorder ◽

Secondary Progressive ◽

Brain White Matter

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P25 VASCULAR AGING IS ASSOCIATED WITH THE SEVERITY OF CEREBRAL WHITE MATTER LESION LOAD

Artery Research ◽

10.1016/j.artres.2017.10.166 ◽

2017 ◽

Vol 20 (C) ◽

pp. 100

Author(s):

Lisanne Tap ◽

Annegreet van Opbroek ◽

Wiro Niessen ◽

Marion Smits ◽

Francesco Mattace- Raso

Keyword(s):

White Matter ◽

White Matter Lesion ◽

Cerebral White Matter ◽

Vascular Aging ◽

Lesion Load ◽

Cerebral White Matter Lesion

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T1 hypointense lesion load in secondary progressive multiple sclerosis: a comparison of pre versus post contrast loads and of manual versus semi automated threshold techniques for lesion segmentation

Multiple Sclerosis Journal ◽

10.1177/135245859800400502 ◽

1998 ◽

Vol 4 (5) ◽

pp. 408-412 ◽

Cited By ~ 18

Author(s):

J I O'Riordan ◽

M Gawne Cain ◽

A Coles ◽

L Wang ◽

D AS Compston ◽

...

Keyword(s):

Multiple Sclerosis ◽

Strong Correlation ◽

Measurement Techniques ◽

Progressive Multiple Sclerosis ◽

Secondary Progressive Multiple Sclerosis ◽

Lesion Volume ◽

Mri Findings ◽

Lesion Load ◽

Post Contrast ◽

Secondary Progressive

Magnetic resonance imaging (MRI) is increasingly being used as a monitoring tool for disease activity in therapeutic trials in multiple sclerosis. There is, however, only a limited relationship between MRI findings and clinical outcome measurements. It has been suggested that hypointense lesion load on T1 weighted imaging has a better correlation with disability than the more conventional T2 hyper intense lesion load. This study was undertaken to (i) evaluate different measurement techniques used to quantify T1 hypointense lesion load, and (ii) to compare lesion load as measured using different parameters and disability. Twenty-five patients with secondary progressive multiple sclerosis, mean age of 40 years (23-57), mean EDSS 5.7 (4-7) were analysed. T2 lesion load on FSE correlated well with both the hypointense lesion load on T1 pre-gadolinium (r=0.8, P50.0001) and T1 post-gadolinium (r=0.8, P50.0001) but less so with the enhancing lesion load (r=0.4, P50.05). There was a very strong correlation with T1 hypo-intense lesion volume pre and post gadolinium (r=0.96, P50.001). However, the EDSS was not correlated with the T2 lesion load (r=70.27, P=0.2), T1 pre-gadolinium load (r=70.3, P=0.1), T1 post gadolinium load (r=70.4, P=0.7) and enhancing lesion load (r=70.28, P=0.2), or with the degree of hypointensity of T1 weighted images determined using the threshold technique. There is a strong correlation between T1 hypointense lesion volume both pre and post gadolinium and also between T1 and T2 lesion volumes.

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Microstructural fronto-striatal and temporo-insular alterations are associated with fatigue in patients with multiple sclerosis independent of white matter lesion load and depression

Multiple Sclerosis Journal ◽

10.1177/1352458519869185 ◽

2019 ◽

Vol 26 (13) ◽

pp. 1708-1718 ◽

Cited By ~ 7

Author(s):

Miklos Palotai ◽

Michele Cavallari ◽

Ismail Koubiyr ◽

Alfredo Morales Pinzon ◽

Aria Nazeri ◽

...

Keyword(s):

Multiple Sclerosis ◽

White Matter ◽

Physical Disability ◽

Disease Duration ◽

White Matter Lesion ◽

Brain Magnetic Resonance Imaging ◽

Brain Regions ◽

Specific Substrate ◽

Patient Stratification ◽

Lesion Load

Background: Fatigue in multiple sclerosis (MS) has been inconsistently associated with disruption of specific brain circuitries. Temporal fluctuations of fatigue have not been considered. Objective: The aim of this study was to investigate the association of fatigue with brain diffusion abnormalities, using robust criteria for patient stratification based on longitudinal patterns of fatigue. Methods: Patient stratification: (1) sustained fatigue (SF, n = 26): latest two Modified Fatigue Impact Scale (MFIS) ⩾ 38; (2) reversible fatigue (RF, n = 25): latest MFIS < 38 and minimum one previous MFIS ⩾ 38; and (3) never fatigued (NF, n = 42): MFIS always < 38 (five assessments minimum). 3T brain magnetic resonance imaging (MRI) was used to perform voxel-wise comparison of fractional anisotropy (FA) between the groups controlling for age, sex, disease duration, physical disability, white matter lesion load (T2LV), and depression. Results: SF and, to a lesser extent, RF patients showed lower FA in multiple brain regions compared to NF patients, independent of age, sex, disease duration, and physical disability. In cingulo-postcommissural-striato-thalamic regions, the differences in FA between SF and NF (but not between RF and NF or SF) patients were independent of T2LV, and in ventromedial prefronto-precommissuro-striatal and temporo-insular areas, independent of T2LV and depression. Conclusion: Damage to ventromedial prefronto-precommissuro-striatal and temporo-insular pathways appears to be a specific substrate of SF in MS.

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