Multiple Sclerosis Progression Can Be Predicted With MRI

ScienceDaily (Nov. 6, 2008) — A new study published in Journal of Neuroimaging shows that MRI scans used on multiple sclerosis (MS) patients to determine if the disease has affected gray matter in the brain can identify those at-risk for progression of disability.

MS affects approximately 400,000 people in the United States and as many as 2.5 million worldwide. It is the most common cause of progressive disability in young adults. While the cause of the disease remains unknown, it is characterized by damage to the covering over the nerve fibers in the brain and spinal cord, or to the nerve fiber itself.

In an attempt to understand the causes of disease progression, researchers at the Partners MS Center, led by Dr. Rohit Bakshi and his team, have developed new ways to detect gray matter damage.

Dr. Bakshi, Director of the Laboratory for Neuroimaging Research and an Associate Professor of Neurology and Radiology at the Brigham and Women's Hospital and Harvard Medical School, led a four year follow-up study, which found that patients with unnatural darkness of gray matter structures as seen on MRI pictures carried a higher risk for progression of physical disability. This abnormal darkness is referred to as T2 hypointensity, and is suggestive of excessive iron deposits. In addition, the researchers found that the new marker of gray matter damage showed closer correlations with patients' clinical status than other established MRI markers of disease severity, including lesions, also known as "plaques," and shrinkage of the brain, also know as "atrophy."

"MRI scans obtained from patients with MS are being used to develop measures and techniques that can accurately measure the visible and hidden damage to the brain, especially in gray matter areas and can more accurately predict the course of the disease," says Bakshi.

As a result of the findings, MRI-based measurement of gray matter damage may be used as a surrogate marker of disease progression. Physicians may therefore be able to more accurately identify patients at risk for developing this progressive disease.

MS has been traditionally viewed as a disease affecting the white matter of the brain, where messages are transferred between the brains gray matter sections, which control the processing of information. While prior research has shown that the brain's gray matter is also affected, studies detailing its effects have been limited. In addition, current therapies for MS are incomplete, raising the need to better understand disease mechanisms and the biomarkers of disease progression. If excessive iron in gray matter contributes to damage, this would open a new avenue for developing better therapies.

Journal reference:

1. Neema et al. Deep Gray Matter Involvement on Brain MRI Scans Is Associated with Clinical Progression in Multiple Sclerosis. Journal of Neuroimaging, 2008; DOI: 10.1111/j.1552-6569.2008.00296.x

Adapted from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.
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Wiley-Blackwell (2008, November 6). Multiple Sclerosis Progression Can Be Predicted With MRI. ScienceDaily. Retrieved November 10, 2008, from http://www.sciencedaily.com­ /releases/2008/11/081105164308.htm

Gender influences MS’ effect on brain

By LOIS BAKER
Contributing Editor

A new multiple sclerosis study conducted by UB neurologists has shown that in addition to affecting women two-to-three times more than men, multiple sclerosis (MS) damages different regions of the brain in men and women.

The differences were defined by analyzing brain scans of 795 MS patients and 101 healthy controls using conventional magnetic resonance imaging (MRI) techniques, plus more advanced nonconventional MRI techniques, such as diffusion weighted imaging and magnetization transfer imaging.

Results of the study were presented recently at the annual meeting of the American Academy of Neurology.

The research showed that MS in women results in more atrophy of the brain’s white matter, the network of nerves that transport messages to the various brain regions, while the condition in men appears to cause more atrophy in the brain’s gray matter, the regions where messages are received and interpreted.

Ronald Antulov is first author on the study. He conducted the research while a neuroimaging fellow at the Buffalo Neuroimaging Analysis Center (BNAC), part of the Jacobs Neurological Institute, which is the Department of Neurology in the School of Medicine and Biomedical Sciences.

Antulov and colleagues examined consecutively 620 female and 175 male MS patients who were seen at the institute and compared scans with those of the healthy controls. All were assessed using conventional and nonconventional MRI measures.

“We found that atrophy of gray matter and central brain regions was more advanced in men, while atrophy of white matter was more advanced in women,” said Antulov. The phenomenon was not observed in healthy controls.

“We think these changes are influenced by a decrease in sex hormones,” Antulov said. “A recent study showing that male MS patients receiving testosterone treatment showed a lower rate of brain volume decline supports this concept. This finding also suggests that higher levels of estrogen may protect women against more severe MS-related brain damage.”

The BNAC is applying for grants to extend this research.

Contributing to the study, all from the BNAC-JNI, were Bianca Weinstock-Guttman, Jennifer Cox, Sara Hussein, Jackie Durfee, Michael Dwyer, Niels Bergsland, Nadir Abdelrahman, Milena Stosic, David Hojnacki, Frederick E. Munschauer and Robert Zivadinov.

The study was conducted in collaboration with the University of Rijeka, Croatia. Vladimir Miletic of that university also contributed to the research.