This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (77)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Multiple Sclerosis/ Demyelinating Disease  • Radiologic Imaging  • Magnetic Resonance Imaging  • Immunologic Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

A Diffusion-Tensor Magnetic Resonance Imaging Study

Marco Rovaris, MD; Marco Bozzali, MD; Giuseppe Iannucci, MD; Angelo Ghezzi, MD; Domenico Caputo, MD; Enrico Montanari, MD; Antonio Bertolotto, MD; Roberto Bergamaschi, MD; Ruggero Capra, MD; Giovanni Luigi Mancardi, MD; Vittorio Martinelli, MD; Giancarlo Comi, MD; Massimo Filippi, MD

Arch Neurol. 2002;59:1406-1412.

Background  Diffusion-tensor magnetic resonance imaging is sensitive to the more destructive aspects of multiple sclerosis (MS) evolution occurring outside and within T2-visible lesions and, as a consequence, holds promise for providing a more complete picture of primary progressive (PP) MS–related tissue damage than conventional magnetic resonance imaging.

Objective  To improve our understanding of PPMS by assessing the extent of occult pathological features in the normal-appearing white and gray matter of the brain using diffusion-tensor magnetic resonance imaging.

Methods  Ninety-six patients with PPMS, 47 patients with secondary progressive (SP) MS, and 44 healthy control subjects were studied. T2-hyperintense and T1-hypointense lesion volumes were calculated, and the volume of the whole brain tissue was measured. Diffusion-tensor magnetic resonance imaging scans were postprocessed and analyzed to obtain the mean diffusivity and fractional anisotropy histograms from the brain and from the normal-appearing white and gray matter in isolation.

Results  The mean T2-hyperintense and T1-hypointense lesion volumes were lower in patients with PPMS than in patients with SPMS, while the mean absolute brain volumes were similar in the 2 groups. The average lesion diffusivity was significantly higher in patients with SPMS than in patients with PPMS (P<.001). Histogram-derived metrics of the brain tissue and normal-appearing white and gray matter were significantly different between patients with PPMS and healthy subjects (range, P = .004 to <.001). Average diffusivity values were significantly higher in patients with SPMS than in patients with PPMS for all the tissues studied (range, P = .001 to <.001). Fractional anisotropy histogram–derived quantities did not significantly differ between the 2 patient groups (range, P = .94 to .03).

Conclusion  This study confirms that, in patients with PPMS, normal-appearing white and gray matter are not spared by disease-related pathological processes, although they are affected to a lesser degree than in patients with SPMS.

From the Neuroimaging Research Unit (Drs Rovaris, Bozzali, Iannucci, and Filippi) and the Clinical Trials Unit (Drs Martinelli and Comi), Department of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan; the Multiple Sclerosis Center, Ospedale di Gallarate, Gallarate (Dr Ghezzi); the Departments of Neurology, Scientific Institute Don Gnocchi, University of Milan, Milan (Dr Caputo), Ospedale di Orbassano, Orbassano (Dr Bertolotto), and Spedali Civili, University of Brescia, Brescia (Dr Capra); the Multiple Sclerosis Center, Ospedale di Fidenza, Fidenza (Dr Montanari); and the Departments of Neurological Sciences, Scientific Institute C. Mondino, University of Pavia, Pavia (Dr Bergamaschi), and University of Genoa, Genoa (Dr Mancardi), Italy.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Thalamic Involvement and Its Impact on Clinical Disability in Patients with Multiple Sclerosis: A Diffusion Tensor Imaging Study at 3T
Tovar-Moll et al.
Am. J. Neuroradiol. 2009;30:1380-1386.
ABSTRACT | FULL TEXT  

Contribution of White Matter Lesions to Gray Matter Atrophy in Multiple Sclerosis: Evidence From Voxel-Based Analysis of T1 Lesions in the Visual Pathway
Sepulcre et al.
Arch Neurol 2009;66:173-179.
ABSTRACT | FULL TEXT  

Magnetic resonance imaging metrics and their correlation with clinical outcomes in multiple sclerosis: a review of the literature and future perspectives
Bar-Zohar et al.
Mult Scler 2008;14:719-727.
ABSTRACT  

Large-scale, multicentre, quantitative MRI study of brain and cord damage in primary progressive multiple sclerosis
Rovaris et al.
Mult Scler 2008;14:455-464.
ABSTRACT  

Evidence of thalamic gray matter loss in pediatric multiple sclerosis
Mesaros et al.
Neurology 2008;70:1107-1112.
ABSTRACT | FULL TEXT  

Diffusion-Tensor MR Imaging of Cortical Lesions in Multiple Sclerosis: Initial Findings
Poonawalla et al.
Radiology 2008;246:880-886.
ABSTRACT | FULL TEXT  

Improved Identification of Intracortical Lesions in Multiple Sclerosis with Phase-Sensitive Inversion Recovery in Combination with Fast Double Inversion Recovery MR Imaging
Nelson et al.
Am. J. Neuroradiol. 2007;28:1645-1649.
ABSTRACT | FULL TEXT  

Cortical white-matter microstructure in schizophrenia: Diffusion imaging study
ANDREONE et al.
Br. J. Psychiatry 2007;191:113-119.
ABSTRACT | FULL TEXT  

Grey matter damage predicts the evolution of primary progressive multiple sclerosis at 5 years
Rovaris et al.
Brain 2006;129:2628-2634.
ABSTRACT | FULL TEXT  

Magnetization transfer MRI metrics predict the accumulation of disability 8 years later in patients with multiple sclerosis
Agosta et al.
Brain 2006;129:2620-2627.
ABSTRACT | FULL TEXT  

Regional Gray Matter Atrophy in Early Primary Progressive Multiple Sclerosis: A Voxel-Based Morphometry Study.
Sepulcre et al.
Arch Neurol 2006;63:1175-1180.
ABSTRACT | FULL TEXT  

Voxel-based analysis of quantitative T1 maps demonstrates that multiple sclerosis acts throughout the normal-appearing white matter.
Vrenken et al.
Am. J. Neuroradiol. 2006;27:868-874.
ABSTRACT | FULL TEXT  

Most patients with multiple sclerosis or a clinically isolated demyelinating syndrome should be treated at the time of diagnosis.
Frohman et al.
Arch Neurol 2006;63:614-619.
FULL TEXT  

Selective magnetization transfer ratio decrease in the visual cortex following optic neuritis
Audoin et al.
Brain 2006;129:1031-1039.
ABSTRACT | FULL TEXT  

Enhanced visualization and quantification of magnetic resonance diffusion tensor imaging using the p:q tensor decomposition
Pena et al.
Br. J. Radiol. 2006;79:101-109.
ABSTRACT | FULL TEXT  

Diffusion MRI in multiple sclerosis
Rovaris et al.
Neurology 2005;65:1526-1532.
ABSTRACT | FULL TEXT  

Cortical demyelination and diffuse white matter injury in multiple sclerosis
Kutzelnigg et al.
Brain 2005;128:2705-2712.
ABSTRACT | FULL TEXT  

Oral Presentations
Mult Scler 2005;11:S1-S182.
 

Axonal Injury and Overall Tissue Loss Are Not Related in Primary Progressive Multiple Sclerosis
Rovaris et al.
Arch Neurol 2005;62:898-902.
ABSTRACT | FULL TEXT  

Diffusion-Tensor Magnetic Resonance Imaging Detects Normal-Appearing White Matter Damage Unrelated to Short-term Disease Activity in Patients at the Earliest Clinical Stage of Multiple Sclerosis
Gallo et al.
Arch Neurol 2005;62:803-808.
ABSTRACT | FULL TEXT  

Progressive Gray Matter Damage in Patients With Relapsing-Remitting Multiple Sclerosis: A Longitudinal Diffusion Tensor Magnetic Resonance Imaging Study
Oreja-Guevara et al.
Arch Neurol 2005;62:578-584.
ABSTRACT | FULL TEXT  

Cortical Lesions in Multiple Sclerosis: Combined Postmortem MR Imaging and Histopathology
Geurts et al.
Am. J. Neuroradiol. 2005;26:572-577.
ABSTRACT | FULL TEXT  

Quantification of cervical cord pathology in primary progressive MS using diffusion tensor MRI
Agosta et al.
Neurology 2005;64:631-635.
ABSTRACT | FULL TEXT  

Regional Brain Atrophy Evolves Differently in Patients with Multiple Sclerosis According to Clinical Phenotype
Pagani et al.
Am. J. Neuroradiol. 2005;26:341-346.
ABSTRACT | FULL TEXT  

A review of structural magnetic resonance neuroimaging
Symms et al.
J. Neurol. Neurosurg. Psychiatry 2004;75:1235-1244.
ABSTRACT | FULL TEXT  

The use of magnetic resonance imaging in multiple sclerosis: lessons learned from clinical trials
Boneschi et al.
Mult Scler 2004;10:341-347.
ABSTRACT  

Imaging primary progressive multiple sclerosis: the contribution of structural, metabolic, and functional MRI techniques
Filippi et al.
Mult Scler 2004;10:S36-S45.
ABSTRACT  

Imaging primary progressive multiple sclerosis: the contribution of structural, metabolic, and functional MRI techniques
Filippi et al.
Mult Scler 2004;10:S36-S45.
ABSTRACT  

Progressive change in primary progressive multiple sclerosis normal-appearing white matter: a serial diffusion magnetic resonance imaging study
Schmierer et al.
Mult Scler 2004;10:182-187.
ABSTRACT  

Diffusion tensor imaging of early relapsing-remitting multiple sclerosis with histogram analysis using automated segmentation and brain volume correction
Rashid et al.
Mult Scler 2004;10:9-15.
ABSTRACT  

Pure Neuropsychiatric Presentation of Multiple Sclerosis
Asghar-Ali et al.
Am. J. Psychiatry 2004;161:226-231.
FULL TEXT  

Evidence of early cortical atrophy in MS: Relevance to white matter changes and disability
De Stefano et al.
Neurology 2003;60:1157-1162.
ABSTRACT | FULL TEXT