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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.