Changes in cerebral perfusion precede plaque formation in multiple sclerosis: a longitudinal perfusion MRI study

Area of Science:

• Neuroimaging
• Neurology
• Medical Physics

Background:

• Multiple sclerosis (MS) involves progressive tissue damage and plaque formation.
• Blood-brain barrier (BBB) leakage is a hallmark of MS lesions.
• Early detection of MS lesion development is crucial for timely intervention.

Purpose of the Study:

• To investigate if altered local perfusion precedes blood-brain barrier (BBB) breakdown in early multiple sclerosis (MS) lesions.
• To identify early indicators of MS lesion development using advanced MRI techniques.
• To test the hypothesis that microcirculatory changes are among the first signs of MS lesion formation.

Main Methods:

• Utilized advanced MRI techniques including magnetization transfer and diffusion analysis.
• Analyzed perfusion parameters (cerebral blood volume, cerebral blood flow, mean transit time) and apparent diffusion coefficient (ADC) in 20 relapsing-remitting MS patients.
• Monitored monthly follow-up scans for the development of new gadolinium-enhancing lesions.

Main Results:

• Changes in perfusion parameters were detected before BBB breakdown in developing MS lesions.
• Altered local perfusion was observed even before increases in the apparent diffusion coefficient (ADC).
• These perfusion changes indicate an inflammatory process impacting microcirculation early in lesion development.

Conclusions:

• Altered local cerebral perfusion is an early indicator of inflammatory processes in multiple sclerosis.
• Changes in blood flow detectable by MRI can precede BBB permeability and diffusion changes in MS lesions.
• Perfusion imaging may offer a novel approach for detecting the earliest stages of MS lesion development.