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Updated: Aug 30, 2026
Longitudinal In Vivo Imaging of the Cerebrovasculature: Relevance to CNS Diseases
Published on: December 6, 2016
Changes in cerebral perfusion precede plaque formation in multiple sclerosis: a longitudinal perfusion MRI study
Jens Wuerfel1, Judith Bellmann-Strobl, Peter Brunecker
1Institute of Neuroimmunology, Charité, Berlin, Germany.
Abstract:
New MRI techniques such as the analysis of magnetization transfer or diffusion have provided evidence for subtle progressive alterations in tissue integrity prior to focal leakage of the blood-brain barrier (BBB) as part of plaque formation in multiple sclerosis. Since inflammation is capable of modulating the microcirculation, we investigated the hypothesis that changes in the local perfusion might be one of the earliest signs of lesion development. 20 patients with definite relapsing-remitting multiple sclerosis were analysed with regard to cerebral blood volume, cerebral blood flow, mean transit time and apparent diffusion coefficient (ADC), as well as conventional MRI parameters, on monthly follow-up scans. Among 89 gadolinium-enhancing lesions, we selected 18 that developed during the study and met strict inclusion criteria. In these, changes of perfusion parameters were detectable not only prior to the BBB breakdown, but also prior to increases in the ADC. Our data indicate that inflammation is accompanied by altered local perfusion, which can be detected prior to permeability of the BBB.
Insights
Early inflammation in multiple sclerosis alters local blood flow before blood-brain barrier breakdown. This study shows changes in cerebral perfusion precede detectable damage, offering new insights into early lesion development.
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.
