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Updated: Jun 26, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
White matter hemodynamic abnormalities precede sub-cortical gray matter changes in multiple sclerosis
Andrew W Varga1, Glyn Johnson, James S Babb
1Department of Radiology, New York University, New York, NY, USA.
Background:
Hypoperfusion has been reported in lesions, normal-appearing white (NAWM) and gray matter (NAGM) of patients with clinically definite multiple sclerosis (MS) by using perfusion MRI. However, it is still unknown how early such changes in perfusion occur. The aim of our study was to assess the presence of hemodynamic changes in the NAWM and subcortical NAGM of patients with clinically isolated syndrome (CIS) in comparison to healthy controls and to patients with early relapsing-remitting (RR) MS.
Methods:
Absolute cerebral blood flow (CBF), blood volume (CBV) and mean transit time (MTT) were measured in the periventricular and frontal NAWM, thalamus and putamen nuclei of 12 patients with CIS, 12 with early RR-MS and 12 healthy controls using dynamic susceptibility contrast enhanced (DSC) T2*-weighted MRI.
Results:
Compared to controls, CBF was significantly decreased in the periventricular NAWM of CIS patients and in the periventricular NAWM and putamen of RR-MS patients. Compared to CIS, RR-MS patients showed a significant CBF decrease in the putamen.
Conclusions:
CBF was decreased in the NAWM of both CIS and RR-MS patients and in the subcortical NAGM of RR-MS patients suggesting a continuum of tissue perfusion decreases beginning in white matter and spreading to gray matter, as the disease progresses.
Insights
Cerebral blood flow decreases in normal-appearing white matter of patients with clinically isolated syndrome (CIS) and early relapsing-remitting (RR) multiple sclerosis (MS). These perfusion changes suggest an early stage of the disease impacting brain tissue.
Area of Science:
- Neuroimaging
- Neurology
- Medical Science
Background:
- Hypoperfusion is observed in multiple sclerosis (MS) lesions and normal-appearing brain tissue using perfusion MRI.
- Early hemodynamic changes in clinically isolated syndrome (CIS) and early relapsing-remitting (RR) MS are not well understood.
Purpose of the Study:
- To assess hemodynamic changes in normal-appearing white matter (NAWM) and subcortical gray matter (NAGM) in CIS patients.
- To compare these changes with healthy controls and early RR-MS patients.
Main Methods:
- Dynamic susceptibility contrast enhanced (DSC) T2*-weighted MRI was used.
- Absolute cerebral blood flow (CBF), blood volume (CBV), and mean transit time (MTT) were measured.
- Participants included 12 CIS patients, 12 early RR-MS patients, and 12 healthy controls.
Main Results:
- CBF was significantly decreased in the periventricular NAWM of CIS patients compared to controls.
- RR-MS patients showed significantly decreased CBF in periventricular NAWM and putamen compared to controls.
- RR-MS patients exhibited a significant CBF decrease in the putamen compared to CIS patients.
Conclusions:
- Decreased CBF in NAWM of CIS and RR-MS patients indicates early disease-related perfusion changes.
- CBF reduction in subcortical NAGM of RR-MS patients suggests disease progression.
- These findings suggest a continuum of perfusion decrease from white to gray matter as MS progresses.
