Transcranial brain sonography findings predict disease progression in multiple sclerosis

Area of Science:

• Neuroimaging
• Neurology
• Medical Diagnostics

Background:

• Multiple sclerosis (MS) is increasingly recognized to involve early neurodegeneration in subcortical gray matter.
• Transcranial sonography (TCS) is a technique that can reveal hyperechogenic lesions in the substantia nigra (SN) and basal ganglia, often associated with iron accumulation in primary neurodegenerative diseases.

Purpose of the Study:

• To investigate the presence of deep gray matter lesions using TCS in patients with MS.
• To determine if these sonographic findings correlate with the severity and progression of MS.

Main Methods:

• Prospective study of 75 MS patients and 55 healthy controls using clinical assessment and TCS.
• 1.5-T MRI was performed on 23 MS patients concurrently with TCS.
• Disease progression was clinically assessed 2 years post-TCS.

Main Results:

• Abnormal hyperechogenicity in the substantia nigra (SN), lenticular nucleus (LN), caudate nucleus, and thalamus was observed in 41%, 54%, 40%, and 8% of MS patients, respectively, significantly more than in controls.
• SN and LN hyperechogenicity correlated with increased MRI T2 hypointensity, suggesting iron deposition.
• Larger bilateral SN echogenic areas were linked to faster disease progression, while SN hypoechogenicity predicted a stable disease course over 2 years.

Conclusions:

• Deep gray matter lesions, similar to those in neurodegenerative diseases, are frequently detectable by TCS in MS patients.
• TCS findings reflect changes in brain iron metabolism that correlate with the future progression of MS.