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Thalamic damage predicts the evolution of primary-progressive multiple sclerosis at 5 years.

S Mesaros1, M A Rocca, E Pagani

  • 1Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, University Ospedale San Raffaele, Milan, Italy.

AJNR. American Journal of Neuroradiology
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Thalamic damage and white matter changes measured by diffusion tensor imaging (DTI) can predict long-term disability progression in primary progressive multiple sclerosis (PPMS). These imaging markers offer potential for monitoring disease in PPMS patients.

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Area of Science:

  • Neuroimaging
  • Neurology
  • Multiple Sclerosis Research

Background:

  • Primary progressive multiple sclerosis (PPMS) lacks reliable monitoring markers.
  • Thalamic damage and white matter integrity are potential indicators of disease progression.

Purpose of the Study:

  • To investigate if conventional and diffusion tensor imaging (DTI) measures of thalamic damage predict long-term disability accumulation in PPMS.
  • To identify reliable imaging biomarkers for monitoring PPMS progression.

Main Methods:

  • Conventional and DTI brain scans were acquired at baseline and follow-up (15 months) in 54 PPMS patients and 8 controls.
  • Clinical reassessment occurred after 5 years.
  • Measures included lesion load, brain atrophy, NTV, and MD/FA histograms of normal-appearing white matter (NAWM) and gray matter (GM), including thalami.

Main Results:

  • PPMS patients showed lower NTV and thalamic FA, and higher thalamic and GM MD at baseline compared to controls.
  • Changes in thalamic FA during follow-up were greater in PPMS patients.
  • Multivariate analysis identified average NAWM MD and thalamic FA change as independent predictors of EDSS score deterioration.

Conclusions:

  • Short-term thalamic damage accrual and NAWM involvement severity predict long-term disability accumulation in PPMS.
  • DTI measures of thalamic and NAWM damage are promising biomarkers for predicting long-term outcomes in PPMS.