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Published on: July 19, 2019
Regional Frontal Perfusion Deficits in Relapsing-Remitting Multiple Sclerosis with Cognitive Decline
R Vitorino1, S-P Hojjat2,3, C G Cantrell4
1Medical Imaging (R.V., S.-P.H., L.Z., R.I.A.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada rita.vitorino@sunnybrook.ca.
Background And Purpose:
Cortical dysfunction, quantifiable by cerebral perfusion techniques, is prevalent in patients with MS, contributing to cognitive impairment. We sought to localize perfusion distribution differences in patients with relapsing-remitting MS with and without cognitive impairment and healthy controls.
Materials And Methods:
Thirty-nine patients with relapsing-remitting MS (20 cognitively impaired, 19 nonimpaired) and 19 age- and sex-matched healthy controls underwent a neurocognitive battery and MR imaging. Voxel-based analysis compared regional deep and cortical GM perfusion and volume among the cohorts.
Results:
After we adjusted for localized volumetric differences in the right frontal, temporal, and occipital lobes, progressive CBF and CBV deficits were present in the left middle frontal cortex for all cohorts and in the left superior frontal gyrus for patients with cognitive impairment compared with patients without impairment and controls. Compared with healthy controls, reduced CBF was present in the limbic regions of patients with cognitive impairment, and reduced CBV was present in the right middle frontal gyrus in patients with cognitive impairment and in the temporal gyrus of relapsing-remitting MS patients without cognitive impairment.
Conclusions:
Consistent regional frontal cortical perfusion deficits are present in patients with relapsing-remitting MS, with more widespread hypoperfusion in those with cognitive impairment, independent of structural differences, indicating that cortical perfusion may be a useful biomarker of cortical dysfunction and cognitive impairment in MS.
Insights
Patients with relapsing-remitting multiple sclerosis (MS) show frontal cortical perfusion deficits. Cognitive impairment in MS is linked to more widespread hypoperfusion, independent of brain structure, suggesting perfusion is a key biomarker.
Area of Science:
- Neuroscience
- Medical Imaging
- Neurology
Background:
- Cortical dysfunction is common in multiple sclerosis (MS), often leading to cognitive impairment.
- Cerebral perfusion imaging can quantify this dysfunction.
Purpose of the Study:
- To identify differences in cerebral perfusion distribution in patients with relapsing-remitting MS (RRMS) with and without cognitive impairment.
- To compare these differences with healthy controls.
Main Methods:
- 39 RRMS patients (20 cognitively impaired, 19 non-impaired) and 19 healthy controls underwent neurocognitive testing and MRI.
- Voxel-based analysis was used to compare regional gray matter (GM) perfusion and volume.
Main Results:
- Reduced cerebral blood flow (CBF) and cerebral blood volume (CBV) were observed in the left middle frontal cortex in all MS patients.
- Cognitively impaired MS patients showed additional deficits in the left superior frontal gyrus and limbic regions.
- Reduced CBV was noted in the right middle frontal gyrus (cognitively impaired MS) and temporal gyrus (non-impaired MS) compared to controls.
Conclusions:
- Frontal cortical perfusion deficits are characteristic of RRMS.
- Widespread hypoperfusion in MS patients with cognitive impairment is independent of structural brain changes.
- Cerebral perfusion may serve as a valuable biomarker for cortical dysfunction and cognitive impairment in MS.
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