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Investigation of cerebral microbleeds in multiple sclerosis as a potential marker of blood-brain barrier dysfunction
Philipp Eisele1, Angelika Alonso1, Martin Griebe1
1Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Objective:
In multiple sclerosis (MS) lesions blood-brain-barrier (BBB) breakdown is a common phenomenon delineating the phase of focal inflammation in developing MS lesions. In other pathologies like cerebral amyloid angiopathy or arteriosclerotic cerebral small vessel disease permanent cerebral microbleeds (CMB) have been shown to be sensitive markers indicating BBB dysfunction. We were interested in the potential role of T(2)*-weighted MRI and CMBs as BBB integrity markers in MS.
Methods:
A large cohort of 189 MS patients (179 relapsing remitting MS and 10 secondary progressive MS) was investigated on a 3T MRI system with conventional and T(2)*-weighted gradient echo MRI (T(2)*w) sequences. T(2)*w images were analysed for CMBs by experienced raters.
Results:
None of the MS patients showed a CMB.
Conclusion:
On T(2)*w MRI the prevalence of CMBs is not higher in MS patients than what is to be expected in young healthy people. In contrast to pathologies with structural vascular changes like small vessel disease or cerebral amyloid angiopathy, CMBs are not seen in MS where the immune reaction is causing a functional change in the BBB.
Insights
Cerebral microbleeds (CMBs) are not more prevalent in multiple sclerosis (MS) patients than in healthy individuals. This suggests CMBs are not reliable markers for blood-brain barrier (BBB) dysfunction in MS.
Area of Science:
- Neuroimaging
- Neurology
- Vascular Biology
Background:
- Blood-brain barrier (BBB) breakdown is a hallmark of active multiple sclerosis (MS) lesions.
- Cerebral microbleeds (CMBs) indicate BBB dysfunction in conditions like small vessel disease.
- The utility of CMBs as BBB integrity markers in MS remains unexplored.
Purpose of the Study:
- To investigate the role of T(2)*-weighted MRI and CMBs as markers of BBB integrity in MS.
- To determine the prevalence of CMBs in a cohort of MS patients.
Main Methods:
- A cohort of 189 MS patients underwent 3T MRI with T(2)*-weighted gradient echo sequences.
- Experienced raters analyzed T(2)*-weighted images for the presence of CMBs.
Main Results:
- No CMBs were detected in any of the MS patients.
- The prevalence of CMBs in MS patients was not higher than expected in young healthy individuals.
Conclusions:
- T(2)*-weighted MRI does not reveal an increased prevalence of CMBs in MS.
- Unlike conditions with structural vascular changes, CMBs are not observed in MS, indicating BBB dysfunction in MS is primarily functional, not structural.
