Enlarged Virchow Robin spaces associate with cognitive decline in multiple sclerosis

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• The clinical significance of enlarged Virchow Robin spaces (eVRS) in inflammatory brain disorders like multiple sclerosis (MS) remains unclear.
• Understanding eVRS may offer insights into MS pathophysiology and clinical progression.

Purpose of the Study:

• To analyze enlarged Virchow Robin spaces (eVRS) using phase-sensitive inversion recovery (PSIR) MRI in multiple sclerosis (MS) patients.
• To investigate the association of eVRS with brain inflammation, atrophy, and clinical disability in MS.

Main Methods:

• Forty-three MS patients (clinically isolated syndrome, relapsing-remitting, and progressive forms) and 10 healthy controls underwent 3T MRI (3DT1, 3DFLAIR, 2D-PSIR).
• Manual segmentation (ITK-SNAP) quantified eVRS number and volume; Freesurfer assessed brain parenchymal fraction (BPF).
• Clinical (EDSS) and cognitive evaluations (Rao's BRB, DKEFS) were performed.

Main Results:

• 2D-PSIR detected significantly more eVRS than 3DT1 and 3DFLAIR.
• eVRS were significantly increased in MS patients compared to controls, with higher prevalence in progressive MS and males.
• eVRS volume correlated with disease duration and showed significant associations with cognitive function (SPARTd, DKEFSfs) in relapse-onset MS, but not with BPF or lesion load.

Conclusions:

• 2D-PSIR is a superior MRI technique for detecting eVRS in MS.
• Increased eVRS in MS patients, especially those with longer disease duration and cognitive deficits, suggest a potential role in MS-related neurodegeneration and cognitive decline.