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Updated: Dec 18, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Enlarged perivascular spaces in multiple sclerosis on magnetic resonance imaging: a systematic review and
Tobias Granberg1,2, Thomas Moridi1, Judith S Brand3
1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Background:
Perivascular spaces can become detectable on magnetic resonance imaging (MRI) upon enlargement, referred to as enlarged perivascular spaces (EPVS) or Virchow-Robin spaces. EPVS have been linked to small vessel disease. Some studies have also indicated an association of EPVS to neuroinflammation and/or neurodegeneration. However, there is conflicting evidence with regards to their potential as a clinically relevant imaging biomarker in multiple sclerosis (MS).
Methods:
To perform a systematic review and meta-analysis of EPVS as visualized by MRI in MS. Nine out of 299 original studies addressing EPVS in humans using MRI were eligible for the systematic review and meta-analysis including a total of 457 MS patients and 352 control subjects.
Results:
In MS, EPVS have been associated with cognitive decline, contrast-enhancing MRI lesions, and brain atrophy. Yet, these associations were not consistent between studies. The meta-analysis revealed that MS patients have greater EPVS prevalence (odds ratio = 4.61, 95% CI = [1.84; 11.60], p = 0.001) as well as higher EPVS counts (standardized mean difference [SMD] = 0.46, 95% CI = [0.26; 0.67], p < 0.001) and larger volumes (SMD = 0.88, 95% CI = [0.19; 1.56], p = 0.01) compared to controls.
Conclusions:
Available literature suggests a higher EPVS burden in MS patients compared to controls. The association of EPVS to neuroinflammatory or -degenerative pathology in MS remains inconsistent. Thus, there is currently insufficient evidence supporting EPVS as diagnostic and/or prognostic marker in MS. In order to benefit future comparisons of studies, we propose recommendations on EPVS assessment standardization in MS. PROSPERO No: CRD42019133946.
Insights
Enlarged perivascular spaces (EPVS) are more prevalent in multiple sclerosis (MS) patients compared to controls. However, their role as a diagnostic or prognostic marker in MS requires further investigation due to inconsistent findings.
Area of Science:
- Neurology
- Radiology
- Neuroimaging
Background:
- Enlarged perivascular spaces (EPVS), also known as Virchow-Robin spaces, are visible on MRI and linked to small vessel disease.
- EPVS have been associated with neuroinflammation and neurodegeneration, but their utility as a biomarker in multiple sclerosis (MS) is debated.
Purpose of the Study:
- To systematically review and meta-analyze the presence and significance of EPVS in MS using MRI.
- To evaluate the potential of EPVS as a clinically relevant imaging biomarker in MS.
Main Methods:
- A systematic review and meta-analysis was conducted on studies imaging EPVS in humans.
- Nine eligible studies included 457 MS patients and 352 control subjects.
Main Results:
- MS patients exhibited a significantly higher prevalence of EPVS (OR=4.61, p=0.001).
- Meta-analysis showed increased EPVS counts (SMD=0.46, p<0.001) and volumes (SMD=0.88, p=0.01) in MS patients versus controls.
- Associations between EPVS and cognitive decline, contrast-enhancing lesions, or brain atrophy in MS were inconsistent across studies.
Conclusions:
- MS patients generally have a greater burden of EPVS compared to controls.
- The link between EPVS and neuroinflammatory or neurodegenerative pathology in MS is not consistently supported by current evidence.
- Further research and standardization of EPVS assessment are needed to clarify their role as diagnostic or prognostic markers in MS.
