Revealing vascular abnormalities and measuring small vessel density in multiple sclerosis lesions using USPIO

Area of Science:

• Neuroimaging
• Vascular Biology
• Neurology

Background:

• Multiple Sclerosis (MS) is a neuro-degenerative disease affecting the central nervous system (CNS), often involving vascular abnormalities.
• Understanding these vascular changes is crucial for diagnosing and managing MS.

Purpose of the Study:

• To investigate vascular abnormalities and density in MS lesions using high-resolution susceptibility weighted imaging (SWI).
• To utilize Ferumoxytol, an ultra-small superparamagnetic iron oxide (USPIO) contrast agent, to enhance visualization of cerebral microvasculature.

Main Methods:

• Six relapsing-remitting MS (RRMS) patients and 14 healthy controls underwent SWI before and after Ferumoxytol infusion.
• FLAIR and SWI data were fused to highlight vascular information within MS lesions.
• Vascular features like the central vein sign (CVS) and multiple vessel sign (MVS) were identified, along with vessel density in lesions and normal-appearing white matter (NAWM).

Main Results:

• Ferumoxytol enhanced SWI revealed a significant increase in detectable vascular abnormalities within MS lesions post-contrast.
• Vessel abnormalities included small lesions at vessel boundaries, dilated vessels, and developmental venous angiomas.
• Periventricular lesional vessel density was significantly higher than in periventricular NAWM.

Conclusions:

• Ferumoxytol-enhanced SWI effectively visualizes vascular abnormalities and quantifies small vessel density in MS lesions.
• This approach shows potential for monitoring venous vasculature in MS and understanding its role in disease pathophysiology.
• Enhanced vascular imaging may provide novel insights into the mechanisms underlying Multiple Sclerosis.