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Diffusely abnormal white matter in clinically isolated syndrome is associated with parenchymal loss and elevated
I M Vavasour1, P Becquart2, J Gill2
1Radiology, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract:
We characterized the frequency of diffusely abnormal white matter (DAWM) across a broad spectrum of multiple sclerosis (MS) participants. 35% of clinically isolated syndrome (CIS), 57% of relapsing remitting and 64% of secondary progressive MS participants demonstrated DAWM. CIS with DAWM had decreased cortical thickness, higher lesion load and a higher concentration of serum neurofilament light chain compared to CIS without DAWM. DAWM may be useful in identifying CIS patients with greater injury to their brains. Larger and longitudinal studies are warranted.
Insights
Diffusely abnormal white matter (DAWM) is frequent in multiple sclerosis (MS). In early stages (clinically isolated syndrome), DAWM indicates greater brain injury, suggesting its utility in identifying at-risk patients.
Area of Science:
- Neuroscience
- Neurology
- Medical imaging
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
- White matter lesions are a hallmark of MS, but diffusely abnormal white matter (DAWM) represents a more subtle form of white matter damage.
- The prevalence and clinical significance of DAWM across the MS spectrum require further characterization.
Purpose of the Study:
- To determine the frequency of DAWM in participants with clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and secondary progressive MS (SPMS).
- To investigate the relationship between DAWM and indicators of brain injury in CIS patients.
Main Methods:
- Brain MRI was used to identify and quantify DAWM in a cohort of MS participants.
- Cortical thickness, lesion load, and serum neurofilament light chain (sNfL) concentrations were measured in CIS patients with and without DAWM.
Main Results:
- DAWM was present in 35% of CIS, 57% of RRMS, and 64% of SPMS participants.
- CIS patients with DAWM exhibited reduced cortical thickness, increased lesion burden, and higher sNfL levels compared to those without DAWM.
Conclusions:
- DAWM is a common finding across the multiple sclerosis disease course.
- The presence of DAWM in CIS is associated with more significant brain pathology.
- DAWM may serve as an early imaging biomarker for identifying CIS patients with greater neurological injury, warranting further investigation in larger, longitudinal studies.
