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Enlarged perivascular spaces are associated with brain microangiopathy and aging in multiple sclerosis

Serena Borrelli1, François Guisset2, Colin Vanden Bulcke3

  • 1Neuroinflammation Imaging Lab (NIL), Institute of NeuroScience, Université catholique de Louvain, Brussels, Belgium/Department of Neurology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Brussels, Brussels, Belgium.

Multiple Sclerosis (Houndmills, Basingstoke, England)
|June 8, 2024
PubMed
Abstract

Insights

Enlarged perivascular spaces (EPVS) in multiple sclerosis (MS) are linked to microangiopathic disease, not neuroinflammation. High EPVS correlates with accelerated neurodegeneration and brain aging, suggesting a role in MS progression.

Area of Science:

  • Neuroimaging
  • Neurology
  • Radiology

Background:

  • Growing evidence links enlarged perivascular spaces (EPVS) on brain MRI with multiple sclerosis (MS).
  • The specific role of EPVS in MS pathogenesis remains unclear.
  • This study investigates the association between EPVS and key MS features.

Purpose of the Study:

  • To examine the cross-sectional relationship between EPVS and neuroinflammatory/neurodegenerative markers in a large, multicenter MS cohort.
  • To identify predictors of high EPVS burden in MS patients.

Main Methods:

  • 207 MS patients underwent 3T brain MRI for EPVS assessment, dichotomized into high (>=2) and low (<2) categories.
  • MRI biomarkers included brain-predicted age difference (brain-PAD), central vein sign (CVS%), lesion load, brain volumetry, and cortical lesions.
  • A classification random forest approach was used to determine the relative importance of variables in predicting EPVS category.

Main Results:

  • Patients with high EPVS were older, had more vascular risk factors, lower CVS%, reduced brain volumes, and older brain-predicted age.
  • After adjusting for age and vascular risk factors, high EPVS correlated with lower CVS%, reduced brain volumes, and higher brain-PAD.
  • Random forest analysis identified brain-PAD as the most significant predictor of high EPVS.

Conclusions:

  • EPVS in MS likely represent microangiopathic disease rather than neuroinflammation.
  • EPVS may contribute to accelerated neurodegeneration in multiple sclerosis.
  • Brain-PAD is a key predictor of high EPVS burden in MS.
Keywords:
Enlarged perivascular spacesbrain-predicted agecerebral small vessel diseasemagnetic resonance imagingmultiple sclerosisvascular risk factors

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