Imaging phenotypic differences in multiple sclerosis: at the crossroads of aging, sex, race, and ethnicity

Nabeela Nathoo ^1,2, Nur Neyal ^1,2,3, Orhun H Kantarci ^1,2

⁰Department of Neurology, Mayo Clinic, Rochester, MN, United States.

Frontiers in Global Women's Health +

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July 15, 2024

View abstract on PubMed

Summary

Sex differences significantly impact multiple sclerosis (MS) clinical and imaging phenotypes across the lifespan. This review details how hormones, age, and race influence MS neuroimaging biomarkers and treatment responses.

Area Of Science

Neurology
Radiology
Immunology

Background

Multiple sclerosis (MS) exhibits distinct sex-based differences in clinical presentation and disease progression.
Neuroimaging serves as a critical tool for monitoring MS, reflecting both subclinical disease activity and future clinical outcomes.

Purpose Of The Study

To comprehensively review sex and hormone influences on structural and functional neuroimaging biomarkers in MS.
To explore the impact of hormone-modulating therapies on MS imaging across different life stages.
To examine the interplay of age, sex, and race/ethnicity on MS imaging biomarkers.

Main Methods

Literature review of studies investigating sex differences in MS neuroimaging.
Analysis of structural MRI (lesion burden, atrophy, white matter integrity, iron distribution) and functional MRI (functional connectivity) data.
Examination of research on hormonal influences and demographic factors (age, race/ethnicity) in MS.

Main Results

Significant sex disparities exist in MS lesion characteristics, atrophy patterns, and white matter abnormalities.
Hormonal fluctuations during reproductive milestones and menopause alter MS imaging phenotypes.
Age, sex, and race/ethnicity intersect to modulate MS imaging biomarkers and potentially treatment efficacy.

Conclusions

Understanding sex and hormone differences in MS neuroimaging is crucial for personalized medicine.
Therapeutic strategies targeting sex hormones may differentially affect MS progression in men and women.
Further research is needed to elucidate the complex interactions between age, sex, race/ethnicity, and MS pathophysiology.

Keywords:

aging hormone therapy magnetic resonance imaging multiple sclerosis race sex