Increased periventricular thalamic damage gradient in multiple sclerosis detected by quantitative gradient echo MRI
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Updated: Jun 14, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Amjad Samara1, Biao Xiang1, Bradley Judge2
1Department of Neurology, Washington University School of Medicine, St. Louis, St. Louis, MO 63110, USA.
Objective:
Thalamic tissue damage in multiple sclerosis (MS) follows a 'surface-in' gradient from the ventricular surface. The clinical consequences of this gradient are not completely understood. Using quantitative gradient-recalled echo (qGRE) MRI, we evaluated a periventricular thalamic gradient of tissue integrity in MS and its relationship with clinical variables.
Methods:
Structural and qGRE MRI scans were acquired for a cohort of MS patients and healthy controls (HC). qGRE-derived R2t* values were used as a measure of tissue integrity. Thalamic segmentations were divided into 1-mm concentric bands radiating from the ventricular surface, excluding the CSF-adjacent band. Median R2t* values within these bands were used to calculate the periventricular thalamic gradient.
Results:
We included 44 MS patients and 17 HC. R2t* increased slightly with distance from the ventricular surface in HC. MS patients had a steeper periventricular thalamic gradient compared to HC (mean slope 0.55 vs. 0.36; p < 0.001), which correlated with longer disease duration (β = 0.001 /year; p = 0.027) and higher Expanded Disability Status Scale (EDSS) score (β = 0.07 /EDSS point; p = 0.019). Left and right thalamus were symmetrically affected.
Conclusions:
We detected an increased thalamic gradient in MS in vivo using qGRE MRI, which correlated with disease duration and greater clinical disability. These findings further support the 'surface-in' pathology hypothesis in MS and suggest a CSF-mediated process given symmetric bi-thalamic involvement.
Insights
Multiple sclerosis (MS) shows a steeper thalamic tissue integrity gradient from the ventricle, linked to disease duration and disability. This supports a surface-in pathology, potentially CSF-mediated.
Area of Science:
- Neuroimaging
- Neurology
- Biomedical Engineering
Background:
- Multiple sclerosis (MS) involves thalamic tissue damage, often exhibiting a 'surface-in' gradient from the ventricular surface.
- The clinical implications of this thalamic gradient in MS remain incompletely understood.
Purpose of the Study:
- To evaluate the periventricular thalamic gradient of tissue integrity in MS using quantitative gradient-recalled echo (qGRE) MRI.
- To investigate the relationship between this gradient and clinical variables in MS patients.
Main Methods:
- Acquired structural and qGRE MRI scans from MS patients and healthy controls (HC).
- Utilized qGRE-derived R2t* values as a measure of tissue integrity.
- Calculated the periventricular thalamic gradient by analyzing R2t* values in concentric bands radiating from the ventricular surface.
Main Results:
- MS patients exhibited a significantly steeper periventricular thalamic gradient compared to HC (mean slope 0.55 vs. 0.36; p < 0.001).
- The MS thalamic gradient correlated with longer disease duration (p = 0.027) and higher Expanded Disability Status Scale (EDSS) scores (p = 0.019).
- Thalamic involvement was symmetrical in both left and right hemispheres.
Conclusions:
- An increased thalamic gradient in MS was detected in vivo using qGRE MRI.
- This gradient is associated with disease duration and clinical disability, supporting the 'surface-in' pathology hypothesis in MS.
- The symmetric thalamic involvement suggests a potential cerebrospinal fluid (CSF)-mediated pathological process.
