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Updated: Jun 14, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Increased periventricular thalamic damage gradient in multiple sclerosis detected by quantitative gradient echo MRI
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.
