Quantitative Choroid Plexus Gadolinium Enhancement Is Related to Diffuse Brain Tissue Injury in Multiple Sclerosis

Area of Science:

• Neuroimaging
• Neuroimmunology
• Biomarkers

Background:

• Blood-cerebrospinal fluid (CSF) barrier disruptions at the choroid plexus (ChP) are implicated in multiple sclerosis (MS) pathogenesis.
• Investigating ChP enhancement as a marker for brain tissue injury in MS is crucial.

Purpose of the Study:

• To examine the relationship between quantitative ChP enhancement and focal/diffuse brain tissue injury markers in MS.
• To compare quantitative T1 (qT1) values and ChP volumes between MS patients and healthy controls.

Main Methods:

• Utilized 7T MRI (MP2RAGE, FLAIR) on 34 MS patients and 21 controls.
• Calculated delta T1 (ΔT1) maps to assess ChP enhancement post-contrast.
• Performed linear regression analysis correlating ChP ΔT1 with white matter lesions (WML), normal-appearing white matter (NAWM), and gray matter (GM) qT1 values.

Main Results:

• MS patients exhibited higher mean qT1 and ChP volumes compared to controls (p < 0.001).
• ChP enhancement (ΔT1) significantly correlated with NAWM (β = 0.20, R² = 0.54, p < 0.001) and GM (β = 0.18, R² = 0.49, p < 0.001) qT1.
• No significant association was found between ChP enhancement and WML volume or qT1.

Conclusions:

• Elevated ChP qT1 values and volumes in MS patients suggest ChP dysfunction.
• The link between ChP enhancement and diffuse injury supports a CSF-mediated toxicity mechanism in MS.
• This mechanism appears distinct from traditional white matter lesion pathology in MS.