The role of 7 T MRI to assess atrophy of the subcortical deep gray matter in relapsing–remitting multiple sclerosis

• Published in: Journal of neurology Vol. 271; no. 10; pp. 6935 - 6943
• Main Authors: Callen, Alexis M., Zurawski, Jonathan, Chu, Renxin, Tie, Yanmei, Tauhid, Shahamat, Quattrucci, Molly, Healy, Brian C., Bakshi, Rohit
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2024; Springer Nature B.V
• Subjects: Adult; Atrophy; Atrophy - pathology; Automation; Brain - diagnostic imaging; Brain - pathology; Disability Evaluation; Female; Globus pallidus; Gray Matter - diagnostic imaging; Gray Matter - pathology; Humans; Image processing; Image Processing, Computer-Assisted; Lesions; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Multiple sclerosis; Multiple Sclerosis, Relapsing-Remitting - diagnostic imaging; Multiple Sclerosis, Relapsing-Remitting - pathology; Neurology; Neuroradiology; Neurosciences; Original Communication; Putamen; Substantia alba; Substantia grisea; Thalamus; Atrophy; Disability; Thalamus; Multiple sclerosis; 7 T; MRI
• DOI: 10.1007/s00415-024-12656-y
• ISSN: 0340-5354; 1432-1459

Background Deep gray matter (DGM) atrophy and lesions are found in multiple sclerosis (MS). Objective To optimize automated segmentation for 7 T DGM volumetrics and assess sensitivity to atrophy and relationship to DGM lesions and disability in relapsing–remitting (RR) MS. Methods 30 RRMS subjects [mean age 44.0 years, median Expanded Disability Status Scale (EDSS) score 2] and 14 healthy controls underwent 7 T MRI with 3D magnetization-prepared 2 rapid gradient-echoes (MP2RAGE) and fluid-attenuated inversion recovery. Customizing an automated pipeline to assess DGM structure volumes required pre-processing combining two MP2RAGE inversion times and uniform T1 images, and noise-suppressed reconstruction. DGM volumes were normalized. Brain DGM lesions and white matter T2 lesion volume (T2LV) were expert-quantified. Spearman correlations and Wilcoxon rank-sum tests were assessed. Results DGM lesions were found in 77% ( n  = 23) of MS subjects and no controls, with thalamic lesions most prevalent (73%). An average of 3.6 DGM lesions was found per person with MS. Total DGM volumes were lower in MS vs. controls ( p  = 0.034), varying by region, most pronounced in the caudate ( p  = 0.008). DGM volumes inversely correlated with EDSS (total DGM: r  = – 0.45, p  = 0.014; globus pallidus: r  =  – 0.42, p  = 0.023; putamen: r  = – 0.44, p  = 0.016; caudate: r  = – 0.37, p  = 0.047) and T2LV (total DGM: r  = – 0.53, p  = 0.003; putamen: r  = – 0.40, p  = 0.030; thalamus: r  = – 0.63, p  < 0.001). DGM atrophy was most closely linked to disability among all MRI measures. Thalamic lesion volume correlated inversely with thalamic volume ( r  = – 0.38, p  = 0.045). Conclusion 7 T MRI shows a link between DGM atrophy and both white matter lesions and physical disability in RRMS. Thalamic lesions are associated with thalamic atrophy.