Enlarged Virchow Robin spaces associate with cognitive decline in multiple sclerosis

• Published in: PloS one Vol. 12; no. 10; p. e0185626
• Main Authors: Favaretto, Alice, Lazzarotto, Andrea, Riccardi, Alice, Pravato, Stefano, Margoni, Monica, Causin, Francesco, Anglani, Maria Giulia, Seppi, Dario, Poggiali, Davide, Gallo, Paolo
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.10.2017; Public Library of Science (PLoS)
• Subjects: Adult; Age; Alzheimer's disease; Atrophy; Biology and Life Sciences; Brain; Brain - blood supply; Brain - physiopathology; Case-Control Studies; Cognitive ability; Cognitive disorders; Cognitive Dysfunction - pathology; Cognitive Dysfunction - physiopathology; Correlation; Female; Gadolinium; Gender; Health aspects; Hospitals; Humans; Image processing; Image Processing, Computer-Assisted; Image segmentation; Itk protein; Lesions; Magnetic Resonance Imaging; Male; Medical schools; Medicine and Health Sciences; Multiple sclerosis; Multiple Sclerosis - pathology; Multiple Sclerosis - physiopathology; Multiple Sclerosis, Relapsing-Remitting - pathology; Neurodegeneration; Neurosciences; NMR; Nuclear magnetic resonance; Patients; Population; Research and Analysis Methods; Studies
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0185626

The clinical significance of Virchow Robin spaces (VRS) in inflammatory brain disorders, especially in multiple sclerosis (MS), is still undefined. We analysed enlarged VRS (eVRS) by means of phase sensitive inversion recovery (PSIR) MRI sequence and investigated their association with inflammation or brain atrophy, and to clinical or physical disability. Forty-three MS patients (21 clinically isolated syndrome suggestive of MS [CIS], 15 RRMS, 7 progressive [PMS]) and 10 healthy controls (HC) were studied. 3DT1, 3DFLAIR and 2DPSIR images were obtained with a 3T MRI scanner. eVRS number and volume were calculated by manual segmentation (ITK-SNAP). Freesurfer was used to assess brain parenchymal fraction (BPF). All patients underwent clinical (EDSS) and cognitive (Rao's BRB and DKEFS) evaluation. eVRS number and volume resulted significantly higher on 2D-PSIR compared to both 3D-T1 (p<0.001) and 3D-FLAIR (p<0.001) and were significantly increased in CIS compared to HC (p<0.05), in PMS and RRMS compared to CIS (p<0.001) and in male versus female patients (p<0.05). eVRS volume increased significantly with disease duration (r = 0.6) but did not correlate with EDSS. eVRS significantly correlated with SPARTd (r = -0.47) and DKEFSfs (r = -0.46), especially when RRMS and PMS were merged in a single group (r = 0.89, p = 0.002 and r = 0.66, p = 0.009 respectively), while no correlation was found with BPF (r = 0.3), gadolinium-enhancing lesions (r = 0.2) and WMT2 lesion volume (r = 0.2). 2DPSIR allowed the detection of an impressive higher number of eVRS compared to 3DT1 and 3DFLAIR. eVRS associate with SPARTd and DKEFSfs failure in relapse-onset MS, suggesting they may contribute to cognitive decline in MS.