Ramasamy Deepa Preeti, Benedict Ralph H B, Cox Jennifer L, Fritz David, Abdelrahman Nadir, Hussein Sara, Minagar Alireza, Dwyer Michael G, Zivadinov Robert
Buffalo Neuroimaging Analysis Center, Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA.
J Neurol Sci. 2009 Jul 15;282(1-2):47-54. doi: 10.1016/j.jns.2008.12.034. Epub 2009 Feb 6.
Cortical and subcortical atrophy occurs in multiple sclerosis (MS) and relates to clinical outcomes. FreeSurfer, a voxel-based automated software for brain reconstruction was used to investigate the extent of subcortical and cortical atrophy in 71 MS and 17 clinically isolated syndrome (CIS) patients, and 38 normal controls (NC), and to relate group differences to disease type and severity. Segmentation was performed on 3D SPGR T1-weighted MRI 1.5T images. Region-specific subcortical tissue volumes were calculated in mm(3) and cortical thickness in mm. Logistic regression and general linear model analyses, adjusted for age and intracranial volume, examined differences between NC, MS and CIS patients and disease subtypes. The MS group was characterized by significantly lower volumes of thalamus (left and right p<0.0001), left inferior lateral ventricle, third ventricle (p<0.0001), ventral diencephalon, pallidum and putamen bilaterally, as well as of right accumbens and brainstem with corresponding bilateral increase in volumes of lateral ventricles (p<0.01). Focal cortical atrophy areas in the thalamus, inferior parietal lobule of left hemisphere and in right precuneus were also significant in the MS sample. Versus CIS patients, RR or progressive MS patients showed significantly lower volumes of subcortical regions and cortical thinning. Hippocampal atrophy appeared only in advanced disease stages. Cerebellum WM volumes were significantly lower in MS and CIS patients vs. NC. Subcortical and cortical atrophy correlated with higher disability as measured by EDSS. This study confirmed selective deep gray matter atrophy (mostly thalamic), revealed cerebellum WM atrophy from the earliest clinical stages, and showed that cortical thinning advances with disease progression.
皮质和皮质下萎缩发生在多发性硬化症（MS）中，并与临床结果相关。FreeSurfer是一种基于体素的脑重建自动化软件，用于研究71例MS患者、17例临床孤立综合征（CIS）患者和38例正常对照（NC）的皮质下和皮质萎缩程度，并将组间差异与疾病类型和严重程度相关联。在1.5T的3D SPGR T1加权MRI图像上进行分割。以立方毫米计算特定区域的皮质下组织体积，以毫米计算皮质厚度。在调整年龄和颅内体积后，采用逻辑回归和一般线性模型分析，检查NC、MS和CIS患者以及疾病亚型之间的差异。MS组的特征是丘脑体积显著降低（左右p<0.0001），左侧外侧脑室下角、第三脑室（p<0.0001）、腹侧间脑、双侧苍白球和壳核，以及右侧伏隔核和脑干体积相应降低，同时侧脑室体积双侧增加（p<0.01）。在MS样本中，丘脑、左侧半球顶下小叶和右侧楔前叶的局灶性皮质萎缩区域也很显著。与CIS患者相比，复发缓解型（RR）或进展型MS患者的皮质下区域体积显著降低，皮质变薄。海马萎缩仅出现在疾病晚期。与NC相比，MS和CIS患者的小脑白质体积显著降低。皮质下和皮质萎缩与通过扩展残疾状态量表（EDSS）测量的更高残疾程度相关。本研究证实了选择性深部灰质萎缩（主要是丘脑），揭示了从最早临床阶段就存在的小脑白质萎缩，并表明皮质变薄随疾病进展而加重。
