From the Department of Neurology (T.F., K.C., N.B., D.R., D.J., R.Z., M.G.D.), Buffalo Neuroimaging Analysis Center.
Department of Neurology (T.F., R.H.B.B., N.B., D.R., D.J., B.W.G., M.G.D.), Jacobs Multiple Sclerosis Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.
AJNR Am J Neuroradiol. 2018 Aug;39(8):1480-1486. doi: 10.3174/ajnr.A5720. Epub 2018 Jul 5.
It is unclear to what extent subcortical gray matter atrophy is a primary process as opposed to a result of focal white matter damage. Correlations between WM damage and atrophy of subcortical gray matter have been observed but may be partly attributable to indirect relationships between co-occurring processes arising from a common cause. Our aim was to cross-sectionally and longitudinally characterize the unique impact of focal WM damage on the atrophy of connected subcortical gray matter regions, beyond what is explainable by global disease progression.
One hundred seventy-six individuals with MS and 47 healthy controls underwent MR imaging at baseline and 5 years later. Atrophy and lesion-based disruption of connected WM tracts were evaluated for 14 subcortical gray matter regions. Hierarchic regressions were applied, predicting regional atrophy from focal WM disruption, controlling for age, sex, disease duration, whole-brain volume, and T2-lesion volume.
When we controlled for whole-brain volume and T2-lesion volume, WM tract disruption explained little additional variance of subcortical gray matter atrophy and was a significant predictor for only 3 of 14 regions cross-sectionally (Δ = 0.004) and 5 regions longitudinally (Δ = 0.016). WM tract disruption was a significant predictor for even fewer regions when correcting for multiple comparisons.
WM tract disruption accounts for a small percentage of atrophy in connected subcortical gray matter when controlling for overall disease burden and is not the primary driver in most cases.
皮质下灰质萎缩是原发性病变，还是继发于局灶性白质损伤，目前尚不清楚。虽然已经观察到 WM 损伤与皮质下灰质萎缩之间存在相关性，但这种相关性可能部分归因于共同病因导致的并发过程之间的间接关系。我们的目的是从整体疾病进展中无法解释的程度出发，通过横断面和纵向研究来描述局灶性 WM 损伤对连接的皮质下灰质区域萎缩的独特影响。
176 名 MS 患者和 47 名健康对照者在基线和 5 年后接受了 MRI 检查。评估了 14 个皮质下灰质区域的萎缩和基于病变的连接 WM 束中断。应用层次回归，从局灶性 WM 破坏预测区域萎缩，控制年龄、性别、疾病持续时间、全脑体积和 T2 病变体积。
当我们控制全脑体积和 T2 病变体积时，WM 束中断仅能解释皮质下灰质萎缩的一小部分额外差异，并且仅在横断面（Δ=0.004）和 5 个区域（Δ=0.016）中对 14 个区域中的 3 个具有显著预测作用。当进行多次比较校正时，WM 束中断对更少的区域具有显著预测作用。
在控制整体疾病负担的情况下，WM 束中断仅能解释连接的皮质下灰质萎缩的一小部分，并且在大多数情况下不是主要驱动因素。
