Structural MRI correlates of cognitive impairment in patients with multiple sclerosis |
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| Authors: | Paolo Preziosa Maria A. Rocca Elisabetta Pagani Maria Laura Stromillo Christian Enzinger Antonio Gallo Hanneke E. Hulst Matteo Atzori Deborah Pareto Gianna C. Riccitelli Massimiliano Copetti Nicola De Stefano Franz Fazekas Alvino Bisecco Frederik Barkhof Tarek A. Yousry Maria J. Arévalo Massimo Filippi and the MAGNIMS Study Group |
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| Affiliation: | 1. Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele University, Milan, Italy;2. Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita‐Salute San Raffaele University, Milan, Italy;3. Department of Neurological and Behavioral Sciences, University of Siena, Siena, Italy;4. Department of Neurology, Medical University of Graz, Graz, Austria;5. MRI Center “SUN‐FISM,” Second University of Naples and Institute of Diagnosis and Care “Hermitage‐Capodimonte,”, Naples, Italy;6. Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, I Division of Neurology, Second University of Naples, Naples, Italy;7. Department of Radiology and Nuclear Medicine, MS Centre Amsterdam, VU Medical Centre, Amsterdam, Netherlands;8. NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, London, United Kingdom;9. Unitat De Neuroimmunologia Clinica, CEM‐Cat, Hospital Universitari Vall D'Hebron, Barcelona, Spain |
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| Abstract: | In a multicenter setting, we applied voxel‐based methods to different structural MR imaging modalities to define the relative contributions of focal lesions, normal‐appearing white matter (NAWM), and gray matter (GM) damage and their regional distribution to cognitive deficits as well as impairment of specific cognitive domains in multiple sclerosis (MS) patients. Approval of the institutional review boards was obtained, together with written informed consent from all participants. Standardized neuropsychological assessment and conventional, diffusion tensor and volumetric brain MRI sequences were collected from 61 relapsing‐remitting MS patients and 61 healthy controls (HC) from seven centers. Patients with ≥2 abnormal tests were considered cognitively impaired (CI). The distribution of focal lesions, GM and WM atrophy, and microstructural WM damage were assessed using voxel‐wise approaches. A random forest analysis identified the best imaging predictors of global cognitive impairment and deficits of specific cognitive domains. Twenty‐three (38%) MS patients were CI. Compared with cognitively preserved (CP), CI MS patients had GM atrophy of the left thalamus, right hippocampus and parietal regions. They also showed atrophy of several WM tracts, mainly located in posterior brain regions and widespread WM diffusivity abnormalities. WM diffusivity abnormalities in cognitive‐relevant WM tracts followed by atrophy of cognitive‐relevant GM regions explained global cognitive impairment. Variable patterns of NAWM and GM damage were associated with deficits in selected cognitive domains. Structural, multiparametric, voxel‐wise MRI approaches are feasible in a multicenter setting. The combination of different imaging modalities is needed to assess and monitor cognitive impairment in MS. Hum Brain Mapp 37:1627‐1644, 2016. © 2016 Wiley Periodicals, Inc. |
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| Keywords: | multiple sclerosis cognitive impairment diffusion tensor MRI atrophy voxel‐wise analysis multicenter |
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