Abstract
BackgroundBrain atrophy measurement is now a cornerstone in basic neuro-imaging science. While assessment of white matter atrophy by visual inspection is subjective, volumetric approaches are time-consuming and not often feasible. Bi-caudate ratio represents a linear surrogate parameter of brain volume that can be derived from standard imaging sequences. This study highlights the value of the bi-caudate ratio (BCR) as a MRI marker of white matter atrophy in patients with multiple sclerosis and ischemic leukoencephalopathy and set a cut-off value to differentiate between patients with white matter atrophy and normal subjects.ResultsA total of 115 patients (54 males and 61 females) diagnosed with white matter leukoencephalopathy (MS in 51 patients and ischemic leukoencephalopathy in 64 patients) were included. Another group of 60 subjects with a normal white matter signal was recruited as a control group. BCR for the patient group ranged from 0.13 to 0.27 (mean (± SD) = 0.16 ± 0.02), while for the control group, it ranged from 0.05 mm to 0.13 (mean (± SD) = 0.09 ± 0.01). The difference between the two groups was statistically significant (P value < 0.001). A cut-off value of 0.13 was used to differentiate between the BCR in both patients and control groups with sensitivity, specificity, and accuracy of 99.2%, 100%, and 99%, respectively. The difference in BCR for patients diagnosed with MS and ischemic leukoencephalopathy was also statistically significant (P value < 0.001).ConclusionThe bi-caudate ratio represents a linear measurement of subcortical atrophy that can be useful as a surrogate marker of global supra-tentorial white matter atrophy instead of the usually performed visual and therefore subjective assessment. It is an easily obtained measure that can be performed without complex time-consuming volumetric studies. Our findings also revealed that the BCR is higher in patients with ischemic leukoencephalopathy than in patients with MS.
Highlights
Brain atrophy measurement is a cornerstone in basic neuro-imaging science
Linear markers of brain volume, like the bi-caudate ratio (BCR—the minimum inter-caudate distance divided by brain width along the same level), present a valuable alternative that can be applied to standard imaging sequences in daily practice
This study included 115 adult patients, 54 males (47%) and 61 females (53%). Their ages ranged from 19 to 92 years (mean (+standard deviation (SD)) = 52.51 years + 18.2). They were further divided into 2 groups, group 1 included 51 patients (44.3%) who were diagnosed with multiple sclerosis (MS) according to the Revised McDonald Criteria, published in 2017 by the International Panel on the Diagnosis of Multiple Sclerosis
Summary
Brain atrophy measurement is a cornerstone in basic neuro-imaging science. While assessment of white matter atrophy by visual inspection is subjective, volumetric approaches are time-consuming and not often feasible. The method of choice for their evaluation is the analysis of brain volumes (global brain and brain volume, white and gray substance volume) from three-dimensional sequences and by means of Linear markers of brain volume, like the bi-caudate ratio (BCR—the minimum inter-caudate distance divided by brain width along the same level), present a valuable alternative that can be applied to standard imaging sequences in daily practice. This allows for a more feasible quantitative assessment of supratentorial white matter atrophy [3]. Some key one-dimensional atrophy measurements might be useful in the recognition of progressive atrophic changes [4, 7, 8]
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