Cerebral Blood Flow Changes in Multiple Sclerosis and Neuromyelitis Optica and Their Correlations With Clinical Disability.

Xue Zhang,Li Yang,Jie Sun,Chunshui Yu,Huanhuan Cai,Linjie Zhang,Yuan Qi,Fu-Dong Shi,Ningnannan Zhang,Xi Guo,Qiuhui Wang

doi:10.3389/fneur.2018.00305

Abstract

Distinguishing relapsing-remitting multiple sclerosis (RRMS) and neuromyelitis optica (NMO) is clinically important because they differ in prognosis and treatment. This study aimed to identify perfusion abnormalities in RRMS and NMO and their correlations with gray matter volume (GMV) atrophy and clinical parameters. Structural and arterial spin labeling MRI scans were performed in 39 RRMS patients, 62 NMO patients, and 73 healthy controls. The gray matter cerebral blood flow (CBF) values were voxel-wisely compared among the three groups with and without GMV correction. The regional CBF changes were correlated with the Expanded Disability Status Scale scores in the corresponding patient groups. Although multiple brain regions showed CBF differences among the three groups without GMV correction, only three of these regions remained significant after GMV correction. Specifically, both the RRMS and NMO groups showed reduced CBF in the occipital cortex and increased CBF in the right putamen compared to the control group. The RRMS group had increased CBF only in the medial prefrontal cortex compared to the other two groups. The occipital CBF was negatively correlated with clinical disability in the NMO group; however, the CBF in the right putamen was positively correlated with clinical disability in both patient groups. These findings suggest that there are perfusion alterations independent of GMV atrophy in RRMS and NMO patients. The regional CBF in the occipital cortex and putamen could be used as imaging features to objectively assess clinical disability in these patients.

Highlights

As the most common demyelinating diseases of the central nervous system in Asian populations [1, 2], multiple sclerosis (MS) and neuromyelitis optica (NMO) show both common and distinct features in terms of symptoms and immunological, pathological, and imaging aspects [3,4,5]
The relapsing-remitting multiple sclerosis (RRMS) patients showed increased cerebral blood flow (CBF) in the right anterior cingulate cortex (ACC)/medial prefrontal cortex (MPFC) compared to the NMO patients (P < 0.001) (Figure 1B)
The RRMS patients showed increased CBF in the right ACC/MPFC compared to the NMO patients (P = 0.002) and healthy controls (HC) (P < 0.001) (Figure 2B)

Summary

Introduction

As the most common demyelinating diseases of the central nervous system in Asian populations [1, 2], multiple sclerosis (MS) and neuromyelitis optica (NMO) show both common and distinct features in terms of symptoms and immunological, pathological, and imaging aspects [3,4,5]. Over the past few decades, brain MRI techniques have greatly improved our understanding of the CBF Changes in MS and NMO brain damage in these two disorders. The impairments in neurons, astrocytes, and microvascular components [21, 22] due to disease pathology may lead to neurovascular decoupling, which resulting in CBF changes in these disorders. Many studies using different imaging methods have revealed gray matter CBF changes in patients with MS [3, 6,7,8, 10,11,12, 15]. Only one study has investigated and found gray matter CBF changes in patients with NMO [13]

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