Abstract
The clinical significance of Virchow Robin spaces (VRS) in inflammatory brain disorders, especially in multiple sclerosis (MS), is still undefined. We analysed enlarged VRS (eVRS) by means of phase sensitive inversion recovery (PSIR) MRI sequence and investigated their association with inflammation or brain atrophy, and to clinical or physical disability. Forty-three MS patients (21 clinically isolated syndrome suggestive of MS [CIS], 15 RRMS, 7 progressive [PMS]) and 10 healthy controls (HC) were studied. 3DT1, 3DFLAIR and 2DPSIR images were obtained with a 3T MRI scanner. eVRS number and volume were calculated by manual segmentation (ITK-SNAP). Freesurfer was used to assess brain parenchymal fraction (BPF). All patients underwent clinical (EDSS) and cognitive (Rao’s BRB and DKEFS) evaluation.eVRS number and volume resulted significantly higher on 2D-PSIR compared to both 3D-T1 (p<0.001) and 3D-FLAIR (p<0.001) and were significantly increased in CIS compared to HC (p<0.05), in PMS and RRMS compared to CIS (p<0.001) and in male versus female patients (p<0.05). eVRS volume increased significantly with disease duration (r = 0.6) but did not correlate with EDSS. eVRS significantly correlated with SPARTd (r = -0.47) and DKEFSfs (r = -0.46), especially when RRMS and PMS were merged in a single group (r = 0.89, p = 0.002 and r = 0.66, p = 0.009 respectively), while no correlation was found with BPF (r = 0.3), gadolinium-enhancing lesions (r = 0.2) and WMT2 lesion volume (r = 0.2). 2DPSIR allowed the detection of an impressive higher number of eVRS compared to 3DT1 and 3DFLAIR. eVRS associate with SPARTd and DKEFSfs failure in relapse-onset MS, suggesting they may contribute to cognitive decline in MS.
Highlights
The limited number of healthy controls (HC) included in the study should not be considered a limitation since enlarged VRS (eVRS) were only rarely observed in HC and only in the basal ganglia where they showed a round-shaped morphology
In some relapsing remitting MS (RRMS) and progressive MS (PMS) patients, the number of Virchow– Robin spaces (VRS) observed on 2DPSIR images was unexpectedly and extraordinary higher compared to the number scored both on 3DT1 and 3DFLAIR (Fig 1)
In order to compare our findings with the most relevant literature data, we focus our analysis only on eVRS, defined, by comparison with the VRS observed in HC subjects, as VRS having a diameter >2 mm and a volume >3 mm3 (Figs 2–4)
Summary
The perivascular compartments surrounding small cerebral blood vessels, called Virchow– Robin spaces (VRS), are fluid-filled spaces that become visible on MRI after a substantial. Enlarged VRS (eVRS) can especially be observed in three characteristic locations: along the lenticulostriate arteries entering the basal ganglia (BG), along the arteries entering the cortical grey matter over the high convexities and extending into the white matter, and in the midbrain [1]. EVRS are more frequently detected with increasing age [1,7], a significant increase in their number and volume was reported in vascular or neurodegenerative diseases [8,9,10,11,12,13]. We designed a study aimed at analysing, by means of PSIR, the number and volume of eVRS in MS patients, as well as their association with MRI parameters of inflammation (gadolinium-enhanced lesions and T2 white matter lesion volume) or neurodegeneration (brain atrophy) and with physical or cognitive disability
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