Abstract
Using MR imaging, perfusion can be assessed either by dynamic susceptibility contrast MR imaging or arterial spin-labeling. Alterations of cerebral perfusion have repeatedly been described in multiple sclerosis compared with healthy controls. Acute lesions exhibit relative hyperperfusion in comparison with normal-appearing white matter, a finding mostly attributed to inflammation in this stage of lesion development. In contrast, normal-appearing white and gray matter of patients with MS has been mostly found to be hypoperfused compared with controls, and correlations with cognitive impairment as well as fatigue in multiple sclerosis have been described. Mitochondrial failure, axonal degeneration, and vascular dysfunction have been hypothesized to underlie the perfusion MR imaging findings. Clinically, perfusion MR imaging could allow earlier detection of the acute focal inflammatory changes underlying relapses and new lesions, and could constitute a marker for cognitive dysfunction in MS. Nevertheless, the clinical relevance and pathogenesis of the brain perfusion changes in MS remain to be clarified.
Highlights
Clustering of macrophages and active demyelination are present at the edge of active MS ring-enhancing lesions.[21]. These findings suggest that perfusion MR imaging is highly sensitive to inflammatory activity and able to show changes long before and after blood-brain barrier disruption can be detected with gadolinium enhancement
Studies using either gradient-echo DSC or dynamic contrast-enhanced (DCE) MR imaging found increased CBV and CBF in contrast-enhancing lesions compared with normal-appearing white matter (NAWM) (Table).[12,22,23]
Directions There is a large body of limited-quality-but-concordant evidence demonstrating alteration of cerebral perfusion in MS
Summary
Studies using either gradient-echo DSC or DCE MR imaging found increased CBV and CBF in contrast-enhancing lesions compared with normal-appearing white matter (NAWM) (Table).[12,22,23] Ge et al[12] found no difference between CBV and CBF in contrast-enhancing MS lesions compared with the WM in healthy controls.
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