Brain Advance Access originally published online on October 21, 2003
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Brain, Vol. 127, No. 1, 111-119, 2004
© 2004 Guarantors of Brain
doi: 10.1093/brain/awh007
Changes in cerebral perfusion precede plaque formation in multiple sclerosis: a longitudinal perfusion MRI study
1 Institute of Neuroimmunology, Charité, Berlin, 2 Berlin Neuro Imaging Centre, Department of Neurology, Charité, Berlin, Germany and 3 Neuroimmunology Branch, NINDS, NIH, Bethesda, MD, USA
Correspondence to: Frauke Zipp, Professor of Neuroimmunology, Institute of Neuroimmunology, Neuroscience Research Center, NWFZ 2680, Charité University Hospital, 10098 Berlin, Germany E-mail: frauke.zipp{at}charite.de
New MRI techniques such as the analysis of magnetization transfer or diffusion have provided evidence for subtle progressive alterations in tissue integrity prior to focal leakage of the blood–brain barrier (BBB) as part of plaque formation in multiple sclerosis. Since inflammation is capable of modulating the microcirculation, we investigated the hypothesis that changes in the local perfusion might be one of the earliest signs of lesion development. 20 patients with definite relapsing–remitting multiple sclerosis were analysed with regard to cerebral blood volume, cerebral blood flow, mean transit time and apparent diffusion coefficient (ADC), as well as conventional MRI parameters, on monthly follow-up scans. Among 89 gadolinium-enhancing lesions, we selected 18 that developed during the study and met strict inclusion criteria. In these, changes of perfusion parameters were detectable not only prior to the BBB breakdown, but also prior to increases in the ADC. Our data indicate that inflammation is accompanied by altered local perfusion, which can be detected prior to permeability of the BBB.
Key Words: diffusion; longitudinal; MRI; multiple sclerosis; perfusion
Abbreviations: ADC = apparent diffusion coefficient; AIF = arterial input function; BBB = blood–brain barrier; CBF = cerebral blood flow; CBV = cerebral blood volume; EDSS = expanded disability status scale; GdDTPA = gadolinium diethyltriaminepentaacetic acid; MSFC = multiple sclerosis functional composite; MTR = magnetization transfer ratio; MTT = mean transit time; NAWM = normal-appearing white matter; ROI = region of interest; RRMS = relapsing–remitting multiple sclerosis
Received June 2, 2003. Revised August 5, 2003. Accepted August 7, 2003.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. Wuerfel, M. Haertle, H. Waiczies, E. Tysiak, I. Bechmann, K. D. Wernecke, F. Zipp, and F. Paul Perivascular spaces--MRI marker of inflammatory activity in the brain? Brain, September 1, 2008; 131(9): 2332 - 2340. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Marik, P. A. Felts, J. Bauer, H. Lassmann, and K. J. Smith Lesion genesis in a subset of patients with multiple sclerosis: a role for innate immunity? Brain, November 1, 2007; 130(11): 2800 - 2815. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Soon, D. Tozer, D. Altmann, P. Tofts, and D. Miller Quantification of subtle blood-brain barrier disruption in non-enhancing lesions in multiple sclerosis: a study of disease and lesion subtypes Multiple Sclerosis, August 1, 2007; 13(7): 884 - 894. [Abstract] [PDF]
|
|
|
|
 |
|
 Y. Ge Multiple Sclerosis: The Role of MR Imaging AJNR Am. J. Neuroradiol., June 1, 2006; 27(6): 1165 - 1176. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Rosso, P. Remy, A. Creange, P. Brugieres, P. Cesaro, and H. Hosseini Diffusion-Weighted MR Imaging Characteristics of an Acute Strokelike Form of Multiple Sclerosis. AJNR Am. J. Neuroradiol., May 1, 2006; 27(5): 1006 - 1008. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Simon Ischemia and Multiple Sclerosis: Perfusion MR Imaging Provides Insight into an Underexplored Pathophysiology AJNR Am. J. Neuroradiol., June 1, 2005; 26(6): 1306 - 1308. [Full Text] [PDF]
|
|
|
|
|
|
M. Bendszus, A. Bartsch, and G. Stoll Is the disruption of the blood-brain barrier a prerequisite for cellular infiltration in autoimmune encephalitis? Brain, April 1, 2005; 128(4): E25 - E25. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Manka, F. Traber, J. Gieseke, H. H. Schild, and C. K. Kuhl Three-dimensional Dynamic Susceptibility-weighted Perfusion MR Imaging at 3.0 T: Feasibility and Contrast Agent Dose Radiology, March 1, 2005; 234(3): 869 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Chen, Y. Suzuki, N. Nagai, R. Peeters, K. Coenegrachts, W. Coudyzer, G. Marchal, and Y. Ni Visualization of Stroke with Clinical MR Imagers in Rats: A Feasibility Study Radiology, December 1, 2004; 233(3): 905 - 911. [Abstract] [Full Text] [PDF]
|
|