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Selected Publication:
Jurschitsch, T.
Magnetic resonance imaging assessment of cortical pathology and its relation to periventricular lesions in multiple sclerosis
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2017. pp. 64
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- Authors Med Uni Graz:
- Advisor:
- Enzinger Christian
- Pichler Alexander
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- Abstract:
- Introduction: Multiple sclerosis, a chronic inflammatory demyelinating disease of the central nervous system, is the most common cause for non-traumatic disability in adolescence. As shown in histopathological studies, especially periventricular and cortical regions are damaged throughout the disease course – both representing regions in direct contact with cerebrospinal fluid (CSF). With the technical advances in magnetic-resonance imaging (MRI) and the implementation of non-conventional MRI sequences like magnetisation transfer imaging (MTI), it has become possible to detect microstructural changes in lesions that cannot be seen on conventional sequences. The goal of this study was to investigate a possible correlation between periventricular lesions, their microstructural changes and the cortical thickness. Also, we investigated differences between the degree of damage in periventricular and non-periventricular lesions and whether differences between the phenotypes of MS exist. Methods: We conducted a study in 160 patients (87 clinically isolated syndrome (CIS), 73 clinical definite multiple sclerosis (CDMS)), 105 patients were female (65.5%), the mean age at onset was 29.1 years with a median EDSS of 1.5 (0-7.5). Magnetic resonance images were mapped using FreeSurfer© and further lesions were categorized into periventricular and non-periventricular using a specific algorithm. Further, mean MTR of all lesions were calculated and compared between lesion categories and certain clinical features. Results: The mean MTR of periventricular lesions were significantly lower than those of non-periventricular lesions (p<0.001). The MTR showed no correlation with the cortical thickness. A distinction between disease types could not be made using these parameters. The change of cortical thickness did not correlate with MTR or periventricular lesion load, but with the progression of EDSS scores (p=0.032) Furthermore, the parameters did not show differences between converters from CIS to CDMS and non-converters. Conclusion: Periventricular lesions show a larger degree of microstructural changes than non-periventricular lesions, confirming the hypothesis that CSF-factors may damage brain regions in direct contact with CSF and thus play an important role in the pathogenesis of MS. The change of cortical thickness correlates with disability in patients with CDMS. However, a valid prediction of disease progression on an individual level cannot be made using these parameters.