title: Short-term brain atrophy changes in relapsing-remitting multiple sclerosis.
abstract: The objective of this study was to establish whether the time interval of 3 months is sufficient to detect whole-brain atrophy changes in patients with relapsing-remitting (RR) multiple sclerosis (MS). Another aim was to assess the value of monthly gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) and of different Gd-enhancement patterns as predictors of brain atrophy. Thirty patients with RRMS (mean disease duration 4.9 years, mean age 34.4 years and mean Expanded Disability Status Scale [EDSS] 1.4) were assessed at baseline and monthly for a period of 3 months with clinical and MRI examinations. Calculations of baseline and monthly absolute and percent changes of MRI measures have been obtained using two semiautomated (Buffalo and Trieste) and one automated (SPM99) segmentation method. Changes of brain parenchymal fraction (BPF) were investigated according to Gd-enhancement patterns. Mean absolute and percent changes of BPF did not significantly differ at any time point in the study for any of the three methods. There was slight but not significant decrease of BPF from baseline to month 3: -0.0004 (0.05%), p=0.093 for Trieste; -0.0006 (0.07%), p=0.078 for Buffalo; and -0.0006 (0.08%), p=0.081 for SPM99 method. In ring-enhancement positive patients, there was a significant difference between baseline and month 3 changes of BPF, EDSS, and number of relapses. Over the study period, we did not demonstrate differences between changes of BPF according to the presence of Gd enhancement. Longitudinally, multiple regression analysis demonstrated that the only clinical or MRI parameter that predicted BPF decrease was the mean absolute change of ring-enhancing lesion load (R=0.62, p=0.003). The noteworthy findings of this study are (1) the observation that a significant brain atrophy progression cannot be detected over a 3-month period in RRMS; (2) the demonstration that the ring-enhancement pattern may contribute to more severe brain tissue loss in the short term; and (3) the lack of relationship between the presence and duration of Gd-enhancement activity and brain volume changes in the short term.
authors.affiliation: Department of Clinical Medicine and Neurology, University of Trieste, Trieste, Italy. rzivadinov@thejni.org
authors.forename: Robert
authors.initials: R
authors.lastname: Zivadinov
authors.forename: Francesca
authors.initials: F
authors.lastname: Bagnato
authors.forename: Davide
authors.initials: D
authors.lastname: Nasuelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Bastianello
authors.forename: Alessio
authors.initials: A
authors.lastname: Bratina
authors.forename: Laura
authors.initials: L
authors.lastname: Locatelli
authors.forename: Kelly
authors.initials: K
authors.lastname: Watts
authors.forename: Licia
authors.initials: L
authors.lastname: Finamore
authors.forename: Attilio
authors.initials: A
authors.lastname: Grop
authors.forename: Michael
authors.initials: M
authors.lastname: Dwyer
authors.forename: Mauro
authors.initials: M
authors.lastname: Catalan
authors.forename: Alessandro
authors.initials: A
authors.lastname: Clemenzi
authors.forename: Enrico
authors.initials: E
authors.lastname: Millefiorini
authors.forename: Rohit
authors.initials: R
authors.lastname: Bakshi
authors.forename: Marino
authors.initials: M
authors.lastname: Zorzon
mesh_terms: D000328:Adult; D001284:Atrophy / Q000209:etiology; D001927:Brain Diseases / Q000209:etiology / Q000473:pathology*; D001931:Brain Mapping; D005260:Female; D005682:Gadolinium; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000473:pathology*; D011237:Predictive Value of Tests
chemical_list: D005682:Gadolinium