title: [Total brain T2-hyperintense lesion-volume and the axonal damage in the normal-appearing white matter of brainstem in early lapsing-remitting multiple sclerosis].
abstract: OBJECTIVE
  To evaluate the relationship between the total brain T2-hyperintense lesion volume (TBT2LV) and the axonal damage in the normal-appearing white matter of brainstem measured by 1H-MRS in a group of early relapsing-remitting multiple sclerosis patients.
  
  
  METHODS
  40 relapsing-remitting multiple sclerosis patients and ten sex- and age-matched healthy subjects were prospectively studied for two years. T2-weighted MR and 1H-MRS imaging were acquired at time of recruitment and at year two. The TBT2LV was calculated with a semiautomatic program; N-acetylaspartate (NAA), creatine (Cr) and choline (Cho) resonances areas were integrated with jMRUI program and the ratios were calculated for four volume elements that represented the brainstem.
  
  
  RESULTS
  At basal study we obtained an axonal loss (as a decrement of NAA/ Cho ratio) in the group of patients compared with controls (p = 0.017); this axonal loss increased at the second year of the follow-up for patients (NAA/Cho decrease, p = 0.004, and NAA/Cr decrease, p = 0.002) meanwhile control subjects had no significant metabolic changes. Higher lesion load was correlated with a poor clinical outcome, being the correlation between the basal TBT2LV and the Expanded Disability Status Scale at second year (r = 0.299; p = 0.05). Besides, axonal loss was not homogeneous for all multiple sclerosis patients, being stronger in the subgroup of patients with high basal TBT2LV (p = 0.043; ANOVA).
  
  
  CONCLUSIONS
  Our data suggest that axonal damage is early in multiple sclerosis and higher in patients high basal TBT2LV, suggesting a possible relationship between these two phenomena.
authors.affiliation: Servicio de Neurología, Hospital Universitario La Fe, Valencia, Spain. med004201@saludalia.com
authors.forename: A M
authors.initials: AM
authors.lastname: Pascual-Lozano
authors.forename: M C
authors.initials: MC
authors.lastname: Martínez-Bisbal
authors.forename: I
authors.initials: I
authors.lastname: Boscá-Blasco
authors.forename: C
authors.initials: C
authors.lastname: Valero-Merino
authors.forename: F
authors.initials: F
authors.lastname: Coret-Ferrer
authors.forename: L
authors.initials: L
authors.lastname: Martí-Bonmatí
authors.forename: B
authors.initials: B
authors.lastname: Martínez-Granados
authors.forename: B
authors.initials: B
authors.lastname: Celda
authors.forename: B
authors.initials: B
authors.lastname: Casanova-Estruch
mesh_terms: D000328:Adult; D001369:Axons / Q000473:pathology*; D001933:Brain Stem / Q000473:pathology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000473:pathology*; D011446:Prospective Studies; D013223:Statistics as Topic