MRI characteristics of patients with antiphospholipid syndrome and multiple sclerosis.
MRI findings of primary anti-phospholipid antibody syndrome (PAPLS) are difficult to distinguish from those of multiple sclerosis (MS). Only a few previous studies have compared conventional and non-conventional MRI findings in MS and PAPLS patients. In addition, MRI differences between anti-phospholipid antibody (APLA) positive (+) and APLA negative (-) MS patients have not been reported. Therefore, the aim of this study was to investigate the differences in MRI measures among patients with PAPLS, MS and normal control (NC) subjects. We also explored non-conventional MRI measures in APLA+ and APLA- MS patients. Forty-nine (49) consecutive MS patients among whom 39 had relapsing-remitting (RR) and 10 secondary-progressive (SP) disease course, 30 patients with PAPLS and 49 NC were enrolled. Twenty-eight (28) MS patients were APLA+. MRI measures of T1- and T2-lesion volumes (LV) and brain atrophy, including fractions of whole brain (BPF), gray matter (GMF) and white matter (WMF), were evaluated. The magnetization transfer ratio (MTR) of T2- and T1-LVs and different normal-appearing brain tissue (NABT) compartments as well as diffusion-weighted imaging of whole brain mean parenchyma diffusivity (MPD) were obtained. MS patients differed significantly from NC in all MRI measures. PAPLS patients differed from NC in their T2-LV, in MTR measures and in MPD. When MS patients were compared to PAPLS patients, they showed significantly higher T2- and T1-LVs and T2-LV MTR, lower BPF and GMF and higher MPD. APLA+ RR and SPMS (all APLA+) patients showed significantly higher T2-LV, lower GMF, lower normal-appearing gray matter MTR and higher MPD when compared to APLA- patients. The results indicate that brain abnormalities can be detected in PAPLS patients with non-conventional MRI. MRI reveals more profound injury in patients with MS versus PAPLS. APLA mediates heterogeneous cerebral pathology that remains to be further investigated.
Stosic
Milena
M
Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY 14203, USA.
Ambrus
Julian
J
Garg
Neeta
N
Weinstock-Guttman
Bianca
B
Ramanathan
Murali
M
Kalman
Bernadette
B
Minagar
Alireza
A
Munschauer
Frederick E
FE
Galey
Timothy M
TM
Hussein
Sara
S
Bakshi
Rohit
R
Zivadinov
Robert
R
D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000378:metabolism; D016736:Antiphospholipid Syndrome / Q000378:metabolism / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology; D009929:Organ Size
D017152:Antibodies, Antiphospholipid