Transcranial brain sonography findings predict disease progression in multiple sclerosis.
OBJECTIVE
In multiple sclerosis (MS), an early neurodegenerative affection of subcortical gray matter has been suggested. Transcranial sonography (TCS) shows hyperechogenic lesions of substantia nigra (SN) and basal ganglia, thought to reflect iron accumulation, in a number of primary neurodegenerative diseases. The present study deals with the question of whether TCS can also display deep gray matter lesions in patients with MS and whether sonographic findings relate to severity and progression of MS.


METHODS
We prospectively studied 75 patients with different courses of MS and 55 age-matched healthy subjects clinically and with TCS. Twenty-three patients additionally had 1.5-T MRI at the time of TCS. Disease progression was assessed clinically 2 years after TCS.


RESULTS
Abnormal hyperechogenicity of SN, lenticular nucleus (LN), caudate nucleus, and thalamus was found in 41%, 54%, 40%, and 8% of the patients with MS, with similar frequency in patients with relapsing-remitting and primary or secondary progressive MS if corrected for disease duration, but only in 13%, 13%, 5% (each, p < 0.001), and none (p = 0.028) of the control subjects. Hyperechogenicity of SN and LN correlated with more pronounced MRI T2 hypointensity, thought to reflect iron deposition. Larger bilateral SN echogenic area was related to higher rate of disease progression, whereas small SN echogenic area (SN hypoechogenicity) predicted a disease course without further progression within 2 years.


CONCLUSIONS
Neurodegenerative disease-like deep gray matter lesions can be frequently detected by transcranial sonography (TCS) in patients with multiple sclerosis (MS). Findings suggest that TCS shows changes of brain iron metabolism which correlate with future progress of MS.
Walter
U
U
Department of Neurology, University of Rostock, Rostock, Germany. uwe.walter@med.uni-rostock.de
Wagner
S
S
Horowski
S
S
Benecke
R
R
Zettl
U K
UK
D000328:Adult; D002421:Caudate Nucleus / Q000098:blood supply / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation; D003342:Corpus Striatum / Q000098:blood supply / Q000000981:diagnostic imaging; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000000981:diagnostic imaging* / Q000473:pathology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D016548:Prosencephalon / Q000098:blood supply* / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013788:Thalamus / Q000098:blood supply / Q000000981:diagnostic imaging; D017585:Ultrasonography, Doppler, Transcranial