title: Increased tissue damage and lesion volumes in African Americans with multiple sclerosis.
abstract: BACKGROUND
  African American (AA) patients with multiple sclerosis (MS) have more rapid disease progression and poorer responses to disease-modifying therapies than white American (WA) patients with MS.
  
  
  OBJECTIVE
  To investigate brain MRI characteristics in AA compared to WA in a cohort of consecutive patients with MS.
  
  
  METHODS
  We studied 567 patients with MS (age: 45.1 +/- SD 9.8 years, disease duration: 13.4 +/- 8.6 years), comprised of 488 WA and 79 AA. All patients obtained clinical and quantitative MRI evaluation. The majority of patients, 96% of AA and 94% of WA, were on disease-modifying therapies. The MRI measures included T1-, T2-, and gadolinium contrast-enhancing (CE) lesion volumes (LV) and CE number, global and tissue-specific brain atrophy, and magnetization transfer ratio (MTR) in lesions and normal-appearing gray matter (NAGM) and white matter (NAWM). The associations between race and clinical and MRI measurements were assessed in regression analysis.
  
  
  RESULTS
  The MTR values in lesions and in NAGM and NAWM were significantly lower in AA compared to WA. The AA group had 31% greater T2-LV and 101% greater T1-LV compared to WA. The MS Severity Score for AA (mean +/- SD = 4.3 +/- 2.9) was greater than for WA (3.8 +/- 2.5), despite a shorter disease duration in AA, indicating more aggressive clinical disease.
  
  
  CONCLUSIONS
  African American patients showed increased tissue damage, as measured by magnetization transfer ratio, and presented higher lesion volumes compared to white Americans. The greater tissue damage and faster lesion volume accumulation may explain the rapid clinical progression in African American patients.
authors.affiliation: The Jacobs Neurological Institute, Baird Multiple Sclerosis Center, Department of Neurology, State University of New York, E2 Buffalo General Hospital, Buffalo, NY 14203, USA. BWeinstock-Guttman@Kaleidahealth.Org
authors.forename: B
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: M
authors.initials: M
authors.lastname: Ramanathan
authors.forename: K
authors.initials: K
authors.lastname: Hashmi
authors.forename: N
authors.initials: N
authors.lastname: Abdelrahman
authors.forename: D
authors.initials: D
authors.lastname: Hojnacki
authors.forename: M G
authors.initials: MG
authors.lastname: Dwyer
authors.forename: S
authors.initials: S
authors.lastname: Hussein
authors.forename: N
authors.initials: N
authors.lastname: Bergsland
authors.forename: F E
authors.initials: FE
authors.lastname: Munschauer
authors.forename: R
authors.initials: R
authors.lastname: Zivadinov
mesh_terms: D000328:Adult; D001741:Black or African American; D001921:Brain / Q000473:pathology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000208:ethnology* / Q000473:pathology* / Q000628:therapy; D044469:Racial Groups; D012044:Regression Analysis; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D044465:White People