title: Gray- and white-matter changes 1 year after first clinical episode of multiple sclerosis: MR imaging.
abstract: OBJECTIVE
  To assess, by means of magnetic resonance (MR) imaging, the longitudinal changes in white matter (WM) and gray matter (GM) in a cohort of patients with clinically isolated syndrome (CIS) who were followed up for 1 year.
  
  
  METHODS
  This prospective, HIPAA-compliant study was approved by the institutional review board. Written informed consent was obtained from all the participants. Changes in GM and WM integrity were respectively investigated by using three-dimensional T1-weighted and diffusion-tensor (DT) imaging sequences and by applying voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) analyses. Thirty-four consecutive patients (21 women, 13 men; mean age, 32.8 years ± 7.7 [standard deviation]) who had CIS were recruited. All the patients underwent a neurologic and an MR examination at baseline and 12 months later; the MR examination consisted of three-dimensional T1-weighted dual-echo turbo spin-echo DT imaging. VBM and TBSS were used to analyze GM volume and WM fractional anisotropy, respectively.
  
  
  RESULTS
  After 1 year, multiple sclerosis (MS) was diagnosed in 33 (97%) of 34 patients with CIS. Longitudinal volumetric analysis revealed a significant (P < .001) reduction in global GM volume. The VBM analysis showed the development of regional GM atrophy involving several cortical and subcortical regions in both hemispheres (P < .05). No significant longitudinal change in global or regional WM fractional anisotropy was otherwise observed.
  
  
  CONCLUSIONS
  WM damage was detectable early and involved most fiber tracts in patients with MS, but it did not worsen significantly during the 1st year after clinical onset. In contrast, GM damage was not detectable at the time of clinical onset, but a significant decrease in cortical and deep GM volume was observed at 1 year.
authors.affiliation: Department of Neurological Sciences, Sapienza University of Rome, Viale dell'Università 30, 00185 Rome, Italy. eytan.raz@uniroma1.it
authors.forename: Eytan
authors.initials: E
authors.lastname: Raz
authors.forename: Mara
authors.initials: M
authors.lastname: Cercignani
authors.forename: Emilia
authors.initials: E
authors.lastname: Sbardella
authors.forename: Porzia
authors.initials: P
authors.lastname: Totaro
authors.forename: Carlo
authors.initials: C
authors.lastname: Pozzilli
authors.forename: Marco
authors.initials: M
authors.lastname: Bozzali
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pantano
mesh_terms: D000328:Adult; D016880:Anisotropy; D001284:Atrophy / Q000473:pathology; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009103:Multiple Sclerosis / Q000473:pathology*; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D011446:Prospective Studies; D012044:Regression Analysis