title: Perivascular spaces in MS patients at 7 Tesla MRI: a marker of neurodegeneration?
abstract: BACKGROUND
  Virchow-Robin spaces (VRS) are associated with vascular and neurodegenerative disease. In multiple sclerosis (MS), VRS have been associated with neuroinflammation. Ultra-high field imaging may be used to gain insight in these contradictory findings.
  
  
  OBJECTIVE
  The objective of this paper is to analyze VRS in MS patients using high-resolution 7 Tesla (T) MRI. Additionally, we investigated whether the widening of VRS is related to inflammatory or neurodegenerative aspects of MS.
  
  
  METHODS
  Thirty-four MS patients and 11 healthy controls were examined at 7T. Number and size of VRS were measured on three-dimensional (3D) T1-weighted images, and 3D fluid-attenuated inversion recovery (FLAIR) images were used for MS lesion detection. Brain atrophy was quantified by computing supratentorial brain volume fraction (sBVF). VRS counts were correlated with clinical variables, lesion count and sBVF.
  
  
  RESULTS
  MS patients displayed more VRS (median 11) than healthy controls (median four), p = 0.001. VRS size did not differ between both groups. VRS count in MS patients was associated with sBVF (rho = -0.40, p = 0.02), but not with lesion count (p = 0.22).
  
  
  CONCLUSIONS
  The 7T MRI reveals increased numbers of VRS in MS. The finding that VRS are associated with supratentorial brain atrophy, but not with lesion count, suggests that VRS might rather serve as a neurodegenerative than an inflammatory marker in MS.
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, the Netherlands i.kilsdonk@vumc.nl.
authors.forename: I D
authors.initials: ID
authors.lastname: Kilsdonk
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, the Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Steenwijk
authors.affiliation: Department of Physics and Medical Technology, VU University Medical Center, the Netherlands.
authors.forename: P J W
authors.initials: PJ
authors.lastname: Pouwels
authors.affiliation: Department of Radiology, University Medical Center Utrecht, the Netherlands.
authors.forename: J J M
authors.initials: JJ
authors.lastname: Zwanenburg
authors.affiliation: Department of Radiology, University Medical Center Utrecht, the Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Visser
authors.affiliation: Department of Radiology, University Medical Center Utrecht, the Netherlands.
authors.forename: P R
authors.initials: PR
authors.lastname: Luijten
authors.affiliation: Department of Anatomy and Neurosciences, VU University Medical Center, the Netherlands.
authors.forename: J  J G
authors.initials: J
authors.lastname: Geurts
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, the Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Department of Radiology and Nuclear Medicine, VU University Medical Center, the Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: Wattjes
mesh_terms: D000328:Adult; D001284:Atrophy / Q000473:pathology; D015415:Biomarkers; D001921:Brain / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000473:pathology*; D019636:Neurodegenerative Diseases / Q000175:diagnosis / Q000473:pathology*
chemical_list: D015415:Biomarkers
keywords: MRI; Multiple sclerosis; Virchow-Robin spaces; neurodegeneration; ultra-high-field MRI