title: Perfusion and Diffusion Abnormalities of Multiple Sclerosis Lesions and Relevance of Classified Lesions to Disease Status.
abstract: OBJECTIVE
  Hemodynamic abnormality and disruption of white matter (WM) integrity are significant components in the pathophysiology of multiple sclerosis (MS) lesions. However, the roles of stratified lesions with distinct degrees of hemodynamic and structural injury in disease states remain to be explored. We tested the hypothesis that hemodynamic and structural impairment, as assessed by cerebral blood volume (CBV) and fractional anisotropy (FA), respectively, characterizes the extent of tissue injury, and the load of lesion with substantial tissue destruction would reflect the disease status and therefore, would be related to clinical disability.
  
  
  METHODS
  Seven relapsing-remitting MS patients and seven healthy controls underwent perfusion, diffusion and conventional MRI scans. Based on T2-FLAIR and T1-weighted image, WM plaques were classified. After image coregistration, values of CBV and FA were estimated in three distinct lesion types (active, T1-hypointense and T1-isointense lesion) and compared with those obtained in WM from controls. A total of 1135 lesions were evaluated. Brain volumetric measurement and correlative analysis between brain atrophy, lesion volume and clinical disability were also performed.
  
  
  RESULTS
  Compared with normal WM, significantly reduced CBV and FA were present in the T1-hypointense lesion, while insignificant changes in both parameters were exhibited in the T1-isointense lesion. However, increased CBV but significantly decreased FA was detected in the active lesion. A close spatial relationship between active and T1-hypointense lesion was observed. Lesion load represented by T1-hypointense plus active lesion volume significantly correlated with brain atrophy, which, in turn, significantly correlated with the severity of clinical disability.
  
  
  CONCLUSIONS
  A distinct combination of CBV and FA characterizes the status of a specific lesion type. A severe structural impairment does not solely occur in the T1-hypointense lesion, but is also associated with the active lesion. The burden of the lesion with extensive structural damage provides an image index, indicative of disease status.
authors: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Lian
authors: L
authors: Li
authors: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA ; Department of Physics, Oakland University, Rochester, Michigan, USA.
authors: Michael
authors: M
authors: Chopp
authors: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Siamak P
authors: SP
authors: Nejad-Davarani
authors: Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Kourosh
authors: K
authors: Jafari-Khouzani
authors: Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Suresh C
authors: SC
authors: Patel
authors: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: John
authors: J
authors: Budaj
authors: Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Mei
authors: M
authors: Lu
authors: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Stanton B
authors: SB
authors: Elias
authors: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors: Mirela
authors: M
authors: Cerghet
authors: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA ; Department of Physics, Oakland University, Rochester, Michigan, USA.
authors: Quan
authors: Q
authors: Jiang
keywords: Brain atrophy; Cerebral blood volume; Clinical disability; Fractional anisotropy; Lesion load; MRI; Multiple sclerosis
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