Volume loss in the deep gray matter and thalamic subnuclei: a longitudinal study on disability progression in multiple sclerosis

Stefano Magon; Charidimos Tsagkas; Laura Gaetano; Raihaan Patel; Yvonne Naegelin; Michael Amann; Katrin Parmar; Athina Papadopoulou; Jens Wuerfel; Christoph Stippich; Ludwig Kappos; M Mallar Chakravarty; Till Sprenger

doi:10.1007/s00415-020-09740-4

Volume loss in the deep gray matter and thalamic subnuclei: a longitudinal study on disability progression in multiple sclerosis

J Neurol. 2020 May;267(5):1536-1546. doi: 10.1007/s00415-020-09740-4. Epub 2020 Feb 10.

Authors

Stefano Magon^{1

2}, Charidimos Tsagkas^{3

4}, Laura Gaetano^{3

4}, Raihaan Patel^{5

6}, Yvonne Naegelin³, Michael Amann^{3

4

7}, Katrin Parmar^{3

4}, Athina Papadopoulou^{3

8}, Jens Wuerfel^{4

7}, Christoph Stippich⁹, Ludwig Kappos³, M Mallar Chakravarty^{5

6

10}, Till Sprenger^{3

11}

Affiliations

¹ Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland. stefano.magon@usb.ch.
² Medical Image Analysis Center AG, Basel, Switzerland. stefano.magon@usb.ch.
³ Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
⁴ Medical Image Analysis Center AG, Basel, Switzerland.
⁵ Cerebral Imaging Centre-Douglas Mental Health University Institute, Verdun, QC, Canada.
⁶ Department of Biomedical Engineering, McGill University, Montreal, QC, Canada.
⁷ Department of Biomedical Engineering, University Basel, Basel, Switzerland.
⁸ NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany.
⁹ Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
¹⁰ Department of Psychiatry, McGill University, Montreal, QC, Canada.
¹¹ Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany.

PMID: 32040710
DOI: 10.1007/s00415-020-09740-4

Abstract

Background: Volume loss in the deep gray matter (DGM) has been reported in patients with multiple sclerosis (MS) already at early stages of the disease and is thought to progress throughout the disease course.

Objective: To investigate the impact and predictive value of volume loss in DGM and thalamic subnuclei on disability worsening in patients MS over a 6-year follow-up period.

Methods: Hundred and seventy-nine patients with RRMS (132 women; median Expanded Disability Status Scale, EDSS: 2.5) and 50 with SPMS (27 women; median EDSS: 4.5) were included in the study. Patients underwent annual EDSS assessments and annual MRI at 1.5 T. DGM/thalamic subnuclei volumes were identified on high-resolution T1-weighted. A hierarchical linear mixed model for each anatomical DGM area and each thalamic subnucleus was performed to investigate the associations with disability scores. Cox regression was used to estimate the predictive properties of volume loss in DGM and thalamic subnuclei on disease worsening.

Results: In the whole sample and in RRMS, volumes of the thalamus and the striatum were associated with the EDSS; however, only thalamic volume loss was associated with EDSS change at follow-up. Regarding thalamic subnuclei, volume loss in the anterior nucleus, the pulvinar and the ventral anterior nucleus was associated with EDSS change in the whole cohort. A trend was observed for the ventral lateral nucleus. Volume loss in the anterior and ventral anterior nuclei was associated with EDSS change over time in patients with RRMS. Moreover, MS phenotype and annual rates of volume loss in the thalamus and ventral lateral nucleus were predictive of disability worsening.

Conclusion: These results highlight the relevance of volume loss in the thalamus as a key metric for predicting disability worsening as assessed by EDSS (in RRMS). Moreover, the volume loss in specific nuclei such as the ventral lateral nucleus seems to play a role in disability worsening.

Keywords: Deep gray matter; Multiple sclerosis; Thalamic subnuclei; Thalamus; Volumetric MRI.

MeSH terms

Adult
Aged
Disease Progression*
Female
Gray Matter / pathology*
Humans
Longitudinal Studies
Magnetic Resonance Imaging
Male
Middle Aged
Multiple Sclerosis, Chronic Progressive / diagnostic imaging
Multiple Sclerosis, Chronic Progressive / pathology*
Multiple Sclerosis, Relapsing-Remitting / diagnostic imaging
Multiple Sclerosis, Relapsing-Remitting / pathology*
Predictive Value of Tests
Thalamic Nuclei / diagnostic imaging
Thalamic Nuclei / pathology*
Young Adult