Deep medullary veins: a promising neuroimaging marker for neurodegeneration in multiple sclerosis.

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS). Recent studies have shown that different forms of vascular abnormalities may be related to the pathogenesis of MS. Susceptibility-weighted imaging (SWI) can directly image intracranial venules. The aim of this study was to investigate the association between deep medullary veins (DMVs) and the degree of neurodegeneration in patients with MS.

Methods: In this prospective cross-sectional study, 34 patients with MS and 30 age-matched healthy controls (HCs) were recruited. The count and score of DMVs, which can reflect the visibility and continuity of DMVs were evaluated based on SWI. The differences between the group with a high DMV score (DMV >10) and the group with a low DMV score (DMV ≤10) were assessed. The association of DMV change with neurodegeneration neuroimaging markers [including amount and volume of white matter lesion (WML), degree of cortical atrophy, whole-brain atrophy, and deep gray matter (DGM) atrophy] and clinical Expanded Disability Status Scale (EDSS) were observed in patients with MS.

Results: It was found that compared with controls, patients with MS (n=34) had a significantly lower DMV count (P<0.001) and a significantly higher DMV score (P<0.001). The low- and high-DMV score groups differed significantly in terms of EDSS (P=0.048) and neurodegeneration neuroimaging indicators, including WML volume (P=0.015), brain parenchymal fraction (BPF) (P=0.047), thalamic fraction (P=0.036), and caudate fraction (P=0.015). In the correlation analysis of the MS group, DMV count was negatively correlated with the number of WMLs (r=-0.535; P=0.001) and the WML volume (r=-0.416; P=0.014) but positively correlated with the neuroimaging measurements reflecting the degree of whole-brain atrophy and DGM atrophy. Furthermore, the DMV score was positively correlated with EDSS (r=0.450; P=0.008), number of WMLs (r=0.490; P=0.003), and WML volumes (r=0.635; P=0.001) but negatively correlated with the neuroimaging measurements reflecting the degree of whole-brain atrophy and DGM atrophy.

Conclusions: Reduced DMV visibility and continuity could reflect the severity of neurodegeneration in patients with MS. DMV count and score may be imaging indicators for assessing the severity of MS.