Quantity and Volume of Perivascular Spaces Are Inversely Associated With Multiple Sclerosis Relative to Cerebrovascular Disease and Migraine.

Abstract

Objective: To quantify the number and volume of whole brain perivascular spaces (PVS) using a detection and segmentation algorithm in participants with multiple sclerosis (MS) and patients with disorders mimicking MS known to potentially influence PVS, such as cerebrovascular disease.

Methods: T1-weighted and T2-weighted FLAIR sequences were obtained on 3T MRI from 40 participants: 10 with MS, 10 with MS and a known comorbidity associated with MRI white matter abnormalities, 10 with migraine and MRI T2 hyperintense lesions, and 10 who were previously misdiagnosed with MS due to a variety of diagnoses. MRIs were analyzed using a previously validated automated segmentation pipeline. Primary outcomes included PVS number and volume, which were evaluated separately in each model.

Results: MS diagnosis was inversely associated with the number of PVS (t(23.99) = 3.92, p < 0.001) and PVS volume (t(22.49) = 3.64, p < 0.001). ROC analysis demonstrated an AUC above 0.8 for both the number of PVS and PVS volume for differentiating the MS and non-MS cohorts. In logistic regression, the number of PVS (OR = 0.98, 95% CI [-0.03, -0.01], p < 0.05) and volume of PVS (OR = 0.98, 95% CI = [0.97, 0.99], p < 0.006) were significantly inversely associated with MS diagnosis.

Interpretation: These findings suggest that those with a confirmed diagnosis of MS had a lower PVS burden compared to individuals with migraine or misdiagnosis of MS, irrespective of vascular comorbidities. The degree to which cerebrovascular disease influences PVS in patients with MS and other diagnoses warrants further study in larger longitudinal cohorts.