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AJNR - American Journal of Neuroradiology

Published ahead of print on April 15, 2009
doi: 10.3174/ajnr.A1564

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American Journal of Neuroradiology 30:1380-1386, August 2009
© 2009 American Society of Neuroradiology

BRAIN

Thalamic Involvement and Its Impact on Clinical Disability in Patients with Multiple Sclerosis: A Diffusion Tensor Imaging Study at 3T

F. Tovar-Moll^a, I.E. Evangelou^a, A.W. Chiu^a, N.D. Richert^a, J.L. Ostuni^a, J.M. Ohayon^a, S. Auh^b, M. Ehrmantraut^a, S.L. Talagala^c, H.F. McFarland^a and F. Bagnato^a

^a Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
^b Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md
^c NIH-MRI Research Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md

Please address correspondence to Francesca Bagnato, MD, PhD, Building 10, Room 5C103, 9000 Rockville Pike, Bethesda, MD, 20892-1400; e-mail: bagnatof{at}ninds.nih.gov

BACKGROUND AND PURPOSE: Several studies suggest that grey matter involvement may play a role in multiple sclerosis (MS) pathology. Diffusion tensor imaging (DTI) at 3T was used to investigate the presence of damage to the normal-appearing thalamus in MS and its relationship with disability.

MATERIALS AND METHODS: Twenty-four patients with relapsing-remitting (RR, n = 13, age = 41.7 ± 6.1, Expanded Disability Status Scale [EDSS] score = 2.2 ± 1.2) and secondary-progressive (n = 11, age = 46.9 ± 9.6, EDSS = 5.9 ± 1.0) MS and 24 age- and sex-matched healthy volunteers were studied. Fractional anisotropy (FA) and mean diffusivity (MD) were measured in regions of interest of normal-appearing thalamus. We examined group differences in MD and FA and correlations between DTI-derived metrics and clinical or imaging measures of disease.

RESULTS: Patients with MS had higher thalamic FA (P < .0001) and MD (P = .035) than volunteers. MD values correlated with the Paced Auditory Serial Addition Task (r = –0.43, P = .034) and motor EDSS (r = 0.47, P = .021) scores. In patients with RRMS, MD values correlated with global EDSS (r = 0.75, P = .003) and motor EDSS (r = 0.68, P = .010). Correlations were found between MD values and T1 and T2 lesion load (r = 0.58, P < .05) and brain parenchymal fraction (r = –0.46, P < .05).

CONCLUSIONS: DTI was able to detect abnormalities in normal-appearing thalamus of patients with MS. The strength of association between thalamic DTI measures and functional impairment was in the same range as those seen with standard MR imaging disease measures. The assessment of the integrity of the thalamus with DTI is a promising metric as a marker of disease for future studies.