PT  - JOURNAL ARTICLE
AU  - D. Damjanovic
AU  - P. Valsasina
AU  - M.A. Rocca
AU  - M.L. Stromillo
AU  - A. Gallo
AU  - C. Enzinger
AU  - H.E. Hulst
AU  - A. Rovira
AU  - N. Muhlert
AU  - N. De Stefano
AU  - A. Bisecco
AU  - F. Fazekas
AU  - M.J. Arévalo
AU  - T.A. Yousry
AU  - M. Filippi
TI  - Hippocampal and Deep Gray Matter Nuclei Atrophy Is Relevant for Explaining Cognitive Impairment in MS: A Multicenter Study
AID  - 10.3174/ajnr.A4952
DP  - 2017 Jan 01
TA  - American Journal of Neuroradiology
PG  - 18--24
VI  - 38
IP  - 1
4099  - http://www.ajnr.org/content/38/1/18.short
4100  - http://www.ajnr.org/content/38/1/18.full
SO  - Am. J. Neuroradiol.2017 Jan 01; 38
AB  - BACKGROUND AND PURPOSE: The structural MR imaging correlates of cognitive impairment in multiple sclerosis are still debated. This study assessed lesional and atrophy measures of white matter and gray matter involvement in patients with MS acquired in 7 European sites to identify the MR imaging variables most closely associated with cognitive dysfunction.MATERIALS AND METHODS: Brain dual-echo, 3D T1-weighted, and double inversion recovery scans were acquired at 3T from 62 patients with relapsing-remitting MS and 65 controls. Patients with at least 2 neuropsychological tests with abnormal findings were considered cognitively impaired. Focal WM and cortical lesions were identified, and volumetric measures from WM, cortical GM, the hippocampus, and deep GM nuclei were obtained. Age- and site-adjusted models were used to compare lesion and volumetric MR imaging variables between patients with MS who were cognitively impaired and cognitively preserved. A multivariate analysis identified MR imaging variables associated with cognitive scores and disability.RESULTS: Twenty-three patients (38%) were cognitively impaired. Compared with those with who were cognitively preserved, patients with MS with cognitive impairment had higher T2 and T1 lesion volumes and a trend toward a higher number of cortical lesions. Significant brain, cortical GM, hippocampal, deep GM nuclei, and WM atrophy was found in patients with MS with cognitive impairment versus those who were cognitively preserved. Hippocampal and deep GM nuclei atrophy were the best predictors of cognitive impairment, while WM atrophy was the best predictor of disability.CONCLUSIONS: Hippocampal and deep GM nuclei atrophy are key factors associated with cognitive impairment in MS. These MR imaging measures could be applied in a multicenter context, with cognition as clinical outcome.CIcognitively impairedCLcortical lesionCPcognitively preservedDIRdouble inversion recoveryEDSSExpanded Disability Status ScaleHChealthy controlsLVlesion volumesWCSTWisconsin Card Sorting Test