TY - JOUR T1 - Thalamic Damage Predicts the Evolution of Primary-Progressive Multiple Sclerosis at 5 Years JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1016 LP - 1020 DO - 10.3174/ajnr.A2430 VL - 32 IS - 6 AU - S. Mesaros AU - M.A. Rocca AU - E. Pagani AU - M.P. Sormani AU - M. Petrolini AU - G. Comi AU - M. Filippi Y1 - 2011/06/01 UR - http://www.ajnr.org/content/32/6/1016.abstract N2 - BACKGROUND AND PURPOSE: Reliable markers to monitor PPMS are still needed. We investigated whether conventional and DTI measures of thalamic damage are predictive of long-term disability accumulation in PPMS. MATERIALS AND METHODS: Brain conventional and DTI scans were obtained at baseline and after a mean follow-up of 15 months in 54 patients with PPMS and 8 healthy controls. Patients were reassessed clinically after 5 years. At baseline and follow-up, measures of lesion load, brain atrophy, and NTV were obtained. MD and FA histograms of the NAWM, the whole GM without the thalami, and the thalami were obtained. A multivariate analysis evaluated the predictors of long-term neurologic deterioration. RESULTS: At follow-up, 35 patients showed disability worsening. At baseline, compared with healthy controls, patients with PPMS had lower NTV (P < .001) and thalamic FA (P = .002) and higher thalamic (P = .002) and whole GM without the thalami (P = .005) MD. During follow-up, the change of thalamic FA was higher in PPMS versus healthy controls (P = .01). Baseline NTV and thalamic DTI quantities differed significantly between patients with PPMS with and without thalamic lesions. Baseline thalamic quantities were significantly correlated with the extent of brain T2 lesions and the severity of NAWM damage. The multivariate model included average NAWM MD (OR = 1.46, P = .005) and FA thalamic change (OR = 0.84, P = .02) as independent predictors of EDSS score deterioration (Nagelkerke R2 = 0.55). CONCLUSIONS: Short-term accrual of thalamic damage and the severity of NAWM involvement predict the long-term accumulation of disability in PPMS. CIconfidence intervalDTIdiffusion tensor imagingEDSSExpanded Disability Status ScaleFAfractional anisotropyGMgray matterLVlesion volumeMDmean diffusivityMSmultiple sclerosisn.a.not applicableNAWMnormal-appearing white mattern.s.not significantNTVnormalized thalamic volumeORodds ratioPDproton densityPGSEpulsed-gradient spin-echo echo-planarPPMSprimary-progressive MSSIENAXstructural image evaluation, with normalization of atrophySPMstatistical parametric mappingWMwhite matter ER -