Imaging Of Brain Perfusion In Multiple Sclerosis And Neurodegenerative Diseases: Association With Endothelial Factors. An Interim Analysis(503 views)(PDF public259 views) Tedeschi E, Lanzillo R, Mancini M, Russo C, Cianflone A, Liuzzi R, Cocozza S, Postiglione E, Palma G, Caprio MG, Incoronato MR, Criscuolo C, Brescia Morra V, Salvatore M
Imaging Of Brain Perfusion In Multiple Sclerosis And Neurodegenerative Diseases: Association With Endothelial Factors. An Interim Analysis
Background: Among the factors contributing to brain damage in Multiple Sclerosis (MS), scientific
evidences indicate ischemic changes, venous outflow abnormalities and accumulation of proinflammatory
and neurotoxic substances.
Objectives: This project aims at acquiring new know ledge about the association of determinants of
brain perfusion in patients w ith MS and neurodegenerative diseases such as Amyotrophic Lateral
Sclerosis (ALS), combining Magnetic Resonance (MR) and Ultrasound (US) imaging of the brain and
intracranial and extracranial circulation, and endothelial factors.
Methods: 300 MS patients, 50 ALS patients, and 300 healthy subjects (HS) w ill be recruited over 3
years. To assess the vascular genetic susceptibility, serum levels of homocystein and endothelial
factors w ill be assayed, as w ell as the association betw een the C677T polymorphism of methylentetrahydrofolate
reductase (MTHFR), informative SNPs in VEGF-A, Endothelin 1 and HIF1A genes
and micro and macro vascular abnormalities in MS and ALS. With MR, w e w ill assess the arterial
inflow and mean transit time using brain Perfusion Weighted Imaging (PWI), the state of the deep
intracranial veins using Susceptibility Weighted Imaging (SWI), and measure iron deposits in the
basal ganglia using dedicated softw are. Extracranial and transcranial color-Doppler US w ith time
intensity curve analysis w as used to quantitatively evaluate cerebral inflow and outflow parameters
and cerebral perfusion.
Results: In the first year w e recruited 228 MS patients, 33 ALS patients and 67 HS. Homocystein
levels (HL) w ere assessed in 132 patients, VEGF-A in 50 patients and in 25 HS. Median HL w ere
similar in MS and ALS patients (13.2 vs 16.0, µmol/L, p=0.2). Higher-than-normal HL w ere found in
32.2% of MS (CI 24-41%) and 66.7 % of ALS patients (CI 30-92%), but not significantly different in
the tw o groups (p= 0.08). Instead, median HL w ere significantly higher in males w ith MS compared
to females (17.3 vs 13.9 µmol/L, p< 0.001) .VEGF-A values tended to be higher in MS patients vs HS
(251.7 vs 145.7 U/mL, p=0,4). 101 patients (78 RR, 2 PP, 11 SPand 10 ALS) underw ent contrastenhanced
brain MR , and 68 patients (54 RR, 1 PP, 10 SPand 3 ALS) underw ent US evaluation.
Conclusions: Combining different imaging modalities and laboratory analysis may provide new
insights into the vascular aspects of MS pathogenesis. These preliminary results favor an altered
vascular profile in MS and ALS patients. Definitive results w ill be available at project termination in
2016.
Imaging Of Brain Perfusion In Multiple Sclerosis And Neurodegenerative Diseases: Association With Endothelial Factors. An Interim Analysis
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Imaging Of Brain Perfusion In Multiple Sclerosis And Neurodegenerative Diseases: Association With Endothelial Factors. An Interim Analysis