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Research ArticleAdult Brain
Open Access

Thalamic Iron Differentiates Primary-Progressive and Relapsing-Remitting Multiple Sclerosis

A. Burgetova, P. Dusek, M. Vaneckova, D. Horakova, C. Langkammer, J. Krasensky, L. Sobisek, P. Matras, M. Masek and Z. Seidl
American Journal of Neuroradiology June 2017, 38 (6) 1079-1086; DOI: https://doi.org/10.3174/ajnr.A5166
A. Burgetova
aFrom the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
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P. Dusek
bNeurology (P.D., D.H.), Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
cInstitute of Neuroradiology (P.D.), University Medicine Göttingen, Göttingen, Germany
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M. Vaneckova
aFrom the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
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D. Horakova
bNeurology (P.D., D.H.), Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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C. Langkammer
dDepartment of Neurology (C.L.), Medical University of Graz, Graz, Austria
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J. Krasensky
aFrom the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
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L. Sobisek
eDepartment of Statistics and Probability (L.S.), University of Economics, Prague, Czech Republic.
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P. Matras
aFrom the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
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M. Masek
aFrom the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
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Z. Seidl
aFrom the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
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    Fig 1.

    Sample MR image section depicting gradient-echo magnitude (A), raw phase (B), and quantitative susceptibility map (C) with ROIs outlined in the caudate nucleus, putamen, globus pallidus, and thalamus.

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    Fig 2.

    Quantitative susceptibility values in the putamen (A) and thalamus (B) across healthy controls and multiple sclerosis subtypes. Lower thalamic susceptibility values are observed in the RRMS compared with PPMS and HC groups. ppb indicates parts per billion.

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    Fig 3.

    The relationship between clinical disability and quantitative susceptibility values in the putamen and thalamus across PPMS and RRMS groups. X-axes indicate EDSS, while y-axes indicate quantitative susceptibility values in parts per billion. A positive correlation between EDSS and putaminal quantitative susceptibility values is present in both the RRMS (A) and PPMS (B) groups. In the thalamus, a negative correlation between EDSS and quantitative susceptibility is present only in the RRMS group (C), while no correlation is observed in the PPMS group (D).

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    Table 1:

    Demographic and clinical data and conventional MRI metrics in HC, RRMS, RREM, and PPMS groupsa

    HC 20 (8/12)RRMS 80 (32/48)RREM MS 40 (16/24)PPMS 24 (9/15)P Valueb
    PPMS vs RRMS (RREM)HC vs RRMS (RREM)HC vs PPMS
    Age (yr)48.0 (7.3)46.9 (7.0)48.6 (7.0)47.4 (6.8).72 (.72).72 (.72).72
    Disease duration (yr)–12.4 (10.7)13.2 (11.0)7.7 (3.3).006c (.006)c––
    EDSSd–2.5 (2.5)4 (0.6)4.5 (1.6)<.001c (.173)––
    T1LLd–1.1 (1.1)1.4 (1.6)1.8 (3.3).023c (.276)––
    T2LLd–2.1 (4.9)3.6 (7.2)2.8 (10.6).431 (.923)––
    BPF (%)86.2 (1.5)84.2 (2.4)83.8 (2.4)84.7 (3.0).490 (.490)<.001 (<.001).08
    CCV (cm3)4.6 (0.6)4.1 (0.7)4.0 (0.7)4.1 (0.8).690 (.690).004 (.001).013
    • Note:— – indicates not relevant.

    • ↵a The number of participants and the female/male ratio are reported for each group. Unless otherwise indicated, data are reported as mean (SD). Numbers in parentheses in the headers of columns 2–5 are No. of subjects in groups (F/M).

    • ↵b Pair-wise comparison (P value). Differences among HC, PPMS, and RRMS (RREM) groups were tested using a t test or Mann-Whitney U test with nonpooled SD (Benjamini-Hochberg correction).

    • ↵c Significant.

    • ↵d Mann-Whitney U test with nonpooled SD (Benjamini-Hochberg correction) (median and interquartile range).

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    Table 2:

    Quantitative susceptibility within deep GM structuresa

    DGM Structure QS (ppb)HCRRMSRREM MSPPMSPair-wise Comparison (P Value)b
    PPMS vs RRMS (RREM)HC vs RRMS (RREM)HC vs PPMS
    CN32.6 (9.5)35.0 (9.6)38.3 (10.1)36.8 (6.8).390 (.470).390 (.230).230
    GP66.7 (8.5)71.9 (14.0)72.4 (14.1)70.8 (13.0).860 (.860).170 (.170).420
    Put20.3 (5.4)24.3 (10.7)27.7 (10.3)28.1 (10.5).158 (.899).042c (.003)c.009c
    Thal5.9 (3.3)2.6 (4.9)2.0 (5.7)5.6 (3.9).007c (.007)c.004c (.004)c.757
    • Note:—Thal indicates thalamus.

    • ↵a All values are means (SD).

    • ↵b Pair-wise comparisons (P value) were tested using t tests with nonpooled SD (Benjamini-Hochberg correction).

    • ↵c Significant.

    • View popup
    Table 3:

    Correlations of QS values in DGM with conventional MRI parameters in the RRMS and PPMS groups

    DGM RegionT1LLT2LLBPFCCV
    rsP ValuersP ValuersP ValuersP Value
    RRMS
        CN−0.09.44−0.07.56−0.01.96−0.05.63
        GP0.02.850.07.53−0.00.99−0.10.37
        Put0.14.230.12.30−0.20.08−0.21.06
        Thal−0.36.001a−0.35.001a0.23.04a0.25.02a
    PPMS
        CN−0.13.55−0.16.460.05.800.02.93
        GP0.07.750.09.69−0.03.860.06.79
        Put0.25.250.36.09−0.28.18−0.16.47
        Thal−0.04.850.03.900.14.520.11.60
    • Note:—rs indicates Spearman correlation coefficient; Thal, thalamus.

    • ↵a Significant.

    • View popup
    Table 4:

    Associations of EDSS with conventional MRI metrics and QS values

    RRMSPPMS
    rsP ValuersP Value
    Conventional MRI metrics
        T1LL0.458<.001a0.195.361
        T2LL0.336.002a0.237.265
        BPF−0.281.012a−0.001.995
        CCV−0.267.017a−0.089.680
    QS
        CN0.234.037a0.127.554
        GP−0.106.350−0.059.785
        Put0.298.007a0.464.022a
        Thal−0.251.024a0.119.581
    • Note:—Thal indicates thalamus.

    • ↵a Significant.

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American Journal of Neuroradiology: 38 (6)
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A. Burgetova, P. Dusek, M. Vaneckova, D. Horakova, C. Langkammer, J. Krasensky, L. Sobisek, P. Matras, M. Masek, Z. Seidl
Thalamic Iron Differentiates Primary-Progressive and Relapsing-Remitting Multiple Sclerosis
American Journal of Neuroradiology Jun 2017, 38 (6) 1079-1086; DOI: 10.3174/ajnr.A5166

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Thalamic Iron Differentiates Primary-Progressive and Relapsing-Remitting Multiple Sclerosis
A. Burgetova, P. Dusek, M. Vaneckova, D. Horakova, C. Langkammer, J. Krasensky, L. Sobisek, P. Matras, M. Masek, Z. Seidl
American Journal of Neuroradiology Jun 2017, 38 (6) 1079-1086; DOI: 10.3174/ajnr.A5166
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