Investigation Of The Perivascular Space,Brain Atrophy And Their Correlation In Patients With Multiple Sclerosis

Part 1:MRI features of perivascular spaces in patients with multiple sclerosisObjective:The perivascular spaces are increasingly recognized for their role in leucocyte trafficking as well as for their potential to modulate immune responses.This study is aim to investigate the imaging features PVS in patients with multiple sclerosis.Methods:This study retrospectively analyzed the characteristics of PVS of patients with MS(n=82)and healthy volunteers(n=35)matched with their sex and age from the second hospital of hebei medical university from 2017 to2020.All MRI images were interpreted using Radi Ant DICOM Viewer software tools.The main analysis and measurement indicators included:measured the number,size,distribution location(CSO of semi-oval center,BG of basal ganglia,midbrain,hippocampus)and morphology of PVS,and then score PVS.1)Compare the number,size,distribution,and morphology of intracranial PVS between MS patients and healthy controls;2)Divided MS patients into acute attack and remission groups,and analyze the differences of PVS characteristics between the two groups;3)the patients were divided into the first episode group and the relapse group according to the number of attacks,and analyze the differences in the characteristics of PVS between the two groups;4)Divided the MS patients into the mild disability group and the severe disability group according to EDSS,then assessed the relationship between PVS and the severity of disability.Results:The PVS score(4 vs.3,P=0.041),number(103.3±45.1 vs.87.6±30.1,P=0.035),and EPVS number(9 vs.1,p<0.001)of MS patients were all significantly higher than those in the healthy controls group.In terms of the distribution of PVS,the number of BG-PVS in MS patients(23.5 vs.13,p<0.001)was significantly higher than that in healthy controls,and the number of CSO-PVS in MS patients was higher than that in healthy controls(46.5 vs.43,P=0.180)but with no statistically significant.There was no significantly difference in PVS morphology between the two groups.In terms of EPVS distribution,CSO-EPVS(3 vs.0,p<0.001)and BG-EPVS(1 vs.0,p<0.001)in the MS group were higher than those in the healthy control group.In terms of the morphology of EPVS,round EPVS(2 vs.0,P<0.001),oval EPVS(2 vs.0,P=<0.001),linear EPVS(5 vs.1,P<0.001)in the MS group are higher than those in the healthy controls group.There were no significant differences in the PVS score,size,number,morphology,and distribution between the acute attack MS group and the remission MS group,the first attack group and the relapsed group.PVS of MS patients was not related to the severity of disability.Conclusion:PVS could be seen in both MS and healthy controls.The MS patients group had higher PVS score and was more,larger compared with the healthy controls group,which meant the PVS burben of MS is higher.The more and larger PVS of BG and CSO meant the PVS burben of there was higher.The number,size,and distribution of PVS were not related to disease stage,number of attacks,and severity of disability.Part 2:Two-dimensional Quantitative Brain Atrophy Indexes in patients with Multiple SclerosisPurpose:Brain atrophy is considered to be a reliable MRI predictor of the development of MS disease.However,it is very difficult to obtain the most accurate brain volume data.This study aims to find a simple and effective MRI two-dimensional quantitative brain atrophy index for patients with multiple sclerosis.Methods:This study retrospectively analyzed the two-dimensional quantitative brain atrophy indicators of the head MRI of patients(n=82)and healthy volunteers(n=35)diagnosed with MS in the Second Hospital of Hebei Medical University from 2017 to 2020.This study measured the corpus callosum area(CCA),corpus callosum index(CCI),corpus-cranial ratio,aligned third ventricle width(a3VW),unaligned third ventricle width(u3VW),bicaudate ratio(BCR),Huckman’s value,Evans index,sylvian-fissure ratio(SFR).The patients grouping was the same as that of the first part.Results:CCI(0.447±0.105 vs.0.502±0.060,P=0.001),CCA(5.382±1.380 cm~2 vs.6.147±1.114 cm~2,P=0.006),corpus-cranial ratio(0.037±0.009 vs.0.043±0.007),P=0.006)of MS patients were significiantly lower than those in control group,while u3VW(4.404±2.711 mm vs.3.024±0.928mm,P=0.006),a3VW(4.428±2.687 mm vs.3.035±0.953 mm,P=0.005),bicaudate ratio(BCR)(0.109±0.031 vs.0.085±0.015,p<0.001),sylvian fissure ratio(SFR)(0.023±0.011 vs.0.019±0.005,p<0.001),Huckman’s value(4.638±0.654 vs.4.181±0.447,p<0.001)),Evans index(0.386±0.088 vs.0.304±0.048,P<0.001)were significantly higher in MS patients.CCI(0.500±0.067 vs.0.407±0.107,p<0.001),CCA(5.963±0.951cm2 vs.5.091±1.489cm2,P=0.008),corpus-cranial ratio(0.041±0.006 vs.0.036±0.100,P=0.015)in the first attack group were significantly higher than those in the relapse group,while u3VW(3.595 mm vs.4.15 mm,P=0.028),a3VW(3.585 mm vs.4.06 mm,P=0.018),bicaudate ratio(BCR)(0.097±0.016 vs.0.111±0.024,P=0.019)lower in the first attack group.The univariate logistic regression analysis showed that CCI(OR:0.495,95%CI:0.296-0.828,P=0.007),CCA(OR:0.677,95%CI:0.479-0.957,P=0.027),corpus-cranial ratio(OR:0.515,95%CI:0.303-0.849,P=0.009),u3VW(OR:1.437,95%CI:1.051-0.963,P=0.023)、a3VW(OR:1.487,95%CI:1.084-2.038,P=0.014)of MS patients were related to the severity of disability.After adjusting gender and age,CCI(OR:0.479,95%CI:0.284-0.808,P=0.006),CCA(OR:0.619,95%CI:0.423-0.906,P=0.013),corpus-cranial ratio(OR:0.466,95%CI:0.274-0.792,P=0.005),u3VW(OR:1.446,95%CI:1.055-1.981,P=0.022),a3VW(OR:1.499,95%CI:1.090-2.061,P=0.013),BCR(OR:2.382,95%CI:1.31-4.331,P=0.004),SFR(OR:2.178,95%CI:1.260-3.765,P=0.005)were related to the severity of disability in MS patients.Conclusion:The brain atrophy of MS patients was severer than the healthy control group,and the brain atrophy of MS in the relapsed group is severer than the first attack group.Brain atrophy could occur in the early stage of the disease and worsen as the disease progressed.CCI,CCA,corpus-cranial ratio,u3VW,a3VW,BCR,SFR,Huckman’s value and Evans index were related with the severity of the disability of MS patients.Part3:Correlation between perivascular space and brain atrophy indexes in patients with multiple sclerosisPurpose:The correlation analysis of the clinical and imaging characteristics of PVS and MS had conflicting results.This study aimed to analyze the correlation between PVS of MS and clinical data and brain atrophy.Methods:Patients collection,image interpretation,and grouping were the same as before,in this study the correlation between PVS and clinical related factors and brain atrophy indicators were analyzed.Results:The number of PVS in MS patients was correlated with age(rs=0.353,P=0.001)and hypertension(rs=0.289,P=0.008),but had nothing to do with other clinical factor.PVS score is also related to age(rs=0.352,P=0.01)and hypertension(rs=0.296,P=0.007).The number of EPVS was only related to age(rs=0.258,P=0.019),but not to other clinical factors.In MS patients,PVS score is correlated with CCA(rs=0.272,P=0.013)and corpus-cranial ratio(rs=0.219,P=0.048);the number of PVS was correlated with corpus callosum area(CCA)(rs=0.255,P=0.021).In the healthy control group,only the PVS score was correlated with men(rs=0.437,P=0.012).In the acute attack MS group,the number of PVS(age:rs=0.39,P=0.002;hypertension:rs=0.303,P=0.02),the number of EPVS(age:rs=0.359,P=0.005;hypertension:rs=0.261,p=0.046),PVS score(age:rs=0.349,P=0.007;hypertension:rs=0.300,P=0.021)were correlated with age and hypertension.In the remission MS group,the number of PVS was correlated with CCA(rs=0.487,P=0.019),corpus-cranial ratio(rs=0.479,P=0.021),and PVS score was correlated with CCA(rs=0.453,P=0.03).There was no correlation between PVS and all brain atrophy indexes in the first attack group and the relapsed group of MS patients.Conclusion:The PVS score and PVS number in MS patients were correlated with age and hypertension.The number of EPVS is correlated with age,but not with gender.There was no correlation between PVS score,number of PVS,EPVS number and EDSS score,the course of MS in MS patients.The PVS score of MS patients was related to CCA and corpus-cranial ratio,the number of PVS is related to CCA.,which meant that the PVS of MS might be related to brain atrophy.