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Isolated U-fiber involvement in MS

Preliminary observations

From the Departments of Radiology (Drs. Miki, R.I. Grossman, Udupa, and Wei, and L.J. Mannon) and Neurology (Drs. Kolson and M. Grossman), Hospital of the University of Pennsylvania, Philadelphia, PA.

Address correspondence and reprint requests to Dr Grossman, Department of Radiology, Hospital of the University of Pennsylvania, Ground Floor. Founders, 3400 Spruce Street, Philadelphia, PA 19104-4283.

We studied the frequency and location of isolated U-fiber involvement in MS and correlated these findings exploratively with physical disability and neuropsychological impairment. Fifty-three MS patients were examined. Three-millimeter-thick, fast spin-echo T2-weighted MR images and spin-echo postgadolinium T1-weighted images were obtained. Computer software that which had been validated previously for quantitation of MS lesions was used to detect lesions on the T2-weighted images. The Expanded Disability Status Scale (EDSS), Ambulation Index (AI), and a battery of neurocognitive tests were performed on each patient. Forty-two arcuate hyperintensities along the U-fiber were detected by the software in 28 patients (53%). Twenty-seven lesions (64.3%) were seen in the frontal lobe, eight (19.0%) in the temporal lobe, three (7.1%) in the parietal lobe, three (7.1%) in the occipital lobe, and one (2.4%) in both frontal and parietal lobes. Four lesions (9.5%) showed gadolinium enhancement. Seventeen lesions (40%) were hypointense on the T1-weighted images. Scores of three of the 11 neuropsychological tests reflecting performance in executive control and memory were significantly different at least at the p = 0.05 level between the eight patients with multiple, isolated U-fiber lesions and the 45 patients without any or with only a single U-fiber lesion. No significant difference was noted for EDSS or AI. Isolated U-fiber involvement is an underappreciated MR finding in MS. Our preliminary hypothesis is that U-fiber lesions may contribute to neuropsychological impairment, although our observation requires confirmation.

Supported in part by grant R01 NS2 9029-01A1 and M01-RR00040 from the National Institutes of Health, and grant RG2109B from the National Multiple Sclerosis Society.

Received June 9, 1997. Accepted in final form December 2, 1997.

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