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Brain atrophy and lesion load in a large population of patients with multiple sclerosis

From the Department of Neurological Sciences (Drs. Tedeschi, Lavorgna, Dinacci, Bonavita, and Di Costanzo), Second University of Naples, Department of Human Physiology and Pharmacology (Dr. Russo), University of Rome "La Sapienza," Department of Diagnostic Imaging (Drs. Prinster, Brunetti, Quarantelli, Alfano, and Salvatore), University of Naples "Federico II," Departments of Neurology, Ophthalmology, Otorhinolaryngology, and Psychiatry (Drs. Savettieri, Salemi, and Cammarata), University of Palermo, Department of Neurology (Drs. Quattrone and Valentino), University of Catanzaro, Department of Neurological and Psychiatric Sciences (Drs. Livrea, Bellacosa, and Simone), University of Bari, Department of Neurology (Drs. Messina and Patti), University of Messina, Department of Neurology (Dr. Reggio), University of Catania, Department of Neurology (Drs. Bresciamorra, Orefice, and Bonavita), University of Naples "Federico II," Department of Neurology (Drs. Paciello and Coniglio), San Carlo Hospital, Potenza, and Institute of Biostructure and Bioimaging (Drs. Brunetti and Salvatore), National Research Council, Naples, Italy.

Address correspondence and reprint requests to Dr. G. Tedeschi, Department of Neurological Sciences, Second University of Naples, Piazza Miraglia 2, 80138 Naples, Italy; e-mail: gioacchino.tedeschi{at}unina2.it

Objective: To measure white matter (WM) and gray matter (GM) atrophy and lesion load in a large population of patients with multiple sclerosis (MS) using a fully automated, operator-independent, multiparametric segmentation method.

Methods: The study population consisted of 597 patients with MS and 104 control subjects. The MRI parameters were abnormal WM fraction (AWM-f), global WM-f (gWM-f), and GM fraction (GM-f).

Results: Significant differences between patients with MS and control subjects included higher AWM-f and reduced gWM-f and GM-f. MRI data showed significant differences between patients with relapsing-remitting and secondary progressive forms of MS. Significant correlations between MRI parameters and between MRI and clinical data were found.

Conclusions: Patients with multiple sclerosis have significant atrophy of both white matter (WM) and gray matter (GM); secondary progressive patients have significantly more atrophy of both WM and GM than do relapsing-remitting patients and a significantly higher lesion load (abnormal WM fraction); lesion load is related to both WM and even more to GM atrophy; lesion load and WM and GM atrophy are significantly related to Expanded Disability Status Scale score and age at onset (suggesting that the younger the age at disease onset, the worse the lesion load and brain atrophy); and GM atrophy is the most significant MRI variable in determining the final disability.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 26 issue to find the title link for this article.

Received December 8, 2004. Accepted in final form April 13, 2005.

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