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Transcranial brain sonography findings predict disease progression in multiple sclerosis

From the Department of Neurology (U.W., S.H., R.B., U.K.Z.), Institute for Diagnostic and Interventional Radiology (S.W.), University of Rostock, Germany.

Address correspondence and reprint requests to Prof. Uwe Walter, Department of Neurology, University of Rostock, Gehlsheimer Str. 20, D-18147 Rostock, Germany uwe.walter{at}med.uni-rostock.de

Objective: In multiple sclerosis (MS), an early neurodegenerative affection of subcortical gray matter has been suggested. Transcranial sonography (TCS) shows hyperechogenic lesions of substantia nigra (SN) and basal ganglia, thought to reflect iron accumulation, in a number of primary neurodegenerative diseases. The present study deals with the question of whether TCS can also display deep gray matter lesions in patients with MS and whether sonographic findings relate to severity and progression of MS.

Methods: We prospectively studied 75 patients with different courses of MS and 55 age-matched healthy subjects clinically and with TCS. Twenty-three patients additionally had 1.5-T MRI at the time of TCS. Disease progression was assessed clinically 2 years after TCS.

Results: Abnormal hyperechogenicity of SN, lenticular nucleus (LN), caudate nucleus, and thalamus was found in 41%, 54%, 40%, and 8% of the patients with MS, with similar frequency in patients with relapsing-remitting and primary or secondary progressive MS if corrected for disease duration, but only in 13%, 13%, 5% (each, p < 0.001), and none (p = 0.028) of the control subjects. Hyperechogenicity of SN and LN correlated with more pronounced MRI T2 hypointensity, thought to reflect iron deposition. Larger bilateral SN echogenic area was related to higher rate of disease progression, whereas small SN echogenic area (SN hypoechogenicity) predicted a disease course without further progression within 2 years.

Conclusions: Neurodegenerative disease–like deep gray matter lesions can be frequently detected by transcranial sonography (TCS) in patients with multiple sclerosis (MS). Findings suggest that TCS shows changes of brain iron metabolism which correlate with future progress of MS.

Abbreviations: CI = confidence interval; EDSS = Expanded Disability Status Scale; LN = lenticular nucleus; MS = multiple sclerosis; MSFC = Multiple Sclerosis Functional Composite; PPMS = primary progressive multiple sclerosis; ROC = receiver operating characteristic; ROI = region of interest; RRMS = relapsing-remitting multiple sclerosis; SN = substantia nigra; SPMS = secondary progressive multiple sclerosis; TCS = transcranial sonography.

Supplemental data at www.neurology.org

Editorial, page 1006

e-Pub ahead of print on August 5, 2009, at www.neurology.org.

Disclosure: Author disclosures are provided at the end of the article.

Received February 9, 2009. Accepted in final form June 23, 2009.

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Transcranial sonography of deep gray nuclei: A new outcome measure in multiple sclerosis?

Istvan Pirko and Robert Zivadinov
Neurology 2009 73: 1006-1007. [Full Text] [PDF]

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				I. Pirko and R. Zivadinov Transcranial sonography of deep gray nuclei: A new outcome measure in multiple sclerosis? Neurology, September 29, 2009; 73(13): 1006 - 1007. [Full Text] [PDF]