Heterogeneous pathological processes account for thalamic degeneration in multiple sclerosis: Insights from 7 T imaging

Abstract

Background:

Thalamic degeneration impacts multiple sclerosis (MS) prognosis.

Objective:

To investigate heterogeneous thalamic pathology, its correlation with white matter (WM), cortical lesions and thickness, and as function of distance from cerebrospinal fluid (CSF).

Methods:

In 41 MS subjects and 17 controls, using 3 and 7 T imaging, we tested for (1) differences in thalamic volume and quantitative T₂* (q-T₂*) (2) globally and (3) within concentric bands originating from the CSF/thalamus interface; (4) the relation between thalamic, cortical, and WM metrics; and (5) the contribution of magnetic resonance imaging (MRI) metrics to clinical scores. We also assessed MS thalamic lesion distribution as a function of distance from CSF.

Results:

Thalamic lesions were mainly located next to the ventricles. Thalamic volume was decreased in MS versus controls (p < 10⁻²); global q-T₂* was longer in secondary progressive multiple sclerosis (SPMS) only (p < 10⁻²), indicating myelin and/or iron loss. Thalamic atrophy and longer q-T₂* correlated with WM lesion volume (p < 0.01). In relapsing-remitting MS, q-T₂* thalamic abnormalities were located next to the WM (p < 0.01 (uncorrected), p = 0.09 (corrected)), while they were homogeneously distributed in SPMS. Cortical MRI metrics were the strongest predictors of clinical outcome.

Conclusion:

Heterogeneous pathological processes affect the thalamus in MS. While focal lesions are likely mainly driven by CSF-mediated factors, overall thalamic degeneration develops in association with WM lesions.

Keywords

Multiple sclerosis thalamus atrophy

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