ISNVD Abstract Book

The Cerebral Perfusion of Patients with
Multiple Sclerosis (MS) using MRI
Zhong Y 1 , Utriainen D 2 , Feng W 1 , Hubbard D 3 , Haacke EM 1,2
1
Depts of Radiology and Biomedical Engineering, Wayne State University, Detroit MI 48201 USA;
2
Magnetic Resonance Innovations, Inc, Detroit, MI 48202 USA;
3
Applied fMRI Institute, San Diego, CA 92131 USA;
Introduction:
Contacts: Yi Zhong (neuzhong@gmail.com),
E. Mark Haacke (nmrimaging@aol.com)
Multiple sclerosis (MS) is an inflammatory disease with no clear causes. Currently, there has been a resurgence of interest in the venous
component of MS (1,2). Along the lines of poor flow (not with a specific focus on venous abnormalities), a number of papers in the last decade
have shown that there is reduced perfusion in the brain (3,4). Using 2D phase contrast (PC) flow measurements, our own work (5) has shown that
there is abnormally low internal jugular venous (IJV) flow in MS patients. The goal of this present work was to take the arterial information from
the upper neck level (C2) and use it to find the average perfusion by normalizing it to brain volume. The internal carotid arteries and the vertebral
arteries were included. The thought was that reduced perfusion would correlate with abnormally low IJV flow.
Methods:
A total of 140 patients with clinically definite MS were imaged (mean
age 48 years, range 27-74 years,100 women, 40 men) under the
standard CCSVI protocol. Two groups were defined based on the
observation of patients’ venous anatomy. Specifically, if the subject’s
jugular veins showed a stenosis (less than 12.5mm 2 at C1/C2 or less
than 25mm 2 from C3 downward, then they were classified as being in
the stenotic group. Otherwise they were classified as non-stenotic.
There were 75 with stenosis and 65 with no stenosis. There were 26
age matched normal controls (mean age 38 years, range 23-59 years)
used for comparison. Flow quantification was performed at the C2
level and only the internal carotid arteries and the vertebral arteries
were included. The average cerebral blood flow (CBF) was defined as ,
where tA represents the total arterial flow to the brain per minute per
100gm tissue. The brain was extracted by first performing a skull
stripping and then keeping the cerebrum, cerebellum and brainstem
(including the pons).
Figure 1. 3D FLAIR data
acquired in the sagittal plane
(A) was used to calculate brain
volume for subjects. (B-D)
demonstrate the postextraction
brain signal which
was used in calculating total
brain volume. Note the
inclusion of the cerebrum,
cerebellum, the pons, and the
ventricular cerebrospinal fluid.
Results:
The average CBF (in ml/min/100gm tissue) as a function of the total
IJV flow (in ml/sec) is plotted in Figure 2. Practically, if there is no
relationship between total CBF and total IJV flow, Figure 1 should
show a population of similar CBF (ignoring age-dependence) spread
out across the total IJV flow. This plot can be better understood if it is
further broken down into age ranges. The MS population was divided
into 2 subgroups with age ranges of less than50 years and greater
than 50 years (included 50Y). The linear trend is much more apparent
now when viewed one group at a time (see for example the cases with
no apparent stenosis.) Overall there is also a trend for not only
reduced CBF for the older population but also a reduced outflow in
the IJVs . The linear fits yielded the following results: for the stenotic
MS younger than 50 years, y=0.604x+45.3, R 2 = 0.060; for the stenotic
MS patients older than 50 years, y=0.141x+48.2, R 2 =0.001 ; for the
non-stenotic MS patients, y=2.167x+24.5,R 2 =0.233 ; and for the
normal controls, y=0.113x+46.2, R 2 =0.001. The non-stenotic has a
stronger linear correlation with CBF. Higher average CBF (β=.46,
p