Peak width of skeletonized mean diffusivity (PSMD) and cognitive functions in relapsing-remitting multiple sclerosis
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Peak width of skeletonized mean diffusivity (PSMD) and cognitive functions in relapsing-remitting multiple sclerosis C. Vinciguerra 1 & A. Giorgio 1 & J. Zhang 1 & V. Nardone 2 & R. Tappa Brocci 1 & L. Pastò 3 & C. Niccolai 3,4 & M.L. Stromillo 1 & M. Mortilla 5 & M.P. Amato 3,4 & N. De Stefano 1 Accepted: 2 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Peak width of skeletonized mean diffusivity (PSMD) is a new MRI marker, which has shown clinical relevance in some neurological conditions and, in preliminary data, in multiple sclerosis (MS). We aimed here to investigate, in a group of relapsing-remitting MS (RRMS) patients, the relationship between PSMD and cognitive performances, in comparison with other MRI measures. RRMS patients (n = 60) and normal controls (n = 15) underwent a 3 T MRI examination. MRI-based white matter (WM) lesion volume, microstructural integrity (assessed with Tract-Based Spatial Statistics of diffusion tensor imaging [DTI] images) and brain volumes (i.e., total brain, grey matter [GM] and WM) were computed. In addition, PSMD was calculated through “skeletonization” of WM tracts and diffusion histograms. Cognition was evaluated with Rao’s Brief Repeatable Battery (BRB), which incorporated tests of verbal and visual memory, attention, concentration, information processing speed and verbal fluency. PSMD closely correlated with symbol digit modalities test (SDMT) (r = −0.70, p < 0.001) and, to a lesser extent, with verbal and visual memory tests. Multiple regression analysis showed that PSMD explained SDMT variance (R2 = 0.54, p < 0.001) more than other MRI measures. Results point out the relevance of microstructural damage, as assessed by PSMD, as a reliable marker of cognition in MS, especially in explaining dysfunction in information processing speed. Keywords Multiple sclerosis . MRI . Cognition . PSMD . DTI . Atrophy
Introduction Cognitive impairment affects 40–70% of multiple sclerosis (MS) patients (Chiaravalloti and DeLuca 2008) and might be relevant since the earliest disease stages, involving specific Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11682-020-00394-4) contains supplementary material, which is available to authorized users. * N. De Stefano [email protected] 1
Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
2
Unit of Radiation Therapy, Ospedale del Mare, Naples, Italy
3
Department of NEUROFARBA, Neuroscience Division, University of Florence, Florence, Italy
4
IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
5
Department of Radiology, Anna Meyer Children’s University Hospital, Florence, Italy
cognitive domains such as information processing speed, memory and executive functions (Rocca et al. 2015). The pathologic substrate of cognitive impairment seems to be related with focal (macroscopic lesions) and diffuse (atrophy) gray matter (GM) damage although the role of diffuse microscopic white matter (WM) dama
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