Thalamic damage predicts the evolution of primary-progressive multiple sclerosis at 5 years.

BACKGROUND AND PURPOSE: Reliable markers to monitor PPMS are still needed. We investigated whether conventional and DTI measures of thalamic damage are predictive of long-term disability accumulation in PPMS. MATERIALS AND METHODS: Brain conventional and DTI scans were obtained at baseline and after a mean follow-up of 15 months in 54 patients with PPMS and 8 healthy controls. Patients were reassessed clinically after 5 years. At baseline and follow-up, measures of lesion load, brain atrophy, and NTV were obtained. MD and FA histograms of the NAWM, the whole GM without the thalami, and the thalami were obtained. A multivariate analysis evaluated the predictors of long-term neurologic deterioration. RESULTS: At follow-up, 35 patients showed disability worsening. At baseline, compared with healthy controls, patients with PPMS had lower NTV (P < .001) and thalamic FA (P = .002) and higher thalamic (P = .002) and whole GM without the thalami (P = .005) MD. During follow-up, the change of thalamic FA was higher in PPMS versus healthy controls (P = .01). Baseline NTV and thalamic DTI quantities differed significantly between patients with PPMS with and without thalamic lesions. Baseline thalamic quantities were significantly correlated with the extent of brain T2 lesions and the severity of NAWM damage. The multivariate model included average NAWM MD (OR = 1.46, P = .005) and FA thalamic change (OR = 0.84, P = .02) as independent predictors of EDSS score deterioration (Nagelkerke R(2) = 0.55). CONCLUSIONS: Short-term accrual of thalamic damage and the severity of NAWM involvement predict the long-term accumulation of disability in PPMS.

Assessment of white matter tract damage in patients with amyotrophic lateral sclerosis: a diffusion tensor MR imaging tractography study.

BACKGROUND AND PURPOSE: Most DTI studies in ALS have been limited to the assessment of the CST damage. In this study, we used DTI tractography to investigate whether microstructural abnormalities occur in the major motor and extramotor WM tracts in mildly disabled patients with ALS. MATERIALS AND METHODS: Brain conventional MR imaging and DTI were performed in 24 patients with probable or definite ALS and mild disability (ALSFRS score, ≥20) and 20 healthy controls. The mean disease progression rate was 0.62 (range = 0.08-2.50). DTI tractography was used to segment the CST, the corpus callosum, and the major WM association tracts (ie, cingulum, uncinate fasciculus, inferior fronto-occipital, inferior longitudinal, and superior longitudinal fasciculi). RESULTS: Compared with healthy controls, patients with ALS showed significantly decreased FA and significantly increased MD and radial D of the CST bilaterally (P values from .005 to .01). Patients with ALS also had a significantly increased axial D of the right uncinate fasciculus relative to controls (P = .04). CST FA significantly correlated with the rate of disease progression (right CST: r = -0.50, P = .02; left CST: r = -0.41, P = .05). CONCLUSIONS: Patients with ALS and mild disability have preferential damage to the CST. The association of CST damage with the rate of disease progression suggests that DTI has the potential to provide in vivo markers of ALS evolution. The subtle involvement of the uncinate fasciculus may precede the appearance of behavioral symptoms in patients with ALS.