Iron accumulation in the basal ganglia was found in patients with advanced multiple sclerosis (MS), but not in patients with a clinically isolated syndrome (CIS) that is suggestive of MS, Austrian researchers reported.
In this quantitative study, 113 MS and CIS patients, as well as 35 healthy controls, underwent 3T MRI imaging, which showed increased levels of brain iron in MS patients compared with CIS patients (P<0.001) and healthy controls (P<0.005), wrote Franz Fazekas, MD, of the Medical University of Graz, and colleagues in Neurology.
MRI-based iron mapping has been proposed as a marker of neurodegeneration in various neurologic disorders, including MS, explained Alex Rovira, MD, from the Hospital Vall d’Hebron in Barcelona, in an accompanying editorial. “Iron is an essential trace element with a vital role in normal brain metabolism, oxygen transport, myelin production, and neurotransmitter synthesis, and in reactions critical to oxidative stress,” he wrote.
Abnormal iron accumulation has been identified pathologically in MS, but few studies have investigated brain iron levels in patients with CIS, the investigators stated. Recently R2* relaxometry has been validated for measuring brain iron.
Of the 113 consecutive patients, 78 had MS and 35 had CIS. Along with the MR studies, the participants underwent clinical and neuropsychological examination. Iron deposition in subcortical gray matter was assessed by automated, regional calculation of R2* rates.
In addition to significantly increased R2* levels in the basal ganglia of MS patients, the authors found that the levels correlated with age (r=0.5, P<0.001), disease duration (r=0.5, P<0.001), the Expanded Disability Status Scale (r=0.3, P<0.005), and the z values of mental processing speed (r=-0.3, P< 0.01).
The regional brain R2* relaxation rates were as follows in CIS, MS, and controls, respectively:
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