Assessing Abnormal Iron Content in the Deep Gray Matter of Patients with Multiple Sclerosis versus Healthy Controls
R. Zivadinov and
From the Departments of Biomedical Engineering (C.A.H., M.L., N.B., E.M.H.), Radiology (C.A.H., M.L., E.M.H.), and Neurology (J.G.), Wayne State University, Detroit, Michigan; Medical Physics Group (I.K., J.R.) and Section of Pediatric Radiology, (H.-J.M.), Institute for Diagnostic and Interventional Radiology I, Center for Radiology, Jena University Hospital, Jena, Germany; Buffalo Neuroimaging Analysis Center (C.M., R.Z.), Jacobs Neurological Institute, University of Buffalo, Buffalo, New York; and The MRI Institute for Biomedical Research (E.M.H.), Detroit, Michigan.
BACKGROUND AND PURPOSE: It is well known that patients with MS tend to have abnormal iron deposition in and around the MS plaques, in the basal ganglia and the THA. In this study, we used SWI to quantify iron content in patients with MS and healthy volunteers.
MATERIALS AND METHODS: Fifty-two patients with MS were recruited to assess abnormal iron content in their basal ganglia and THA structures. One hundred twenty-two healthy subjects were recruited to establish a baseline of normal iron content in deep GM structures. Each structure was separated into 2 regions: a low-iron-content region and a high-iron-content region. The average phase, the percentage area, and the total phase of the high-iron-content region were evaluated. A weighting was also assigned to each subject depending on the level of iron content and its deviation from the normal range.
RESULTS: A clear separation between iron content in healthy subjects versus patients with MS was seen. For healthy subjects 13% and for patients with MS 65% showed an iron-weighting factor >3 SDs from the normal mean (P < .05). The results for those patients younger than 40 years are even more impressive. In these cases, only 1% of healthy subjects and 67% of patients with RRMS showed abnormally high iron content.
CONCLUSIONS: Iron-weighting factors in the basal ganglia, THA, and the midbrain appeared to be abnormal in roughly two-thirds of patients with MS as measured by SWI.
CN caudate nucleus EDSS Expanded Disability Status Scale GM gray matter GP globus pallidus ICC intraclass correlation coefficient PT pulvinar thalamus PUT putamen RI normal iron-content region RII high iron-content region RN red nucleus RR relapsing-remitting SN substantia nigra SP secondary progressive SPIN signal processing in nuclear magnetic resonance THA thalamus
On the plus side, iron levels in the brain are normal in one-third of us!
There is some support for green tea extract (EGCG) as an iron chelator that can cross the blood-brain barrier. One concern is that after CCSVI venoplasty our blood-brain barrier will tighten up and it will be more difficult to get the iron out. I think it is universally agreed that iron is bad for the brain? The presence of iron in the brain is not proof of CCSVI, because iron can be a result of neurological disease and not of diapedesis leakage of red blood cells into the CNS, but I think the latter theory is a likely one, given the hemodynamic effects of turbulent flow on the endothelium.