Inwards damage

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Cerebrospinal Fluid-In Gradient of Cortical and Deep Gray Matter Damage in Multiple Sclerosis

https://www.neurology.org/doi/full/10.1 ... 0000200271

Background and Objectives

A CSF-in gradient in cortical and thalamic gray matter (GM) damage has been found in multiple sclerosis (MS). We concomitantly explored the patterns of cortical, thalamic, and caudate microstructural abnormalities at progressive distances from CSF using a multiparametric MRI approach.

Discussion

CSF-in damage gradients are heterogeneous among different GM regions and through MS course, possibly reflecting different dynamics of demyelination and iron loss/accumulation.

Excerpt

The accumulation of focal white matter (WM) lesions resulting from blood-brain barrier disruption and immune cell infiltration stands as the primary pathologic feature of multiple sclerosis (MS). However, recent pathologic studies have identified a CSF-in gradient of damage,1 being more severe at periventricular2,3 and subpial levels, and potentially related to the infiltration of proinflammatory cytokines from the CSF. This pathologic process may contribute not only to WM and gray matter (GM) lesion accrual but also to microstructural damage accumulation in thalamic2 and cortical4 normal-appearing tissue.

The application of advanced high-field (3T) or ultra-high-field (7T) MRI techniques specific to different MS-related pathologic processes has further supported the relevance of surface-in damage gradient in both CSF-adjacent GM5-10 and WM.10-12 In thalamic and cortical GM, a gradient of microstructural alterations, in diffusivity abnormalities, lower magnetization transfer ratio (MTR),9 lower T1/T2-weighted ratio,8 and increased T2*5-7 has been observed from the earliest phases of the disease,6,8,9 becoming more severe in progressive patients with MS.5,6,9