Publication: Klinik izole sendromlu olgularda konvansiyonel manyetik rezonans görüntüleme incelemelerinde normal görünen beyaz ve gri cevherde, difüzyon tensor ve manyetizasyon transfer görüntüleme yöntemleriyle, tespit edilen doku hasar oranları ile kognitif süreçler arasındaki ilişkinin değerlendirilmesi
Abstract
Klasik olarak beyaz cevher hastalığı olarak bilinen Multipl Skleroz (MS)’da yapılan son histopatolojik çalışmalarda gri madde alanlarında da etkilenimin olduğu gösterilmiştir. Ancak bu değişiklikleri Klinik İzole Sendrom (KİS) hastalarında gösteren sınırlı sayıda çalışma mevcuttur. Çalışmamızda, KİS hastalarında Normal Görünen Beyaz Cevher (NGBC) ve Gri Cevher (NGGC)’deki değişiklikleri ve bu değişikliklerle korele olabilecek kognitif etkilenimin ortaya konulması amaçlanmıştır. Bu değişiklikler Difüzyon Tensör Görüntüleme (DTG), Manyetizasyon Transfer Görüntüleme (MTG), Fraksiyonel Anizotropi (FA) teknikleri ile tespit edilebilmektedir. Çalışma KİS tanısıyla takip edilen 16 hasta ve demografik özellikleri benzer 16 olguluk kontrol grubunda gerçekleştirilmiştir. Kontrol ve hasta grubunda normal görünen korpus kallosum genu ve splenium, sol ve sağ anterior cingulat girus, sağ ve sol dorsalateral prefrontal korteks (DLPF), sağ ve sol serebellum dentat nukleus alanlarından DTG, MTR, FA ölçümleri yapılmıştır. Winsconsin Kart Eşleme Testi (WCST), California Sözel Öğrenme Testi (CVLT), Stroop Test, Hayvan ve KAS, Sayı Menzili gibi Nörokognitif Testler uygulanmıştır. Hasta grubunda DLPF korteksteki DTG ile hesaplanan FA değerlerinde sağlıklı gruba göre istatiksel olarak anlamlı yükseklik saptadık. Nörokognitif Test değerlendirmesinde hasta grubunda WCST, CVLT, Stroop Test, Sayı Menzili Testi, Hayvan ve KAS testlerinde performans düşüklüğü gözlemledik. Bu performans düşüklüğünü saptanan sol DLPF korteksteki FA değişikliği ile ilişkilendirdik. PASAT’da ise her iki grup arasında istatiksel olarak anlamlı farklılık saptamadık. Çalışmamızın sonuçları da göstermektedir ki kortikal-gri cevherde oluşan demiyelinizasyon MS hastalığında önemlidir, çünkü beyaz cevherdeki fokal demiyelinizasyon, hastalığın kliniğini özellikle kognitif etkilenimi tam olarak açıklayamamaktadır. Önerimiz, kortikal-gri maddede oluşan fonksiyonel hasarlanma ve kognitif etkilenimin KİS hastalarında tespit edilip tedavi edilmesidir. Anahtar sözcükler: Multipl Skleroz, Klinik İzole Sendrom, Nörokognisyon, Aksonal hasar, DTG-FA iii
Multiple Sclerosis (MS) has been traditonally regarded as a white matter disease. However, recent histopathological studies have convincingly shown that grey matter regions are also heavily affected. On the other hand, there are not enough studies to predict these changes at the clinically isolated syndrome (CIS). Our aim was to assess the normal-appearing white matter and grey matter changes in CIS patients and its correlations if exist with neurocognitive tasks. Those changes can be revealed by magnetization transfer imaging (MTI), Diffusion-tensor imaging (DTI) and Fractional anizotropi (FA) techniques. Sixteen CIS patients were included in the study. DTI, FA and MTI measurements at normal appearing left-right dorsolateral prefrontal cortex, right-left anterior cingulate gyrus, right-left dentate nucleus, corpus callosum genu-splenium were calculated for the patient and control groups. Wisconsin Card Sorting Test (WCST), California Verbal Learning Test (CVLT), Stroop Test (ST), Paced Auditory Serial Addition Test (PASAT), Digit Range (DR) were performed. The patients were found to have a higher fractional anisotropy compared to the controls in the left dorsolateral prefrontal cortex at DTI technique. The neurocognitive assessment showed that patients did not perform well in WCST, CVLT, ST, DR. Those results were associated with abnormal FA in the left dorsolateral prefrontal cortex. No statistical difference has been observed between the patient and control groups in PASAT. According to this study results, cortical-grey matter functional damages (especially demyelinization of axons in the cortex ) are of importance, because focal demyelinization in the white matter, visible on MRI, cannot explain the full extent of clinical, including cognitive deficits in patients with MS. In our suggestion corticalgrey matter functional damages and cognitive impairment can be detected and treated in the very early stages of MS.
Multiple Sclerosis (MS) has been traditonally regarded as a white matter disease. However, recent histopathological studies have convincingly shown that grey matter regions are also heavily affected. On the other hand, there are not enough studies to predict these changes at the clinically isolated syndrome (CIS). Our aim was to assess the normal-appearing white matter and grey matter changes in CIS patients and its correlations if exist with neurocognitive tasks. Those changes can be revealed by magnetization transfer imaging (MTI), Diffusion-tensor imaging (DTI) and Fractional anizotropi (FA) techniques. Sixteen CIS patients were included in the study. DTI, FA and MTI measurements at normal appearing left-right dorsolateral prefrontal cortex, right-left anterior cingulate gyrus, right-left dentate nucleus, corpus callosum genu-splenium were calculated for the patient and control groups. Wisconsin Card Sorting Test (WCST), California Verbal Learning Test (CVLT), Stroop Test (ST), Paced Auditory Serial Addition Test (PASAT), Digit Range (DR) were performed. The patients were found to have a higher fractional anisotropy compared to the controls in the left dorsolateral prefrontal cortex at DTI technique. The neurocognitive assessment showed that patients did not perform well in WCST, CVLT, ST, DR. Those results were associated with abnormal FA in the left dorsolateral prefrontal cortex. No statistical difference has been observed between the patient and control groups in PASAT. According to this study results, cortical-grey matter functional damages (especially demyelinization of axons in the cortex ) are of importance, because focal demyelinization in the white matter, visible on MRI, cannot explain the full extent of clinical, including cognitive deficits in patients with MS. In our suggestion corticalgrey matter functional damages and cognitive impairment can be detected and treated in the very early stages of MS.