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MRI characteristics of patients with antiphospholipid syndrome and multiple sclerosis

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Abstract

MRI findings of primary anti-phospholipid antibody syndrome (PAPLS) are difficult to distinguish from those of multiple sclerosis (MS). Only a few previous studies have compared conventional and non-conventional MRI findings in MS and PAPLS patients. In addition, MRI differences between anti-phospholipid antibody (APLA) positive (+) and APLA negative (−) MS patients have not been reported. Therefore, the aim of this study was to investigate the differences in MRI measures among patients with PAPLS, MS and normal control (NC) subjects. We also explored non-conventional MRI measures in APLA+ and APLA− MS patients. Forty-nine (49) consecutive MS patients among whom 39 had relapsing-remitting (RR) and 10 secondary-progressive (SP) disease course, 30 patients with PAPLS and 49 NC were enrolled. Twenty-eight (28) MS patients were APLA+. MRI measures of T1- and T2-lesion volumes (LV) and brain atrophy, including fractions of whole brain (BPF), gray matter (GMF) and white matter (WMF), were evaluated. The magnetization transfer ratio (MTR) of T2- and T1-LVs and different normal-appearing brain tissue (NABT) compartments as well as diffusion-weighted imaging of whole brain mean parenchyma diffusivity (MPD) were obtained. MS patients differed significantly from NC in all MRI measures. PAPLS patients differed from NC in their T2-LV, in MTR measures and in MPD. When MS patients were compared to PAPLS patients, they showed significantly higher T2- and T1-LVs and T2-LV MTR, lower BPF and GMF and higher MPD. APLA+ RR and SPMS (all APLA+) patients showed significantly higher T2-LV, lower GMF, lower normal-appearing gray matter MTR and higher MPD when compared to APLA− patients. The results indicate that brain abnormalities can be detected in PAPLS patients with non-conventional MRI. MRI reveals more profound injury in patients with MS versus PAPLS. APLA mediates heterogeneous cerebral pathology that remains to be further investigated.

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Acknowledgments

Dr. Milena Stosic was supported by the Dr. Larry D. Jacobs Jog-for-the-Jake Fellowship. We also thank Eve Salczynski for technical support in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurology, Buffalo Neuroimaging Analysis Center, School of Medicine and Biomedical Sciences, State University of New York, 100 High St., Buffalo, NY, 14203, USA

    Milena Stosic, Timothy M. Galey, Sara Hussein & Robert Zivadinov

  2. Department of Rheumatology and Immunology, State University of New York, Buffalo, NY, USA

    Julian Ambrus

  3. Multiple Sclerosis Center, UMass Memorial Medical Center, Worcester, MA, USA

    Neeta Garg

  4. Department of Neurology, The Jacobs Neurological Institute, University at Buffalo, State University of New York, Buffalo, NY, USA

    Bianca Weinstock-Guttman, Frederick E. Munschauer & Robert Zivadinov

  5. Department of Pharmaceutical Sciences, State University of New York, Buffalo, NY, USA

    Murali Ramanathan

  6. VAMC, SUNY Upstate Medical University, Syracuse, NY, USA

    Bernadette Kalman

  7. Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA

    Alireza Minagar

  8. Departments of Neurology and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Rohit Bakshi

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  1. Milena Stosic
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  2. Julian Ambrus
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Correspondence to Robert Zivadinov.

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Stosic, M., Ambrus, J., Garg, N. et al. MRI characteristics of patients with antiphospholipid syndrome and multiple sclerosis. J Neurol 257, 63–71 (2010). https://doi.org/10.1007/s00415-009-5264-6

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  • DOI: https://doi.org/10.1007/s00415-009-5264-6

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