Thalamic involvement in multiple sclerosis: A diffusion-weighted magnetic resonance imaging study

Background and Purpose. Injury to deep gray matter structures in multiple sclerosis (MS) has been suggested by recent neuroimaging and neuropathology studies. Diffusion-weighted magnetic resonance imaging (MRI) can assess tissue damage with greater sensitivity than conventional MRI. The authors' objective was to assess thalamic gray matter damage by diffusion-weighted imaging in MS patients. Methods. This was a retrospective study performed at a tertiary care, university-affiliated comprehensive MS center of 82 MS patients and 43 controls. The main outcome measures were thalamic apparent diffusion coefficients (ADCs), whole-brain atrophy (brain parenchymal fraction), fluid-attenuated inversion recovery (FLAIR) hyperintense lesion volume, and clinical course. Results. ADCs in the left thalamus were higher in MS patients (0.741 +/- 0.044 x 10(-3) mm(2)/s) than controls (0.723 +/- 0.036 x 10(-3) mm(2)/s)(P=.027) and higher in secondary progressive MS patients (0.761 +/- 0.044 x 10(-3) mm(2)/s) than relapsing-remitting MS patients (0.735 +/- 0.032 x 10(-3) mm(2)/s) (P =.029). ADCs in the right thalamus were higher in secondary progressive MS patients (0.784 +/- 0.069 x 10(-3) mm(2)/s) than controls (0.757 +/- 0.038 x 10(-3) mm(2)/s) (p = .033). In the MS group, left thalamus ADCs correlated negatively with brain parenchymal fraction (r = -0.30, P = .008), total left hemispheric FLAIR lesion volume correlated with ADCs in the left (r = 0.35, P = .001) and right (r = 0.39, P < .001) thalami, and total right hemispheric FLAIR lesion volume correlated with ADCs in the left (r = 0.31, P = .006) and right thalami (r = 0.22, P = .048). Conclusion. MIS patients have increased water diffusion in the thalamus that is partly associated with clinical course, lesion load, and whole-brain atrophy. Both indirect and direct mechanisms of gray matter injury may play a role in the pathophysiology of MS.