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Effect of Virchow–Robin Spaces on Multiple Sclerosis (MS)

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Published: Mon, 14 May 2018

Effect of Virchow –Robin Spaces in Early Diagnosed Multiple Sclerosis patients.

A Case – Control Study in a Chinese ethenic Group.

MD Eqbal Ahmad. Prof. Li Yong Mei.

Key Words:-

Magnetic resonance imaging. Multiple sclerosis. Virchow –Robin space .Chinese .

Abbreviation:-

MS= Multiple sclerosis; VRS= Virchow robin space; CSF= Cerebro spinal fluid; FLAIR=Fluid-attenuated inversion recovery;

ABSTRACT:-

Background: Virchow-Robin space (VRS) are pia-lined extensions of the subarachnoid space surround the walls of arteries, arterioles, veins, venules , that enter the brain parenchyma. These spaces are responsible for inflammatory processes within the brain.

Objectives: This study is designed to give more light on the frequency, location, and size of Virchow Robin spaces in three different regions of the brain in patients of Chinese ethnic group who is newly diagnosed with multiple sclerosis (MS) and compare the results with healthy age and gender matched controls.

Methods: We obtained MRI Scans of 50 newly diagnosed MS patients within 3 month of MS onset and compared with 50 healthy age and gender matched controls without any neurological problem. MRI was performed with noncontrast axial and coronal T1W FSE, axial T2W FSE, axial T2W FLAIR and sagittal FLAIR sequence followed by post contrast axial and coronal T1W sequences. The frequency, location, and size of Virchow Robin spaces in three different regions compared between the newly diagnosed MS patients and healthy age and gender matched controls.

Results:

Conclusions: the results of this study giving more light on the significance of VRS as a marker for MS and can be used as a prognostic tool. however ,larger studies with more advanced MRI techniques are needed to further evaluation and confirmation of our results.

Introduction :-

Virchow-Robin space (VRS) are pia-lined extensions of the subarachnoid space surround the walls of arteries, arterioles, veins, venules , that perforate the surface of the brain and enter the brain parenchyma[1].these Virchow-Robin space play an important role in immune responses within the brain[2].Increased vessel wall permeability ,decreased vascular compliance ,vascular ectasia and tortuosity,leads to cortical atrophy and ischemic perivascular tissue loss are consider to be responsible for dilation of VR spaces [3,4].Many researchers have described the significance of VR Spaces in the Multiple sclerosis (MS)[5,6,7].

MS is chronic disease of the central nervous system considered to be immune mediated demyelinating disease.the etiology and pathophysiology of the disease is still unknown however it is consider to be a combination of genetic and environmental factors [7].

MS lesion are found in perivenous location or on pial and ependymal surfaces and deposition of inflammatory cells in VR spaces is an important feature in acute lesions [8]. Although it is explained in previous studies that dialated perivascular spaces could be more predominant in MS disease [5,6,7].therefore ,the aim of our study was to analyze the frequency and size of VR spaces at three different regions of the brain in patients of Chinese ethenic group .who is newly diagnosed with multiple sclerosis (MS) and compare the results with healthy age and gender matched controls.

METHODS:-

Study designed: This study was a case-control study conducted in Chongqing PR China.This research protocol was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. Written consent was acquired from all of the participants after being fully informed about the nature of the study prior to enrollment.

Subjects: 50 MS patients (age ranges 15 to 51 years )subjects were recruited from November 2013 to February 2014. The inclusion criteria for patients is diagnosed by using McDonald criteria for MS followed by clinical evaluation and test done. 50 healthy age and gender matched controls without any neurological problem recruited for MRI scan. Subjects in the control group were excluded if they had a history of any acute or chronic disease, or their MRI revealed any white matter lesions. Both groups were interview and a detailed history was taken.

MRI data acquisition and protocol :- All volunteers were examined on a 3.0-T MR Device (Signal HD , GE healthcare ,USA) which using a 8-channel phased array head coils. MRI was performed with noncontrast axial and coronal T1W FSE, axial T2W FSE ,axial T2W FLAIR and sagittal FLAIR sequence followed by post contrast axial and coronal T1W sequences.

No obvious structural damage was found in any subject based on conventional MRI scans that were examined by two experienced radiologists.

VRs characteristics :- The VR spaces were identified using the following criteria:1 punctate foci with similar to CSF signal intensity on all MRI pulse sequences. 2 areas conforming to the pathway of the penetrating arteries. 3 areas that had no mass effect [9,10]. There is absence of any rim of hyperintensity on the FLAIR images is used to to differentiate VR spaces from chronic lacunar infarctions[11]

MS lesions are generally arranged like fingers pointing away from the wall of lateral ventricles (dawson finger) and can be easily differentiate from large VR space by signal intensity characteristics. T2 and FLAIR images showed hyperintense lesion while hypointense on TI -weighted image. The enhancement is depend on the current degree of inflammation [12].

The frequency of VRs is evaluated in 3 different region of the brain par enchyma which is as follow:region 1 The midbrain ; region 2 the lenticulostriate nucleus ,and region 3 the supraventricular region (fig)

Conflict of interest :

The authors declare that they have no conflict of interest.

References:

[1] Hutchings M, Weller RO: Anatomical relationships of the pia mater to cerebral blood vessels in man. J Neurosurg 1986; 65: 316–325.

[2] Achiron A, Faibel M. Sand like appearance of Virchow-Robin spaces in early multiple sclerosis: a novel neuroradiologic marker. AJNR Am J Neuroradiol 2002;23:376–80.

[3] Barkof F: Enlarged Virchow-Robin spaces: do they matter? J Neurol Neurosurg Psychiatry 2004; 75: 1516–1517.

[4] Maclullich AM, Wardlaw JM, Ferguson KJ, Starr JM, Seckl JR, Deary IJ: Enlarged perivascular spaces are associated with cognitive function in healthy elderly man. J Neurol Neurosurg Psychiatry 2004; 75: 1519–1523.

[5] Etemadifar M, Hekmatnia A, Tayari N, Kazemi M, Ghazavi A, Akbari M, Maghzi AH: Features of Virchow-Robin spaces in newly diagnosed multiple sclerosis patients. Eur J Radiol 2011; 80:e104–e108.

[6] Wuerfel J, Haertle M, Waiczies H, Tysiak E, Bechmann I, Wernecke KD, Zipp F, Paul F: Perivascular spaces – MRI marker of inflammatory activity in the brain? Brain 2008; 131: 2332–2340.

[7] Achiron A, Faibel M: Sandlike appearance of Virchow-Robin spaces in early multiple sclerosis: a novel neuroradiologic marker. Am J Neuroradiol 2002; 23: 376–380.

[8] Prineas J: Pathology of the early lesion in multiple sclerosis. Hum Pathol 1975; 6: 531–554.

[9] Braffman BH, Zimmerman RA, Trojanowski JQ, Gonatas NK, Hickey WF, Schlaepfer WW. Brain MR: pathologic correlation with gross and histopathology. I. Lacunarin farction and Virchow-Robin spaces. AJRAmJRoentgenol 1988; 151:551–8.

[10] Heier LA, Bauer CJ, Schwartz L, Zimmerman RD, Morgello S, Deck MD. Large Virchow-Robin spaces: MR-clinical correlation. AJNRAmJNeuroradiol 1989; 10:929–36.

[11] 4 Rouhl RP, van Oostenbrugge RJ, Knottnerus IL, Staals JE, Lodder J: Virchow-Robin spaces relate to cerebral small vessel disease severity. J Neurol 2008; 255: 692–696.

[12] Pretorius PM,Q uaghebeur G. The role of MRI in the diagnosis os MS .Clin Radiol 2003;58:434-448


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