Assessment of GM Damage

Using ROI (172) and histogram analysis (172,188-192), MT MRI and DW MRI abnormalities have been shown in the GM of MS patients, including those with PPMS (188,190), whereas no MD abnormalities have been detected in the GM of patients at presentation with CIS (98). Although GM changes are more pronounced in patients with SPMS than in those with RRMS (190,192), a recent 18-month follow-up study has shown that GM damage increases with time in RRMS patients (Fig. 14) (193). This suggests a progressive accumulation of GM damage already in the RR phase of the disease, which was previously unrecognized and which might be one of the factors responsible for the development of brain atrophy (111). No difference in the extent and severity of GM involvement has been found between patients with SPMS and those with PPMS (188).

Metabolite abnormalities, including decrease of NAA, Cho, and glutamate, have also been shown in the cortical GM of MS patients (152,194-196) since the early phases of the disease (194), but not in CIS patients (197). These changes are more pronounced in patients with SPMS than in those with RRMS (195,198). Reduced

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