Robust Perfusion Deficits in Cognitively Impaired Patients with Secondary-Progressive Multiple Sclerosis

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Fig 1.
A, Decreased qCBV detected by SPM and PLS. Inferior-to-superior arrangement of axial sections with 3 different color overlays. The red overlay represents significantly reduced qCBV in cognitively impaired patients with SPMS identified by SPM alone. The green overlay represents significantly reduced qCBV in the same patients identified by PLS alone. The yellow overlay represents the overlap of the SPM and PLS results and thus significantly reduced qCBV found by both analytic techniques. B, Decreased qCBV and qCBF detected by PLS. Inferior-to-superior arrangement of axial sections with 3 different color overlays. The red overlay represents significantly reduced qCBV in cognitively impaired patients with SPMS identified by PLS. The green overlay represents significantly reduced qCBF in the same patients identified by PLS. The yellow overlay represents the overlap of the qCBV and qCBF hypoperfusion.

Table 1:

Clinical characteristics of patients with SPMS

Note:—BDI indicates Beck Depression Inventory; EDSS, Expanded Disability Status Scale.
↵a Wilcoxon rank sum test (median [interquartile range]).
↵b Pearson χ² test.

Table 2:

Global tissue volumes normalized to total intracranial volume

Table 3:

Regions of decreased qCBV in cognitively impaired patients with SPMS (PLS Analysis)

Cluster No.	Brain Region	Peak Voxel Coordinates^{^a}	Cluster Size	Bootstrap Ratio
1	Bilateral thalami (pulvinar)	0, −28, 4	171	9.29^{^b}
2	Left caudate body	−12, 6, 16	235	9.20^{^b}
3	Bilateral superior frontal gyri (BA 9)	−2, 52, 24	64	9.02^{^b}
4	Bilateral superior frontal gyri (BA 6)	0, 22, 46	161	7.29^{^b}
5	Right caudate body	12, 10, 8	105	7.71^{^b}
6	Right corpus callosum	26, −46, 18	26	7.04^{^b}
7	Left caudate tail	−20, −42, 8	111	6.63^{^b}
8	Right thalamus (pulvinar)	20, −36, 10	20	6.08^{^b}

Table 4:

Regions of decreased qCBF in cognitively impaired patients with SPMS (PLS Analysis)

Cluster No.	Brain Region	Peak Voxel Coordinates^{^a}	Cluster Size	Bootstrap Ratio
1	Bilateral thalami (pulvinar)	4, −28, 4	303	7.20^{^b}
2	Bilateral medial frontal gyrus (BA 9)	0, 50, 22	74	6.92^{^b}
3	Right cingulate gyrus (BA 31)	18, −38, 42	42	6.50^{^b}
4	Right caudate body	10, 10, 6	163	6.28^{^b}
5	Left caudate body	−12, −2, 14	62	5.91^{^b}
6	Right caudate tail	20, −18, 18	23	5.90^{^b}

Table 5:

Correlations between predictive variables and brain scores based on either qCBF or qCBV (PLS Analysis)

Predictive Variable	Correlation Coefficient (qCBF)	Correlation Coefficient (qCBV)
Normalized WML volume	−0.71^{^a}	−0.72^{^a}
SDMT	−0.56^{^a}	−0.52^{^a}
COWAT	−0.54^{^a}	−0.53^{^a}
Overall patient impairment	−0.53^{^a}	−0.53^{^a}
BVMT-R Delayed Recall	−0.51^{^a}	−0.51^{^a}
BVMT-R Total Learning	−0.49^{^a}	−0.46^{^a}
JLO	−0.45^{^a}	−0.43^{^a}
Normalized GM volume	0.44^{^a}	0.39^{^a}
PASAT	−0.41^{^a}	−0.38^{^a}
D-KEFS	−0.42^{^a}	−0.35^{^a}
CVLT-II Total Learning	−0.34^{^a}	−0.28^{^a}
CVLT-II Delayed Recall	−0.28^{^a}	−0.28

Note:—BVMT-R indicates Brief Visuospatial Memory Test-Revised; COWAT, Controlled Word Association Test; CVLT, California Verbal Learning Test; D-KEFS, Delis-Kaplan Executive Function System; JLO, judgment of line orientation; PASAT, Paced Auditory Serial Addition Test; SDMT, Symbol Digit Modalities Test.
↵a 95% confidence interval does not overlap zero.