Diffusion Tensor Imaging-Defined Sulcal Enlargement Is Related to Cognitive Impairment in Multiple Sclerosis

Zafer Keser, Khader M. Hasan, Benson Mwangi, Refaat E. Gabr, Flavia M. Nelson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND AND PURPOSE: Cerebrospinal fluid (CSF) in the brain can be compartmentalized into two main divisions: ventricular CSF and subarachnoid space (sulcal CSF). Changes in CSF volumetry are seen in many neurological conditions including multiple sclerosis (MS) and found to correlate with clinical outcomes. We aimed to test the relation between the volumetry of sulcal and ventricular CSF and cognitive impairment (CI) based on the minimal assessment of cognitive function in MS (MACFIMS) in patients with MS. MATERIAL AND METHODS: Forty-six patients with MS underwent the MACFIMS battery and classified as nonimpaired (MSNI) (n = 10) and cognitively impaired (MSCI) (n = 30) and borderline (MSBD) MS patients (n = 6). Volumes of sulcal and ventricular CSF along with global gray and white matter volumes and cortical thickness were obtained by diffusion tensor imaging (DTI) and T1-weighted (T1w)-based segmentation. These measures were statistically analyzed for associations with CI after adjusting for the age, education in years, lesion load, and disease duration. RESULTS: Sulcal CSF showed the strongest correlation with CI (r =.51, P =.001) in our cohort, whereas ventricular CSF (P =.28, P =.19) along with cortical thickness and gray matter volume failed to show a significant correlation. Group analyses unadjusted for multiple comparisons showed significant difference in volumes of sulcal CSF and ventricular CSF between MSNI and MSCI groups (P <.05). CONCLUSION: Sulcal CSF correlates with CI in patients with MS, possibly explained by cortical atrophy. DTI/T1w-based sulcal CSF segmentation method might be used as an indirect and simple neuroimaging marker to monitor CI in MS patients.

Original languageEnglish (US)
Pages (from-to)312-317
Number of pages6
JournalJournal of Neuroimaging
Issue number3
StatePublished - May 1 2017

Bibliographical note

Publisher Copyright:
Copyright © 2016 by the American Society of Neuroimaging

Copyright 2018 Elsevier B.V., All rights reserved.


  • CSF
  • Diffusion tensor imaging
  • cognitive impairment
  • multiple sclerosis
  • sulcal CSF
  • ventricular CSF


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