Active brain changes after initiating fingolimod therapy in multiple sclerosis patients using individual voxel-based analyses for diffusion tensor imaging

作者：Senda Joe; Watanabe Hirohisa; Endo Kuniyuki; Yasui Keizo; Hawsegawa Yasuhiro; Yoneyama Noritaka; Tsuboi Takashi; Hara Kazuhiro; Ito Mizuki; Atsuta Naoki; Epifanio Bagarinao Jr; Katsuno Masahisa; Naganawa Shinji; Sobue Gen^*

来源：Nagoya Journal of Medical Science, 2016, 78(4): 455-463.

DOI：10.18999/nagjms.78.4.455

• multiple sclerosis (MS)
• fingolimod
• voxel based morphometry (VBM)
• diffusion tensor imaging (DTI)
• fluid-attenuated inversion recovery (FLAIR) high-intensity signals

Voxel-based analysis (VBA) of diffusion tensor images (DTI) and voxel-based morphometry (VBM) in patients with multiple sclerosis (MS) can sensitively detect occult tissue damage that underlies pathological changes in the brain. In the present study, both at the start of fingolimod and post-four months clinical remission, we assessed four patients with MS who were evaluated with VBA of DTI, VBM, and fluid-attenuated inversion recovery (FLAIR). DTI images for all four patients showed widespread areas of increased mean diffusivity (MD) and decreased fractional anisotropy (FA) that were beyond the high-intensity signal areas across images. After four months of continuous fingolimod therapy, DTI abnormalities progressed; in particular, MD was significantly increased, while brain volume and high-intensity signals were unchanged. These findings suggest that VBA of DTI (e.g., MD) may help assess MS demyelination as neuroinflammatory conditions, even though clinical manifestations of MS appear to be in complete remission during fingolimod.

• 出版日期2016-11