Differentiating multiple sclerosis from cerebral small vessel disease using diffusion tensor imaging and magnetic resonance spectroscopy on normally appearing thalami

Diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (1H-MRS) can detect the microstructural changes in normal-appearing conventional MRI. So, they may differentiate between multiple sclerosis (MS) cases and cerebral small vessel disease (CSVD). This work aimed to investigate if MRS and DTI are helpful in differentiating between MS and CSVD cases.

The study was conducted on 90 subjects divided into three groups: 30 relapsing–remitting MS patients, 30 patients with MRI showing CSVD, and 30 healthy controls. Diffusion tensor imaging measuring thalamic FA, ADC values, and 1H-MRS were conducted on patients and controls.

Thalamic FA values were significantly higher in the RRMS group than in the control and CSVD groups (P < 0.001, for each) but significantly lower in the CSVD group than the control group (P < 0.001). Moreover, thalamic ADC values were significantly higher in the CSVD group than in the control and MS groups (P < 0.001, for each). Also, thalamic NAA values were significantly lower in RRMS and CSVD groups than in controls (P < 0.001 for each). Still, they were significantly lower in the RRMS group than the CSVD group only on the left side (P = 0.004). The thalamic NAA/Cr values were significantly lower in RRMS (P < 0.001 for both sides) and CVSD than in controls (P = 0.044 and 0.036, for RT and LT sides, respectively).

Thalamic DTI and 1H-MRS can help detect the microstructural changes in normal-appearing thalami in RRMS and CSVD patients. Moreover, they can help differentiate MS from CSVD patients.