AUTHOR=Dziadkowiak Edyta , Koszewicz Magdalena , Podgórski Przemysław , Wieczorek Małgorzata , Budrewicz Sławomir , Zimny Anna 

TITLE=Central nervous system involvement in chronic inflammatory demyelinating polyradiculoneuropathy—MRS and DTI study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1301405

DOI=10.3389/fneur.2024.1301405

ISSN=1664-2295

ABSTRACT=Objective: The aim of the current research was to analyze the alterations within the motor cortex and pyramidal pathways and their association with the degree of damage within peripheral nerve fibres in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). To achieve that goal we investigated microstructural changes within pyramidal white matter tracts using diffusion tensor imaging (DTI) parameters and also evaluated metabolic alterations in both precentral gyri using magnetic resonance spectroscopy (MRS) ratios and correlated them with neurographic findings in patients with CIDP.Methods: Spectroscopic ratios of NAA/Cr, Cho/Cr and mI/Cr from both precentral gyri as well as the values of FA, AD and MD from both corticospinal tracts were correlated with the results of neurological and neurographic findings. The comparison of DTI parameters between the patients and the controls was performed using the Student's t test or the Mann-Whitney U test.Due to the lack of normal distribution of most variables, Spearman's Rho rank coefficient was used to test all correlations. All analyses were performed at a significance level of alpha = 0.05 using STATISTICA 13.3.Compared to control group, the patient group showed significantly lower ratios of NAA/Cr (1.66±0.11 vs. 1.61±0.15; p=0.022) and higher ratios of ml/Cr in the right precentral gyrus (0.57±0.15 vs. 0.61±0.08; p=0.005) as well as higher levels of Cho/Cr within the left precentral gyrus (0.83±0.09 vs. 0.88±0.14; p=0.012). The DTI parameters of MD from the right CST and AD from the right and left CSTs showed strong positive correlation (0.52 -0.53) with the SNAP latency of the right sural nerve. There were no other significant correlations found between other DTI and MRS parameters and neurographic results.Significance: In our study, significant metabolic alterations were found in the precentral gyri in patients with CIDP without clinical symptoms of central nervous system involvement. The revealed changes reflected neuronal loss or dysfunction, myelin degradation and increased gliosis. Our results suggest coexisting CNS damage in these patients and may give a new insight into the still unknown patomechanism of CIDP.