Bicaudate Ratio as a Magnetic Resonance Imaging Marker of Brain Atrophy in Multiple Sclerosis | Radiology | JAMA Neurology | JAMA Network
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Loevner  LAGrossman  RICohen  JALexa  FJKessler  DKolson  DL Microscopic disease in normal-appearing white matter on conventional MR images in patients with multiple sclerosis: assessment with magnetization-transfer measurements.  Radiology.1995;196:511-515.Google Scholar
Barkhof  F MRI in multiple sclerosis: correlation with Expanded Disability Status Scale (EDSS) [review].  Mult Scler.1999;5:283-286.Google Scholar
Losseff  NAWang  LLai  HM  et al Progressive cerebral atrophy in multiple sclerosis: a serial MRI study.  Brain.1996;119:2009-2019.Google Scholar
Simon  JHJacobs  LDCampion  MK  et alfor the Multiple Sclerosis Collaborative Research Group A longitudinal study of brain atrophy in relapsing multiple sclerosis.  Neurology.1999;53:139-148.Google Scholar
Fox  NCJenkins  RLeary  SM  et al Progressive cerebral atrophy in MS: a serial study using registered, volumetric MRI.  Neurology.2000;54:807-812.Google Scholar
Rudick  RAFisher  ELee  JCSimon  JJacobs  Lfor the Multiple Sclerosis Collaborative Research Group Use of the brain parenchymal fraction to measure whole brain atrophy in relapsing-remitting MS.  Neurology.1999;53:1698-1704.Google Scholar
Bakshi  RBenedict  RHBermel  RAJacobs  L Regional brain atrophy is associated with physical disability in multiple sclerosis: semiquantitative magnetic resonance imaging and clinical findings.  J Neuroimaging.2001;11:129-136.Google Scholar
Ge  YGrossman  RIUdupa  JK  et al Brain atrophy in relapsing-remitting multiple sclerosis and secondary progressive multiple sclerosis: longitudinal quantitative analysis.  Radiology.2000;214:665-670.Google Scholar
Aylward  EHSchwartz  JMachlin  SPearlson  G Bicaudate ratio as a measure of caudate volume on MR images.  AJNR Am J Neuroradiol.1991;12:1217-1222.Google Scholar
Doraiswamy  PMPatterson  LNa  C  et al Bicaudate index on magnetic resonance imaging: effects of normal aging.  J Geriatr Psychiatry Neurol.1994;7:13-17.Google Scholar
Hestad  KMcArthur  JHDal Pan  GJ  et al Regional brain atrophy in HIV-1 infection: association with specific neuropsychological test performance.  Acta Neurol Scand.1993;88:112-118.Google Scholar
Starkstein  SEFolstein  SEBrandt  JPearlson  GDMcDonnell  AFolstein  M Brain atrophy in Huntington's disease: a CT-scan study.  Neuroradiology.1989;31:156-159.Google Scholar
Poser  CMPaty  DWScheinberg  L  et al New diagnostic criteria for multiple sclerosis: guidelines for research protocols.  Ann Neurol.1983;13:227-231.Google Scholar
Lublin  FDReingold  SCfor the National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis Defining the clinical course of multiple sclerosis: results of an international survey.  Neurology.1996;46:907-911.Google Scholar
Kurtzke  JF Rating neurologic impairment in multiple sclerosis: an Expanded Disability Status Scale (EDSS).  Neurology.1983;33:1444-1452.Google Scholar
Bakshi  RBenedict  RHBermel  RA  et al T2 hypointensity in the deep gray matter of patients with multiple sclerosis: a quantitative magnetic resonance imaging study.  Arch Neurol.2002;59:62-68.Google Scholar
Smith  A Symbol Digit Modalities Test: Manual.  Los Angeles, Calif: Western Psychological Services; 1982.
Bakshi  RCaruthers  SDJanardhan  VWasay  M Intraventricular CSF pulsation artifact on fast fluid-attenuated inversion-recovery MR images: analysis of 100 consecutive normal studies.  AJNR Am J Neuroradiol.2000;21:503-508.Google Scholar
Jack Jr  CRTwomey  CKZinsmeister  ARSharbrough  FWPetersen  RCCascino  GD Anterior temporal lobes and hippocampal formations: normative volumetric measurements from MR images in young adults.  Radiology.1989;172:549-554.Google Scholar
Emmerson  RYDustman  REShearer  DETurner  CW P3 latency and symbol digit performance correlations in aging.  Exp Aging Res.1989;15:151-159.Google Scholar
Cummings  JL Anatomic and behavioral aspects of frontal-subcortical circuits [review].  Ann N Y Acad Sci.1995;769:1-13.Google Scholar
Beatty  WWPaul  RHWilbanks  SLHames  KABlanco  CRGoodkin  DE Identifying multiple sclerosis patients with mild or global cognitive impairment using the Screening Examination for Cognitive Impairment (SEFCI).  Neurology.1995;45:718-723.Google Scholar
Original Contribution
February 2002

Bicaudate Ratio as a Magnetic Resonance Imaging Marker of Brain Atrophy in Multiple Sclerosis

Author Affiliations

From the Buffalo Neuroimaging Analysis Center, Jacobs Neurological Institute (Messrs Bermel and Tjoa and Drs Bakshi, Puli, and Jacobs); Department of Neurology, Kaleida Health and the University at Buffalo, State University of New York (Drs Bakshi and Jacobs); and the Department of Imaging Services, Kaleida Health (Dr Bakshi), Buffalo, NY.

Arch Neurol. 2002;59(2):275-280. doi:10.1001/archneur.59.2.275

Context  Brain atrophy has emerged as a useful surrogate marker of disease involvement in multiple sclerosis (MS). The relationship between whole-brain or regional atrophy and cognitive dysfunction is poorly understood.

Objectives  To determine whether the bicaudate ratio (BCR)—the minimum intercaudate distance divided by brain width along the same line—is increased in MS and to compare the ability of the BCR, whole-brain atrophy, and other magnetic resonance imaging markers to predict cognitive dysfunction.

Design  Case-control study.

Setting  University-affiliated clinic.

Participants  Sixty patients with MS and 50 age- and sex-matched control subjects.

Main Outcome Measures  Bicaudate ratio, whole-brain atrophy, T2 lesion load, T1 ("black hole") lesion load, and caudate volume were measured quantitatively using fluid-attenuated inversion recovery, T1-weighted, and gradient-echo magnetic resonance imaging scans. Symbol Digit Modalities Test was used to assess cognitive function.

Results  The BCR (mean [SD]) was higher in patients with MS (0.11 [0.03]) than in controls (0.09 [0.02]) (P<.001), suggesting subcortical atrophy in MS. The BCR was related to total T2 (r = 0.56, P<.001) and T1 (r = 0.40, P<.002) lesion volumes, but not caudate volume in patients with MS. Regression modeling selected BCR (P<.05), but not whole-brain atrophy, T1 or T2 lesion volume, or caudate volume as predictive of Symbol Digit Modalities Test score in patients with MS.

Conclusions  The BCR is increased in MS and is more closely associated with cognitive dysfunction than are other magnetic resonance imaging surrogate markers including whole-brain atrophy. Increased BCR is best explained by frontal horn ventricular enlargement due to atrophy of deep frontal subcortical white matter. This highlights the close relationship between subcortical atrophy and cognitive impairment in patients with MS.