Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesis

Background: Studies of thalamic iron levels in multiple sclerosis (MS) have yielded variable findings, potentially due to differences in study cohorts. For example, studies in relatively young cohorts (average ages below 40 years) have reported elevated susceptibility in people with MS (pwMS), where...

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Main Authors: Fahad Salman, Niels Bergsland, Michael G. Dwyer, Jack A Reeves, Abhisri Ramesh, Dejan Jakimovski, Bianca Weinstock-Guttman, Robert Zivadinov, Ferdinand Schweser
Format: Article
Language:English
Published: Elsevier 2025-01-01
Series:NeuroImage: Clinical
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Online Access:http://www.sciencedirect.com/science/article/pii/S2213158225000415
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author Fahad Salman
Niels Bergsland
Michael G. Dwyer
Jack A Reeves
Abhisri Ramesh
Dejan Jakimovski
Bianca Weinstock-Guttman
Robert Zivadinov
Ferdinand Schweser
author_facet Fahad Salman
Niels Bergsland
Michael G. Dwyer
Jack A Reeves
Abhisri Ramesh
Dejan Jakimovski
Bianca Weinstock-Guttman
Robert Zivadinov
Ferdinand Schweser
author_sort Fahad Salman
collection DOAJ
description Background: Studies of thalamic iron levels in multiple sclerosis (MS) have yielded variable findings, potentially due to differences in study cohorts. For example, studies in relatively young cohorts (average ages below 40 years) have reported elevated susceptibility in people with MS (pwMS), whereas studies in older cohorts (above 40 years) found decreased susceptibility. Objective: To test the “early-rise late-decline” hypothesis, which posits that age differences in study cohorts are responsible for conflicting findings regarding thalamic susceptibility in MS. Methods: We chose to replicate one of the previous studies that showed evidence of elevated thalamic iron concentrations in younger pwMS (Rudko et al., 2014). We also replicated a study involving older pwMS (Pudlac et al., 2020) to serve as a control. We assessed thalamic susceptibility using the QSM processing and analysis methodology outlined by Rudko et al. Results: Although cohort characteristics, QSM processing, and analytical methods were closely matched, we found significantly lower thalamic susceptibility in the younger pwMS compared to controls (−1.1 ± 7.8 vs. 5.4 ± 6.1 ppb; effect sizes: −0.35 to −0.91). Study outcomes were robust across a wide range of regularization parameters, with effect size differences influenced by background field removal regularization. A similar pattern was observed in the older cohort, where thalamic susceptibility was again lower in pwMS compared to controls (4.0 ± 9.5 vs. 9.6 ± 10.7 ppb; effect size: −0.55). Conclusions: Our findings contradict the “early rise” hypothesis of thalamic iron levels in pwMS. The consistency of our results across multiple analyses suggests that QSM processing artifacts are unlikely to explain previous reports of increased thalamic iron. Instead, these variations may stem from demographic or clinical differences, such as geographical factors and treatment regimens.
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spelling doaj-art-adbefe3a93874f7cbdc831e667b256fd2025-08-20T02:02:24ZengElsevierNeuroImage: Clinical2213-15822025-01-014610377110.1016/j.nicl.2025.103771Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesisFahad Salman0Niels Bergsland1Michael G. Dwyer2Jack A Reeves3Abhisri Ramesh4Dejan Jakimovski5Bianca Weinstock-Guttman6Robert Zivadinov7Ferdinand Schweser8Buffalo Neuroimaging Analysis Center, Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States; Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United StatesBuffalo Neuroimaging Analysis Center, Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United StatesBuffalo Neuroimaging Analysis Center, Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States; Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, United StatesBuffalo Neuroimaging Analysis Center, Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United StatesBuffalo Neuroimaging Analysis Center, Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United StatesWynn Hospital, Mohawk Valley Health System, Utica, NY, United StatesJacobs Neurological Institute, Buffalo, NY, United StatesBuffalo Neuroimaging Analysis Center, Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States; Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, United StatesBuffalo Neuroimaging Analysis Center, Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States; Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, United States; Corresponding author at: Center for Biomedical Imaging, Clinical and Translational Science Institute, University at Buffalo, The State University of New York, Buffalo, NY, United States.Background: Studies of thalamic iron levels in multiple sclerosis (MS) have yielded variable findings, potentially due to differences in study cohorts. For example, studies in relatively young cohorts (average ages below 40 years) have reported elevated susceptibility in people with MS (pwMS), whereas studies in older cohorts (above 40 years) found decreased susceptibility. Objective: To test the “early-rise late-decline” hypothesis, which posits that age differences in study cohorts are responsible for conflicting findings regarding thalamic susceptibility in MS. Methods: We chose to replicate one of the previous studies that showed evidence of elevated thalamic iron concentrations in younger pwMS (Rudko et al., 2014). We also replicated a study involving older pwMS (Pudlac et al., 2020) to serve as a control. We assessed thalamic susceptibility using the QSM processing and analysis methodology outlined by Rudko et al. Results: Although cohort characteristics, QSM processing, and analytical methods were closely matched, we found significantly lower thalamic susceptibility in the younger pwMS compared to controls (−1.1 ± 7.8 vs. 5.4 ± 6.1 ppb; effect sizes: −0.35 to −0.91). Study outcomes were robust across a wide range of regularization parameters, with effect size differences influenced by background field removal regularization. A similar pattern was observed in the older cohort, where thalamic susceptibility was again lower in pwMS compared to controls (4.0 ± 9.5 vs. 9.6 ± 10.7 ppb; effect size: −0.55). Conclusions: Our findings contradict the “early rise” hypothesis of thalamic iron levels in pwMS. The consistency of our results across multiple analyses suggests that QSM processing artifacts are unlikely to explain previous reports of increased thalamic iron. Instead, these variations may stem from demographic or clinical differences, such as geographical factors and treatment regimens.http://www.sciencedirect.com/science/article/pii/S2213158225000415Multiple sclerosisquantitative susceptibility mapping (QSM)ThalamusIron metabolismReproducibilityDeep gray matter
spellingShingle Fahad Salman
Niels Bergsland
Michael G. Dwyer
Jack A Reeves
Abhisri Ramesh
Dejan Jakimovski
Bianca Weinstock-Guttman
Robert Zivadinov
Ferdinand Schweser
Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesis
NeuroImage: Clinical
Multiple sclerosis
quantitative susceptibility mapping (QSM)
Thalamus
Iron metabolism
Reproducibility
Deep gray matter
title Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesis
title_full Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesis
title_fullStr Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesis
title_full_unstemmed Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesis
title_short Thalamic iron in multiple sclerosis: Waning support for the early-rise late-decline hypothesis
title_sort thalamic iron in multiple sclerosis waning support for the early rise late decline hypothesis
topic Multiple sclerosis
quantitative susceptibility mapping (QSM)
Thalamus
Iron metabolism
Reproducibility
Deep gray matter
url http://www.sciencedirect.com/science/article/pii/S2213158225000415
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