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Corpus Callosum Area: A Reliable and Feasible Neuroimaging Marker of Cognitive Impairment in Multiple Sclerosis

Tomoko Okamoto

Background: Several magnetic resonance imaging markers of cognitive impairment have been reported in multiple sclerosis. Nonetheless, measurement often requires volumetry, a time consuming technique that has problems with respect to accuracy in the segmentation of brain structures. The corpus callosum area is a marker of cognitive impairment that requires no volumetric technique; however, the usefulness of this marker has not been fully examined. This study aimed to determine whether the normalized corpus callosum area is a feasible and sensitive magnetic resonance imaging marker of cognitive impairment in multiple sclerosis.

Methods and findings: A total of 136 patients with multiple sclerosis who underwent the Montreal cognitive assessment and magnetic resonance imaging examination of the head were retrospectively reviewed. The normalized corpus callosum area was manually measured on a sagittal midline T1 weighted sequence using a picture archiving communication system. The normalized volumes of the brain parenchyma, cortex, thalamus, hippocampus, putamen, globus pallidus, caudate, and cerebellum were measured using FreeSurfer software. The normalized lesion volume was measured using the SPM software. Receiver operating characteristic curves were drawn for 10 MRI markers, along with the optimal cutoff value, sensitivity, specificity, and area under the curve. The Youden index was calculated for all parameters.

The normalized corpus callosum area was moderately associated with the Montreal cognitive assessment score after adjusting for age, sex, disease duration, and type of magnetic resonance imaging scanner (ρ=0.56; p<0.001). This indicator showed the strongest correlation among all the magnetic resonance imaging markers. Among all MRI markers, the normalized corpus callosum area showed the largest area under the curve (0.782) and had the second highest Youden index (0.463), following the normalized lesion volume.

Results: 90.2% of the participants were women, 84% had been under surgery with a Sleeve Gastrectomy technique while the rest underwent Roux-Y Gastric Bypass. The obtained model showed a significant correlation between the SCL 90-R subscales and the COVID-19 related psychological distress and both were negatively correlated to participant’s age. The model had adequate goodness-of-fit indicators (Chi-square goodness-of-fit (χ2): 78.007, df: 64, p: 0.112; Root Mean Square Error of Approximation (RMSEA): 0.047; Goodness of Fit Index (GFI): 0.907; Comparative Fit Index (CFI): 0.991; Parsimony Normed Fit Index (PNFI): 0.670; Akaike Information Criterion (AIC): 160.007).

Conclusion: The normalized corpus callosum area, which is easily measured without volumetry, showed the strongest correlation with cognitive function. Therefore, this indicator may be a reliable and feasible marker of cognitive impairment in patients with multiple sclerosis.