Magnetic Resonance Imaging Analysis of Virchow-Robin Space Characteristics in Multiple Sclerosis: A Case-Control Study

Abstract

Background: Virchow-Robin spaces (VRS) are perivascular spaces covered with soft tissue that extend from the subarachnoid space around the arteries and veins into the brain parenchyma. These spaces are involved in inflammatory processes in the brain. The VRS have been implicated in multiple sclerosis (MS), but their characteristics in MS patients are not well understood. This study investigated and compared the MRI features of VRS in MS patients and healthy controls. Objectives: The aim of this study was to compare the MRI features of VRS in patients with MS and those without MS. Patients and Methods: In this case-control study, 91 patients with MS and 91 individuals without MS (control group), all referred for brain MRI, were selected using available and consecutive sampling. The groups were compared based on the number, shape, and size of VRS. Standard MRI was performed using a SIEMENS MAGNETOM Avanto 1.5-Tesla scanner. Data were analyzed using SPSS version 20. Statistical tests included the chi-square test, Student's t-test, and Mann-Whitney U test. Logistic regression was used to adjust for age and gender, and the area under the curve (AUC) was calculated to evaluate model discrimination. A P-value of less than 0.05 was considered statistically significant. Results: The mean number of VRS was 2.82 ± 3.22 in the case group and 0.67 ± 1.97 in the control group [P < 0.001, Cohen's d = 0.82, 95% confidence interval (CI): 0.55 - 1.09]. The ROC curve analysis showed an AUC of 0.7614 (95% CI: 0.697 - 0.82), indicating good diagnostic performance. Logistic regression revealed that the number of VRS [odds ratio (OR) = 1.50, 95% CI: 1.25 - 1.80, P = 0.001] and round-shaped VRS (OR = 2.12, 95% CI: 1.54 - 2.94, P = 0.001) were significant predictors of MS. Conclusion: The number and shape of VRS on brain MRI were statistically associated with MS. These findings suggest potential diagnostic value. However, further prospective studies and high-resolution imaging are needed to confirm their clinical utility. The VRS may complement conventional biomarkers, such as white matter lesions (WMLs), in the evaluation of MS.