Background. Patients with clinically isolated syndrome (CIS) demonstrate brain hemodynamic changes and also suffer from difficulties in processing speed, memory, and executive functions. Objective. To explore whether brain hemodynamic disturbances in CIS patients correlate with executive functions. Methods. Thirty CIS patients and forty-three healthy subjects, matched for age, gender, education level, and FSIQ, were administered tests of visuomotor learning and set shifting ability. Cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) values were estimated in normal-appearing white matter (NAWM) and normal-appearing deep gray Matter (NADGM) structures, using a perfusion MRI technique. Results. CIS patients showed significantly elevated reaction time (RT) on both tasks, while their CBV and MTT values were globally increased, probably due to inflammatory vasodilation. Significantly, positive correlation coefficients were found between error rates on the inhibition condition of the visuomotor learning task and CBV values in occipital, periventricular NAWM and both thalami. On the set shifting condition of the respective task significant, positive associations were found between error rates and CBV values in the semioval center and periventricular NAWM bilaterally. Conclusion. Impaired executive function in CIS patients correlated positively with elevated regional CBV values thought to reflect inflammatory processes. 1. Introduction Conventional MRI (i.e., T2-weighted, FLAIR, DIR, and pre- and postcontrast T1-weighted images) has been widely used for the assessment and monitoring of patients with multiple sclerosis (MS), due to its high sensitivity in detecting MS-related cerebral white matter (WM) and gray matter (GM) lesions and its ability to quantify their volumes [1]. However, histological studies have revealed pathological damage in WM and GM areas that appeared normal in conventional MRI [2], a finding that is probably related to the poor association between brain total T2 lesion load and degree of physical disability of these patients [3]. On the contrary, nonconventional structural MR imaging (i.e., magnetization transfer imaging, diffusion tensor imaging, MR spectroscopy) proved valuable for assessing the extent of microscopic WM and deep GM damage even in clinically isolated syndrome (CIS), which represents the earliest stage of MS development [1, 4]. Further, hemodynamic changes in both WM and GM may serve as an early sign of regional involvement in disease progression [5]. Dynamic susceptibility-contrast-enhanced
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