Choroid plexus volume in multiple sclerosis: a systematic review and meta-analysis of an emerging imaging biomarker

Abstract

BackgroundThe choroid plexus (CP), as a structure located in the ventricles of the brain, is a critical site of immune signaling, and many studies have claimed that it may act as a biomarker for multiple sclerosis (MS). This review aimed to assess the CP volume (CPV) in people with MS (PwMS) and its correlation with disability scores and magnetic resonance imaging (MRI) metrics. MethodsA systematic search was conducted across four databases of PubMed/MEDLINE, Embase, Scopus, and Web of Science databases, covering the period from their inception until January 25, 2025. The meta-analysis was performed using a random-effects model to determine the pooled standard mean difference (SMD) of normalized CP (nCPV) between PwMS and healthy controls (HCs), and its correlation with MRI metrics and disability scores. ResultsA total of 27 studies were included, encompassing 1346 PwMS. The nCPV was found to be significantly higher in PwMS as compared to HCs (SMD = 1.12, 95 CI 0.68 to 1.56, p value < 0.01). In addition, nCPV exhibited the strongest correlations with normalized ventricular volume and (r = 0.59, 95CI 0.5 to 0.68, p < 0.01) and gray matter volume (r = - 0.41, 95 CI - 0.57 to - 0.24, p < 0.01, I2 = 64). Moreover, nCPV demonstrated an association with the Expanded Disability Status Scale (EDSS) (r = 0.23, 95 CI 0.16 to 0.31, p < 0.01, I2 = 15). ConclusionCPV is observed to be elevated in PwMS and exhibits correlations with disability scores and MRI metrics. Consequently, CPV may be a potential diagnostic and disease activity biomarker for MS. However, the strong correlation with the atrophy surrogate of ventricular volume necessitates further investigation.PROSPERO registration IDCRD42024586066