Choroid Plexus MRI Features and Cognitive Outcomes in Multiple Sclerosis: A Scoping Review

Abstract

Highlights What are the main findings? Larger choroid plexus volume was associated in several studies with poorer cognition in MS, particularly processing speed and visuospatial memory. Longitudinal evidence did not show consistent predictive value for choroid plexus volume; one study suggested prognostic value of the CP T1/T2 ratio. What are the implications of the main findings? Choroid plexus volume and microstructural measures are promising MRI research markers, but not yet established clinical biomarkers. Harmonized acquisition and segmentation and adequately powered longitudinal, multidomain studies are needed. Abstract Background/Objectives: Multiple sclerosis (MS) is frequently accompanied by cognitive impairment, yet the neurobiological mechanisms underlying cognitive heterogeneity remain incompletely understood. The choroid plexus (CP), a blood–CSF barrier structure involved in cerebrospinal fluid production and neuroimmune signaling, has recently emerged as a potential MRI marker of inflammatory and neurodegenerative activity in MS. This scoping review mapped evidence on associations between CP features and cognitive functions in adults with MS. Methods: A broad search of PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library identified 1163 records; after deduplication, screening, and full-text assessment, seven studies were included. Results: CP volume or normalized CP volume was assessed in all seven studies, and one study additionally examined the CP T1/T2 ratio. The Symbol Digit Modalities Test was used in six studies, while five applied multidomain cognitive assessment. Larger CP volume was associated in several studies with poorer baseline information-processing speed, visuospatial memory, or multidomain cognition, but longitudinal findings did not show consistent predictive value for CP volume. One study reported that a higher CP T1/T2 ratio predicted faster visuospatial-memory decline. Conclusions: CP-related measures may reflect broader neuroinflammatory and neurodegenerative processes relevant to cognition in MS, but the evidence remains limited and methodologically heterogeneous. Standardized acquisition and segmentation, harmonized cognitive assessment, and adequately powered longitudinal studies are needed to establish their independent and predictive value.