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Magnetization transfer imaging to monitor clinical trials in multiple sclerosis
1Laboratory of Diagnostic Radiology Research, Clinical Center, Bethesda, MD 20892-1074, USA.
Abstract:
Magnetization transfer imaging (MTI) is a sensitive magnetic resonance scanning technique for detecting disease activity and monitoring disease progression in multiple sclerosis (MS) patients. To date, MTI has not been used as an outcome measure in early phase and pivotal clinical trials. Magnetization transfer ratio, a quantitative measure of MT, can be used to follow the evolution of individual MS plaques as well as microscopic disease in normal-appearing white matter (NAWM). Volumetric whole brain MT ratios of every voxel in the brain can be expressed as a histogram, providing an estimate of cerebral atrophy and a global disease activity including "occult" disease in NAWM, thus providing a quantitative measure of a therapeutic response. This report will briefly focus on how MTI could be used to monitor a therapeutic response in a treatment trial and address some of the pitfalls/limitations of MTI that can be encountered even in a well-designed longitudinal study.
Insights
Magnetization transfer imaging (MTI) offers a sensitive method for tracking multiple sclerosis (MS) progression. This technique can quantify disease activity in normal-appearing white matter and assess therapeutic responses in clinical trials.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Multiple sclerosis (MS) requires sensitive monitoring techniques for disease activity and progression.
- Current clinical trials have not widely adopted Magnetization Transfer Imaging (MTI) as a primary outcome measure.
- MTI provides quantitative insights into MS pathology, including in normal-appearing white matter (NAWM).
Purpose of the Study:
- To explore the utility of Magnetization Transfer Imaging (MTI) as an outcome measure in multiple sclerosis (MS) clinical trials.
- To detail how MTI can monitor therapeutic responses in MS treatment studies.
- To identify potential limitations and challenges of using MTI in longitudinal MS studies.
Main Methods:
- Utilizing Magnetization Transfer Ratio (MTR) as a quantitative metric derived from MTI scans.
- Analyzing volumetric whole-brain MTR histograms to assess cerebral atrophy and global disease activity.
- Tracking the evolution of individual MS plaques and microscopic disease in NAWM.
Main Results:
- MTR histograms can estimate cerebral atrophy and global disease activity, including "occult" disease in NAWM.
- MTI enables quantitative assessment of therapeutic responses in MS.
- The technique can monitor the progression of individual MS lesions over time.
Conclusions:
- Magnetization transfer imaging (MTI) shows promise as a sensitive tool for monitoring therapeutic responses in multiple sclerosis (MS) clinical trials.
- Quantitative MTR measures, including histograms, can capture disease activity and atrophy.
- Awareness of MTI's limitations is crucial for successful implementation in longitudinal studies.