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Disability in multiple sclerosis is related to normal appearing brain tissue MTR histogram abnormalities
A Traboulsee1, J Dehmeshki, Kevin R Peters
1NMR Research Unit, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK. trabouls@interchange.ubc.ca
Multiple Sclerosis (Houndmills, Basingstoke, England)
|December 11, 2003
Summary
Magnetization transfer ratio (MTR) histogram analysis reveals widespread abnormalities in normal-appearing brain tissue (NABT) in multiple sclerosis (MS) patients. These changes, particularly pronounced in secondary progressive MS, correlate with clinical disability and disease progression.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Magnetization transfer ratio (MTR) histogram analysis is a valuable tool for assessing global disease burden in multiple sclerosis (MS).
- MTR abnormalities in normal-appearing brain tissue (NABT) offer quantitative insights into tissue damage not detectable by conventional T2-weighted (T2W) MRI.
Purpose of the Study:
- To compare MTR histograms in NABT across diverse relapse-onset MS patient groups, including relapsing-remitting (RR) MS (newly diagnosed and benign) and secondary progressive (SP) MS.
- To investigate the correlation between clinical disability metrics and MTR histogram characteristics in NABT.
Main Methods:
- Magnetization transfer imaging was conducted using a 2D spin echo sequence on 70 RRMS and 25 SPMS patients, alongside 63 controls.
- MTR histograms were generated for NABT following the exclusion of lesions and cerebrospinal fluid (CSF).
- Brain parenchymal fraction (BPF) and T2 lesion load were quantified using T2W images.
Main Results:
- MS patients exhibited significantly reduced mean MTR in NABT compared to controls (P < 0.001), with effect size of 2.56.
- The reduction in NABT mean MTR was most substantial in SPMS (4.9%), followed by RRMS (3%), early RRMS (2.7%), and benign MS (2.5%).
- NABT mean MTR showed significant correlations with T2 lesion load (r = -0.82) and BPF (r = 0.58). Clinical disability (EDSS) correlated with NABT mean MTR (r = -0.43), BPF (r = -0.33), and T2 lesion load (r = 0.59).
Conclusions:
- Diffuse abnormalities in NABT and global brain atrophy are present in relapse-onset MS, including newly diagnosed and benign forms.
- These abnormalities are most severe in SPMS, indicating a greater pathological impact.
- Atrophy, NABT abnormalities, and lesion load are interconnected and collectively contribute to disability in MS, offering complementary insights into its complex pathology.