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Updated: Aug 18, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Brain atrophy and magnetization transfer ratio following methylprednisolone in multiple sclerosis: short-term changes
Robert J Fox1, Elizabeth Fisher, Jean Tkach
1Department of Neurology (Mellen Center), Cleveland Clinic Foundation, Cleveland, OH 44195, USA. foxr@ccf.org
Background:
The short-term effect of corticosteroids on MRI measures of multiple sclerosis (MS) is not well understood and may have a significant impact when using these quantitative measures to evaluate disease activity and changes following other therapeutic interventions.
Objective:
To determine the impact of a course of intravenous methylprednisolone (IVMP) on quantitative measures of disease activity and tissue injury in MS patients.
Methods:
We prospectively measured brain parenchymal fraction (BPF), magnetization transfer ratio (MTR, lesional and whole brain), and lesion volumes on nine weekly brain MRI studies in ten MS patients receiving a course of IVMP. A group of nine MS patients not receiving IVMP served as controls.
Results:
In comparison to untreated controls, BPF declined over the eight weeks following IVMP treatment (P <0.02). BPF decline was most prominent in patients with secondary progressive MS (SPMS, P <0.03), and was not seen in relapsing-remitting (RR) MS patients. Short-term change in BPF correlated with baseline BPF (r =0.62, P =0.05) and short-term change in lesional MTR (r = -0.55, P =0.03), but not with change in enhancing lesion volume. Short-term change in lesional MTR inversely correlated with baseline lesional and whole brain MTR (r = -0.79, P =0.04 for both). There was no significant difference between treated and control patients in measures of MTR or T2, T1 or enhancing lesion volumes.
Conclusions:
Patients with SPMS showed a greater decline in BPF following IVMP than RRMS patients. A correlation between changes in BPF and MTR suggest that these changes are secondary to altered water content within MS lesions. Differential response to a standardized therapeutic intervention in RRMS and SPMS suggests that responses to therapy may differ due to a fundamental pathologic difference between early and late stage MS.
Insights
Corticosteroid treatment impacts brain parenchymal fraction (BPF) in multiple sclerosis (MS) patients, particularly those with secondary progressive MS (SPMS). This suggests differing therapeutic responses based on MS pathology.
Area of Science:
- Neuroimaging
- Neurology
- Quantitative MRI
Background:
- Short-term effects of corticosteroids on MRI in multiple sclerosis (MS) are not fully understood.
- Quantitative MRI measures are crucial for evaluating MS disease activity and treatment efficacy.
Purpose of the Study:
- To assess the impact of intravenous methylprednisolone (IVMP) on quantitative MRI measures of disease activity and tissue injury in MS patients.
- To compare changes in MS patients receiving IVMP with a control group not receiving treatment.
Main Methods:
- Prospective measurement of brain parenchymal fraction (BPF), magnetization transfer ratio (MTR), and lesion volumes over nine weekly MRI scans.
- Inclusion of ten MS patients receiving IVMP and nine untreated MS patients as controls.
Main Results:
- BPF declined significantly in IVMP-treated patients compared to controls over eight weeks.
- BPF decline was more pronounced in secondary progressive MS (SPMS) than in relapsing-remitting MS (RRMS) patients.
- No significant differences were observed in MTR or lesion volumes between treated and control groups.
Conclusions:
- SPMS patients exhibit a greater BPF decline post-IVMP compared to RRMS patients.
- Changes in BPF and MTR suggest altered water content within MS lesions.
- Differential responses to IVMP in RRMS and SPMS indicate potential fundamental pathological differences influencing therapeutic outcomes.
