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Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
The contribution of diffusion-weighted MR imaging in multiple sclerosis during acute attack
Ismail Yurtsever1, Bahattin Hakyemez, Ozlem Taskapilioglu
1Uludag University Medical School, Department of Radiology, Bursa, Turkey.
Purpose:
The aims of the study are firstly, to determine the difference in diffusion-weighted imaging (DWI) in normal appearing white matter (NAWM) between patients with acute multiple sclerosis (MS) and controls; secondly, to determine whether there is a correlation between EDSS scores and DWI in acute plaques and also NAWM.
Materials And Method:
Out of 50 patients with acute MS attack, 35 patients had active plaques with diffuse or ring enhancement on postcontrast images. Eighteen healthy volunteers constituted the control group. While 26 of 35 had relapsing-remitting, 9 had secondary progressive MS. Apparent diffusion coefficients (ADC) of the active plaques, NAWM at the level of centrum semiovale and occipital horn of lateral ventricle in the patients and NAWM in control group were measured. ADC values of active plaques were compared with WM of the patients and the control group. The relationship of ADC value of active plaques and WM in MS with expanded disability status scale (EDSS) was investigated by using Mann-Whitney U-test.
Results:
Of 63 plaques totally, 26 and 37 of the active plaques had diffuse and ring enhancement, respectively. There was no statistically significant difference between ADC value of active plaques and EDSS (p>0.05). However, there was a statistically significant difference between ADC value of WM occipital horn and EDSS (p<0.05). ADC value of active plaques were higher than WM in both groups (p<0.001). The difference between ADC value of WM at the centrum semiovale (p<0.05) and occipital horns (p<0.001) in patients and controls was statistically significant. There was no statistically significant difference between EDSS scores, ADC value at centrum semiovale and WM around occipital horn and active plaques in subgroups (p>0.05).
Conclusion:
Apparently normal tissue in MS patients may show early abnormalities when investigated carefully enough, and there is an even though moderate correlation between EDSS and ADC values and early alterations of ADC value are starting in the occipital white matter along the ventricles. This has to be verified in larger series.
Insights
Diffusion-weighted imaging reveals early white matter abnormalities in multiple sclerosis (MS) patients, even in apparently normal tissue. These early changes in the occipital white matter correlate moderately with disability scores.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple Sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system.
- Diffusion-weighted imaging (DWI) is a sensitive MRI technique for detecting microstructural changes in brain tissue.
- Understanding white matter alterations in MS is crucial for diagnosis and monitoring disease progression.
Purpose of the Study:
- To compare diffusion-weighted imaging (DWI) characteristics of normal-appearing white matter (NAWM) in patients with acute multiple sclerosis (MS) and healthy controls.
- To investigate the correlation between the Expanded Disability Status Scale (EDSS) and DWI metrics in both active MS plaques and NAWM.
Main Methods:
- Apparent diffusion coefficients (ADC) were measured in active plaques, NAWM (centrum semiovale and occipital horns), and control white matter.
- A cohort of 50 patients with acute MS attacks and 18 healthy volunteers were included.
- Statistical analysis, including the Mann-Whitney U-test, was used to compare ADC values and correlate them with EDSS scores.
Main Results:
- ADC values in active MS plaques were significantly higher than in white matter of both MS patients and controls.
- Statistically significant differences in ADC values were observed in the white matter at the centrum semiovale and occipital horns between MS patients and controls.
- A significant correlation was found between EDSS scores and ADC values in the occipital white matter, but not in active plaques.
Conclusions:
- Subtle white matter abnormalities can be detected in MS patients using DWI, even in regions appearing normal on conventional MRI.
- Early microstructural alterations in white matter, particularly in the occipital region, show a moderate correlation with clinical disability (EDSS).
- Further validation in larger studies is recommended to confirm these findings.
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