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Updated: May 1, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Normal appearing and diffusely abnormal white matter in patients with multiple sclerosis assessed with quantitative
Janne West1, Anne Aalto2, Anders Tisell1
1Radiation Physics, Department of Medicine and Health, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
Introduction:
Magnetic Resonance Imaging is a sensitive technique for detecting white matter (WM) MS lesions, but the relation with clinical disability is low. Because of this, changes in both 'normal appearing white matter' (NAWM) and 'diffusely abnormal white matter' (DAWM) have been of interest in recent years. MR techniques, including quantitative magnetic resonance imaging (qMRI) and quantitative magnetic resonance spectroscopy (qMRS), have been developed in order to detect and quantify such changes. In this study, qMRI and qMRS were used to investigate NAWM and DAWM in typical MS patients and in MS patients with low number of WM lesions. Patient data were compared to 'normal white matter' (NWM) in healthy controls.
Methods:
QMRI and qMRS measurements were performed on a 1.5 T Philips MR-scanner. 35 patients with clinically definite MS and 20 healthy controls were included. Twenty of the patients fulfilled the 'Barkhof-Tintoré criteria' for MS, ('MRIpos'), whereas 15 showed radiologically atypical findings with few WM lesions ('MRIneg'). QMRI properties were determined in ROIs of NAWM, DAWM and lesions in the MS groups and of NWM in controls. Descriptive statistical analysis and comparisons were performed. Correlations were calculated between qMRI measurements and (1) clinical parameters and (2) WM metabolite concentrations. Regression analyses were performed with brain parenchyma fraction and MSSS.
Results:
NAWM in the MRIneg group was significantly different from NAWM in the MRIpos group and NWM. In addition, R1 and R2 of NAWM in the MRIpos group correlated negatively with EDSS and MSSS. DAWM was significantly different from NWM, but similar in the MS groups. N-acetyl aspartate correlated negatively with R1 and R2 in MRIneg. R2 of DAWM was associated with BPF.
Conclusions:
Changes in NAWM and DAWM are independent pathological entities in the disease. The correlation between qMRI and clinical status may shed new light on the clinicoradiological paradox.
Insights
Quantitative MRI and MRS reveal distinct changes in normal-appearing white matter (NAWM) and diffusely abnormal white matter (DAWM) in multiple sclerosis (MS) patients, offering new insights into the MS clinicoradiological paradox.
Area of Science:
- Neuroimaging
- Quantitative Magnetic Resonance Imaging (qMRI)
- Quantitative Magnetic Resonance Spectroscopy (qMRS)
Background:
- Magnetic Resonance Imaging (MRI) detects white matter (WM) lesions in MS but shows low correlation with clinical disability.
- Investigating changes in normal-appearing white matter (NAWM) and diffusely abnormal white matter (DAWM) is crucial for understanding MS progression.
- Quantitative MRI (qMRI) and MRS (qMRS) techniques aim to detect and quantify these subtle WM changes.
Purpose of the Study:
- To investigate NAWM and DAWM using qMRI and qMRS in MS patients with typical and atypical lesion loads.
- To compare qMRI/qMRS findings in MS patients with normal white matter (NWM) in healthy controls.
- To explore correlations between qMRI measurements, clinical parameters, and metabolite concentrations.
Main Methods:
- QMRI and qMRS measurements were conducted on a 1.5 T MR scanner.
- 35 MS patients (20 MRI-positive, 15 MRI-negative) and 20 healthy controls were included.
- QMRI properties and metabolite concentrations were analyzed in regions of interest (ROIs) of NAWM, DAWM, and NWM.
Main Results:
- NAWM differed significantly between MRI-negative MS patients, MRI-positive MS patients, and controls.
- R1 and R2 of NAWM in MRI-positive patients correlated negatively with EDSS and MSSS scores.
- DAWM differed from NWM, with R2 of DAWM associated with brain parenchyma fraction (BPF).
Conclusions:
- NAWM and DAWM represent independent pathological entities in MS.
- The observed correlations between qMRI and clinical status may help explain the clinicoradiological paradox in MS.
- qMRI and qMRS provide valuable insights into white matter changes beyond focal lesions in MS.
Related Concept Videos
01:24Magnetic Resonance Imaging
01:19Multiple Sclerosis l: Introduction