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Updated: Jul 31, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Weekly follow up of acute lesions in three early multiple sclerosis patients using MR spectroscopy and diffusion
Gabriel Kocevar1, Claudio Stamile1, Salem Hannoun2
1CREATIS, UMR5520, U1206 Inserm, université Claude-Bernard-Lyon1, 69621 Lyon, France.
Object:
Pathophysiological mechanisms underlying multiple sclerosis (MS) lesion formation, including inflammation, demyelination/remyelination and axonal damage, and their temporal evolution are still not clearly understood. To this end, three acute white matter lesions were monitored using a weekly multimodal magnetic resonance (MR) protocol.
Materials And Methods:
Three untreated patients with early relapsing-remitting MS and one healthy control subject were followed weekly for two months. MR protocol included conventional MR imaging (MRI), diffusion tensor imaging (DTI), and localized MR spectroscopy (MRS), performed on the largest gadolinium-enhancing lesion, selected at the first exam.
Results:
Mean diffusivity increased and fractional anisotropy decreased in lesions compared to healthy control. Cho/Cr ratios remained elevated in lesions throughout the follow-up. In contrast, temporal profiles of mI/Cr ratios varied between patients' lesions. For patient 1, mI/Cr ratios were already elevated at the beginning of the follow-up. Patients 2 and 3 ratios increase was delayed by two and five weeks. Blood-brain barrier (BBB) recovery occurred after three weeks.
Conclusion:
This multimodal MR follow-up highlighted the complementary role of DTI and MRS in identifying temporal relationships between BBB disruption, inflammation, and demyelination. Diffusion metrics showed high sensitivity to detect inflammatory processes. The different temporal profiles of mI suggested a potential better specificity to monitor pathological mechanisms occurring after lesion formation, such as glial proliferation and remyelination.
Insights
Multimodal magnetic resonance imaging reveals inflammation and demyelination in multiple sclerosis (MS) lesions. Diffusion tensor imaging and MR spectroscopy track disease progression and potential remyelination, aiding in understanding MS pathophysiology.
Area of Science:
- Neuroimaging
- Neurology
- Biomedical Engineering
Background:
- Multiple sclerosis (MS) lesion formation involves complex pathophysiological processes including inflammation, demyelination, remyelination, and axonal damage.
- The precise temporal evolution of these processes in MS lesions remains incompletely understood.
- Multimodal magnetic resonance (MR) techniques offer potential for detailed monitoring of these dynamic changes.
Purpose of the Study:
- To investigate the temporal evolution of pathophysiological mechanisms in acute white matter lesions in multiple sclerosis (MS).
- To assess the utility of a weekly multimodal MR protocol, including conventional MRI, diffusion tensor imaging (DTI), and localized MR spectroscopy (MRS), in characterizing MS lesions.
- To explore the relationship between blood-brain barrier (BBB) disruption, inflammation, and demyelination using advanced MR techniques.
Main Methods:
- Three untreated patients with early relapsing-remitting MS and one healthy control were monitored weekly for two months.
- A multimodal MR protocol comprising conventional MRI, DTI, and MRS was applied to the largest gadolinium-enhancing lesion.
- Diffusion metrics (mean diffusivity, fractional anisotropy) and metabolite ratios (Cho/Cr, mI/Cr) were analyzed over time.
Main Results:
- Diffusion metrics indicated increased mean diffusivity and decreased fractional anisotropy in MS lesions compared to controls.
- Elevated Cho/Cr ratios persisted in lesions throughout the follow-up period.
- Temporal profiles of mI/Cr ratios varied, with delayed increases observed in two patients, suggesting different post-lesion formation pathological processes. Blood-brain barrier recovery was noted after three weeks.
Conclusions:
- Multimodal MR imaging, combining DTI and MRS, effectively elucidates temporal relationships between BBB disruption, inflammation, and demyelination in MS.
- Diffusion metrics demonstrate high sensitivity for detecting inflammatory processes in MS lesions.
- Distinct temporal patterns of mI/Cr ratios may offer specificity in monitoring post-lesion formation mechanisms like glial proliferation and remyelination.
