Can T2 blackout effect be a marker of iron accumulation in brains of multiple sclerosis patients?
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Updated: Dec 16, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Mehmet Fatih Erbay1, Özden Kamışlı2, Nur Betül Karatoprak1
1Department of Radiology, Inonu UniversityFaculty of Medicine, Malatya, Turkey.
Objective:
T2 blackout (TBO) effect, which is a common finding in the brains of multiple sclerosis (MS) patients and older population that are imaged for other reasons on diffusion weighted imagings (DWI) and apparent diffusion coefficient (ADC) map show the existence of paramagnetic materials in the tissue. Because iron is known to accumulate in especially deep gray matter (DGM) structures in MS brains, we aimed to investigate the relationship between TBO and clinico-radiological parameters that may be iron-related in MS.
Methods:
We retrospectively reviewed the latest MR images of MS patients on 3 Tesla MR scanner between 2018 and 2019. TBO existence and severity on DWI-ADC was assessed by two radiologists and its correlation with several outcomes of MS was investigated.
Results:
No significant relationship was found between TBO and gender, subtype of MS whereas TBO was positively correlated with parameters such as black-hole lesions, cortical atrophy, duration of disease, age and extended disability status scale (EDSS) score.
Conclusions:
TBO shows correlation with the conditions which were revealed to be associated with iron accumulation in the brain of MS patients in the literature. Therefore, we concluded that TBO and its severity in DGM may represent iron accumulation in MS brains.
Advances In Knowledge:
TBO effect as a frequent imaging finding in daily practice may be used as predictor of the disease course of MS due to possible effects of iron accumulation in brain and thereby may be useful in modifying treatment strategies.
Insights
T2 blackout (TBO) effect on MRI scans correlates with iron accumulation in multiple sclerosis (MS) brains. This finding may help predict MS disease progression and guide treatment strategies.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- T2 blackout (TBO) effect is observed in diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps.
- This effect indicates the presence of paramagnetic materials, such as iron, in brain tissue.
- Iron accumulation is particularly noted in deep gray matter (DGM) structures in multiple sclerosis (MS) patients.
Purpose of the Study:
- To investigate the relationship between T2 blackout (TBO) and clinico-radiological parameters associated with iron accumulation in MS.
- To explore the potential of TBO as an indicator of iron deposition in the MS brain.
Main Methods:
- Retrospective review of MRI scans from MS patients (3 Tesla scanner, 2018-2019).
- Assessment of TBO existence and severity on DWI-ADC maps by two radiologists.
- Correlation analysis between TBO and various MS outcomes.
Main Results:
- No significant correlation found between TBO and gender or MS subtype.
- TBO positively correlated with black-hole lesions, cortical atrophy, disease duration, age, and Expanded Disability Status Scale (EDSS) score.
- These correlated parameters are known to be associated with iron accumulation in MS.
Conclusions:
- T2 blackout (TBO) in MS brains correlates with conditions linked to iron accumulation.
- TBO and its severity in DGM may serve as a marker for iron accumulation in MS.
- TBO is a frequent imaging finding with potential as a predictor of MS disease course, aiding in treatment strategy modification.
