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A New Advanced MRI Biomarker for Remyelinated Lesions in Multiple Sclerosis
Reza Rahmanzadeh1,2,3, Riccardo Galbusera1,2,3, Po-Jui Lu1,2,3
1Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
Annals of Neurology
|June 17, 2022
Summary
Quantitative susceptibility mapping (QSM) can now differentiate chronic multiple sclerosis (MS) lesion types in vivo. This breakthrough aids in developing and evaluating new remyelinating treatments for MS patients.
Area of Science:
- Neuroimaging
- Neuropathology
- Biomarker Discovery
Background:
- Multiple sclerosis (MS) lesions exhibit heterogeneity in myelin/axon damage, repair, and iron content.
- Distinguishing specific chronic MS lesion types, particularly remyelinated ones, in vivo remains a significant clinical challenge.
Purpose of the Study:
- To investigate the utility of quantitative susceptibility mapping (QSM) in classifying chronic white matter (WM) lesions in multiple sclerosis (MS).
- To validate QSM-based lesion classification against postmortem neuropathology.
- To assess the potential of QSM as a biomarker for remyelination in MS.
Main Methods:
- A cross-sectional study of 115 MS patients and 76 controls using 3T MRI for QSM, myelin water fraction (MWF), and neurite density index (NDI).
- Lesions were classified into 5 QSM types: iso-intense, hypo-intense, hyperintense, hypo-intense rims, and paramagnetic rim lesions (PRLs).
- A longitudinal study tracked 40 MS patients over 2 years, and a postmortem study validated QSM classification in 63 WM lesions.
Main Results:
- Hypo- and isointense lesions showed higher MWF and NDI at baseline, with increased MWF over 2 years.
- Postmortem analysis confirmed QSM accuracy: 88.89% sensitivity and 100% specificity for remyelinated lesions (hypo-/iso-intense).
- QSM accurately identified chronic inactive (hyperintense) and active/smoldering (PRLs) lesions with high sensitivity and specificity.
Conclusions:
- QSM can reliably differentiate chronic MS lesion types in vivo.
- This technique offers novel biomarkers for assessing lesion activity and repair.
- QSM findings support the development and evaluation of remyelinating therapies for MS.
