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Updated: Jun 29, 2026
Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Multiple sclerosis iron rim lesions are linked to impaired cervical spinal cord integrity using the T1/T2-weighted
Nicolas Wenzel1, Matthias Wittayer1, Claudia E Weber1
1Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany.
Background And Purpose:
In multiple sclerosis (MS), iron rim lesions (IRLs) are characterized by pronounced tissue matrix damage. The T1/T2-weighted (T1/T2w) ratio represents a postprocessing MRI approach to investigate tissue integrity, but studies investigating spinal cord pathology are missing until now. The aim of this study was to characterize tissue integrity using the T1/T2w ratio in lesions and the normal-appearing white and gray matter (NAWM, NAGM) in the spinal cord and brain in MS patients with and without brain IRLs.
Methods:
Forty MS patients (20 patients with at least one brain IRL and 20 age- and sex-matched patients without IRLs) were included. Normalized cross-sectional area (nCSA) of the upper cervical cord was calculated in addition to T1/T2w values and standard brain and spinal cord MRI parameters.
Results:
Patients with IRLs had higher disability scores, a smaller nCSA, and a higher cervical T2 lesion volume. T1/T2w values of brain IRLs were significantly lower compared to non-IRLs (p < .001). Furthermore, T1/T2w values of lesions were significantly lower compared to the NAGM and NAWM, both in the brain and the spinal cord (p < .05 for all comparisons). T1/T2w values of the NAGM and NAWM in the brain and spinal cord did not statistically differ between the IRL group and the non-IRL group.
Conclusion:
IRLs constitute an imaging marker of disease severity. T1/T2w ratio maps represent an interesting technique to capture diffuse tissue properties. Calculation of T1/T2w ratio maps of the spinal cord might provide additional insights into the pathophysiological processes of MS.
Insights
Iron rim lesions (IRLs) in multiple sclerosis (MS) indicate greater disease severity. The T1/T2-weighted (T1/T2w) ratio effectively measures tissue integrity in brain and spinal cord lesions, offering new insights into MS pathology.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Iron rim lesions (IRLs) in multiple sclerosis (MS) are associated with significant tissue matrix damage.
- The T1/T2-weighted (T1/T2w) ratio is a valuable postprocessing MRI technique for assessing tissue integrity.
- Previous studies have not investigated spinal cord pathology using the T1/T2w ratio.
Purpose of the Study:
- To characterize tissue integrity in MS patients using the T1/T2w ratio.
- To compare T1/T2w values in lesions and normal-appearing white and gray matter (NAWM, NAGM) in both the brain and spinal cord.
- To investigate the utility of T1/T2w ratio in MS patients with and without brain IRLs.
Main Methods:
- Forty MS patients were divided into two groups: 20 with brain IRLs and 20 without.
- MRI parameters, including T1/T2w values and normalized cross-sectional area (nCSA) of the cervical cord, were analyzed.
- Standard brain and spinal cord MRI metrics were also assessed.
Main Results:
- Patients with IRLs exhibited higher disability scores, reduced nCSA, and increased cervical T2 lesion volume.
- T1/T2w values were significantly lower in brain IRLs compared to non-IRLs.
- Lesions in both brain and spinal cord showed significantly lower T1/T2w values than NAWM and NAGM.
Conclusions:
- IRLs serve as an imaging biomarker for MS disease severity.
- T1/T2w ratio mapping is a promising technique for evaluating diffuse tissue properties in MS.
- Spinal cord T1/T2w ratio mapping may offer deeper insights into MS pathophysiology.
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