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Updated: Jun 12, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Cortical Thin Patch Fraction Reflects Disease Burden in MS: The Mosaic Approach
Marlene Tahedl1, Tun Wiltgen2, Cui Ci Voon2
1From the Department of Neuroradiology (M.T., J.S.K., C.Z., B.W.), School of Medicine, Technical University of Munich, Munich, Germany marlene.tahedl@tum.de.
Background And Purpose:
GM pathology plays an essential role in MS disability progression, emphasizing the importance of neuroradiologic biomarkers to capture the heterogeneity of cortical disease burden. This study aimed to assess the validity of a patch-wise, individual interpretation of cortical thickness data to identify GM pathology, the "mosaic approach," which was previously suggested as a biomarker for assessing and localizing atrophy.
Materials And Methods:
We investigated the mosaic approach in a cohort of 501 patients with MS with respect to 89 internal and 651 external controls. The resulting metric of the mosaic approach is the so-called thin patch fraction, which is an estimate of overall cortical disease burden per patient. We evaluated the mosaic approach with respect to the following: 1) discrimination between patients with MS and controls, 2) classification between different MS phenotypes, and 3) association with established biomarkers reflecting MS disease burden, using general linear modeling.
Results:
The thin patch fraction varied significantly between patients with MS and healthy controls and discriminated among MS phenotypes. Furthermore, the thin patch fraction was associated with disease burden, including the Expanded Disability Status Scale, cognitive and fatigue scores, and lesion volume.
Conclusions:
This study demonstrates the validity of the mosaic approach as a neuroradiologic biomarker in MS. The output of the mosaic approach, namely the thin patch fraction, is a candidate biomarker for assessing and localizing cortical GM pathology. The mosaic approach can furthermore enhance the development of a personalized cortical MS biomarker, given that the thin patch fraction provides a feature on which artificial intelligence methods can be trained. Most important, we showed the validity of the mosaic approach when referencing data with respect to external control MR imaging repositories.
Insights
The mosaic approach, using thin patch fraction, effectively identifies gray matter pathology in multiple sclerosis (MS). This neuroradiologic biomarker shows promise for personalized MS assessment and tracking disease progression.
Area of Science:
- Neuroimaging
- Biomarker Development
- Multiple Sclerosis Research
Background:
- Gray matter (GM) pathology significantly impacts multiple sclerosis (MS) disability progression.
- Neuroradiologic biomarkers are crucial for understanding the diverse cortical disease burden in MS.
- Cortical atrophy assessment requires methods to capture localized pathology.
Purpose of the Study:
- To validate the "mosaic approach" for identifying GM pathology through patch-wise cortical thickness analysis.
- To assess the utility of the mosaic approach's output, the thin patch fraction, as a biomarker.
- To evaluate the mosaic approach's performance in discriminating MS patients from controls and classifying MS phenotypes.
Main Methods:
- Investigated the mosaic approach in 501 MS patients and 651 controls (internal and external).
- Calculated the thin patch fraction as a measure of overall cortical disease burden.
- Employed general linear modeling to assess discrimination, classification, and association with established MS biomarkers.
Main Results:
- The thin patch fraction significantly differed between MS patients and healthy controls.
- The thin patch fraction successfully discriminated among different MS phenotypes.
- Thin patch fraction correlated with disease severity metrics like Expanded Disability Status Scale, cognitive/fatigue scores, and lesion volume.
Conclusions:
- The mosaic approach is a valid neuroradiologic biomarker for assessing and localizing cortical GM pathology in MS.
- The thin patch fraction serves as a candidate biomarker for personalized MS assessment.
- The mosaic approach's validity is confirmed across diverse imaging datasets, supporting AI-driven biomarker development.
