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Improving the Assessment of Axonal Injury in Early Multiple Sclerosis
Ahmad A Toubasi1, Gary Cutter2, Caroline Gheen1
1Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center (VUMC), Nashville, TN (A.A.T., C.G., T.V., K.Y., S.A., P.A., F.B.).
Rationale And Objectives:
Several quantitative magnetic resonance imaging (MRI) methods are available to measure tissue injury in multiple sclerosis (MS), but their pathological specificity remains limited. The multi-compartment diffusion imaging using the spherical mean technique (SMT) overcomes several technical limitations of the diffusion-weighted image signal, thus delivering metrics with increased pathological specificity. Given these premises, here we assess whether the SMT-derived apparent axonal volume (Vax) provides a better tissue classifier than the diffusion tensor imaging (DTI)-derived axial diffusivity (AD) in the white matter (WM) of MS brains.
Methods:
Forty-three treatment-naïve people with newly diagnosed MS, clinically isolated syndrome, or radiologically isolated syndrome and 18 healthy controls (HCs) underwent a 3.0 Tesla MRI inclusive of T1-weighted (T1-w) and T2-w fluid-attenuated inversion recovery (FLAIR) sequences, and multi-b shell diffusion-weighted imaging. In patients only, pre- and post-gadolinium diethylenetriamine penta-acetic acid T1-w sequences were obtained for the evaluation of contrast-active lesions (CELs). Vax and AD were calculated in T2-lesions, chronic black holes (cBHs), and normal appearing (NAWM) in patients and normal WM (NWM) in HCs. Vax and AD values were compared across all the possible combinations of these regions. CELs were excluded from the analyses.
Results:
Vax differed in all comparisons (p ≤ 0.047 by paired t-test); AD differed in most comparisons (p < 0.001) except between NAWM and NWM, and between cBHs and T2-lesions. Vax had higher accuracy (p ≤ 0.029 by DeLong test) and larger effect size (p ≤ 0.038 by paired t-test) than AD in differentiating areas with even minimal tissue injury.
Conclusions:
Vax provides a better radiological quantitative discriminator of different degrees of axonal-mediated tissue injury even between areas with expected minimal pathology. Our data support further studies to assess the readiness of Vax as a measure of outcome for clinical trials on neuroprotection in MS.
