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Relationship between sodium and diffusion MRI metrics in multiple sclerosis.

Emilio Cipriano1, Giacomo Boffa1,2, Nicole Graziano3

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Sodium MRI reveals changes in brain sodium levels in multiple sclerosis (MS) patients. Elevated intracellular sodium concentration may indicate early metabolic dysfunction, even before tissue damage is apparent.

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Area of Science:

  • Neuroimaging
  • Biomarkers
  • Multiple Sclerosis Research

Background:

  • Sodium MRI measures in vivo sodium concentrations in multiple sclerosis (MS).
  • The link between sodium alterations and metabolic dysfunction, independent of tissue damage, requires further investigation.
  • Increased total and extracellular sodium concentrations suggest tissue disruption, while increased intracellular sodium may signal early neuronal insult.

Purpose of the Study:

  • To explore the relationship between total sodium concentration, intracellular sodium concentration, and extracellular sodium concentration (via intracellular sodium volume fraction) with microstructural metrics in MS.
  • To assess the utility of different sodium measures as biomarkers for tissue damage and metabolic dysfunction in MS.

Main Methods:

  • Fifty-two individuals with MS and 26 healthy controls underwent 1H/23Na MRI.
  • Diffusion MRI techniques, including Diffusion Basis Spectrum Imaging (DBSI) and Neurite Orientation Dispersion and Density Imaging (NODDI), were used to derive microstructural parameters.
  • Histology-validated microstructural metrics were compared with sodium MRI findings.

Main Results:

  • A progressive increase in total sodium concentration and intracellular sodium volume fraction was observed from healthy controls to normal-appearing white matter and into MS lesions.
  • Total sodium concentration and intracellular sodium volume fraction, but not intracellular sodium concentration, correlated with DBSI and NODDI metrics within MS lesions.
  • These findings suggest that total sodium concentration and extracellular sodium concentration reflect extracellular space expansion and axonal loss.

Conclusions:

  • Total sodium concentration and extracellular sodium concentration are reliable indicators of extracellular expansion and axonal loss in MS.
  • Intracellular sodium concentration emerges as a valuable biomarker for detecting metabolic dysfunction in MS, potentially preceding overt tissue damage.