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Updated: Jan 14, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Quantitative Susceptibility Mapping of Deep Grey Matter in MS: Association With Clinical Scores and Brain Volume
Cui Ci Voon1,2, Jakob Meineke3, Tun Wiltgen1,2
1Dept. of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany.
Background:
Changes in quantitative susceptibility mapping (QSM) of the deep grey matter (DGM) in multiple sclerosis (MS) are thought to reflect tissue damage invisible in conventional magnetic resonance imaging (MRI) sequences, such as iron-related neurodegeneration.
Objective:
To explore the associations of clinical scores and MRI-based volumes with QSM values in the DGM (thalamus, putamen, caudate, and pallidum) in a large cohort of people with MS, and to assess the predictive value of QSM values for clinical outcomes after three years.
Methods:
A total of 771 MS patients (clinically isolated syndrome (CIS): n = 35, relapsing-remitting: n = 637, progressive: n = 63) were scanned at 3T with T1-weighted, T2-FLAIR, and QSM sequences. All patients were included in the cross-sectional analyses examining the relationship of DGM QSM values with MRI variables and clinical scores. Normalized brain volume (NBV) was computed using SIENAX, while total lesion volume (TLV) was derived from the lesion segmentation tool, LST-AI. Clinical scores included the expanded disability status scale (EDSS), timed 25 foot walk (T25FW), Nine Hole Peg Test (9HPT), symbol digit modalities test (SDMT), and fatigue scale for motor and cognitive functions (FSMC). In the longitudinal analyses, only clinical scores were included, with various sample sizes across different clinical scores (NEDSS = 396, NT25Fw = 284, N9HPT = 284, NSDMT = 165, NFSMC = 288). These analyses evaluated the predictive value of baseline DGM QSM values for follow-up clinical scores; these associations were compared to those of corresponding regional DGM volumes.
Results:
At baseline, after adjusting for confounding factors, higher QSM values in the basal ganglia were significantly associated with greater TLV (β = 0.14 - 0.17; p < 0.001), higher clinical severity (EDSS: β = 0.13 - 0.19, p < 0.001), worse dexterity (NHPT: β = 0.14 - 0.16, p = 0.02), and lower cognitive functioning (SDMT: β = -0.13 - -0.15, p = 0.03). In contrast, lower thalamic QSM values were associated with greater TLV (β = -0.07; p = 0.03). Unlike regional volumes, DGM QSM values did not predict clinical outcomes at follow-up.
Conclusion:
DGM QSM values are robustly associated with MS severity and TLV cross-sectionally. However, our large-scale longitudinal analysis suggests that DGM QSM values lack prognostic value for short-term clinical progression in early-stage MS.
Insights
Quantitative susceptibility mapping (QSM) in deep grey matter (DGM) shows associations with multiple sclerosis (MS) severity and lesion load. However, DGM QSM values do not predict short-term clinical progression in early MS.
Area of Science:
- Neuroimaging
- Quantitative Susceptibility Mapping (QSM)
- Multiple Sclerosis (MS) Research
Background:
- Deep grey matter (DGM) quantitative susceptibility mapping (QSM) changes in multiple sclerosis (MS) may indicate sub-visual tissue damage, potentially linked to iron accumulation.
- Conventional magnetic resonance imaging (MRI) sequences may not detect these subtle changes, highlighting the need for advanced imaging techniques like QSM.
Purpose of the Study:
- To investigate the relationship between clinical scores, MRI-derived volumes, and DGM QSM values in a large cohort of MS patients.
- To evaluate the predictive capacity of DGM QSM values for clinical outcomes over a three-year period.
Main Methods:
- Cross-sectional and longitudinal analyses were performed on 771 MS patients using 3T MRI (T1-weighted, T2-FLAIR, QSM).
- Associations between DGM QSM values and clinical scores (EDSS, T25FW, 9HPT, SDMT, FSMC) and MRI variables (NBV, TLV) were examined.
- Baseline DGM QSM values were assessed for their predictive value on follow-up clinical scores, compared with regional DGM volumes.
Main Results:
- Cross-sectionally, higher basal ganglia QSM values correlated with increased total lesion volume (TLV), higher clinical severity (EDSS), worse dexterity (9HPT), and lower cognitive function (SDMT).
- Lower thalamic QSM values were associated with greater TLV.
- Longitudinal analysis indicated that DGM QSM values did not predict future clinical outcomes.
Conclusions:
- DGM QSM values demonstrate a strong cross-sectional association with MS severity and TLV.
- Despite cross-sectional correlations, DGM QSM values lack prognostic value for short-term clinical progression in early-stage MS.
