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Multiparametric Quantitative MRI of Peripheral Nerves to Differentiate Demyelinating from Axonal Polyneuropathies
Jesus E Fajardo1, Vivian B Truong1, Yang Xuan1
1Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA.
Medrxiv : the Preprint Server for Health Sciences
|December 3, 2025
Summary
Multiparametric quantitative MRI (qMRI) can distinguish between demyelinating and axonal polyneuropathies. The developed CMT Imaging Score (CMTIS) shows promise as a biomarker for monitoring disease progression.
Area of Science:
- Neuroimaging
- Peripheral Nerve Imaging
- Quantitative MRI
Background:
- Differentiating demyelinating from axonal polyneuropathies is crucial for effective diagnosis and treatment.
- Quantitative MRI (qMRI) of peripheral nerves is hypothesized to differentiate between these two types of polyneuropathies.
- This study utilized genetically defined polyneuropathies to test this qMRI concept.
Purpose of the Study:
- To determine if multiparametric qMRI can differentiate demyelinating from axonal polyneuropathies.
- To develop a composite qMRI score (CMT Imaging Score - CMTIS) for predicting disease severity.
- To assess the diagnostic performance of qMRI in distinguishing between different types of hereditary neuropathies.
Main Methods:
- Acquired multiparametric qMRI data (MTR, MTsat, T2*, T1, PD, FA, MD, AD, RD, fVol) from sciatic and tibial nerves using 3T MRI.
- Analyzed data from patients with Charcot-Marie-Tooth type 1 (CMT1), CMT2, hereditary neuropathy with liability to pressure palsies (HNPP), and healthy controls (HC).
- Developed CMTIS and correlated it with CMT Neuropathy Score version-2 (CMTNSv2); performed ROC analyses for diagnostic performance.
Main Results:
- CMT1 showed increased fascicular volume (fVol), while CMT2 had reduced T2*.
- Both CMT1 and CMT2 exhibited reduced fractional anisotropy (FA), MT saturation index (MTsat), and axial diffusivity (AD), with elevated T1 and radial diffusivity (RD).
- CMTIS demonstrated strong correlation with CMTNSv2 (r=0.67-0.79) and high diagnostic discrimination for CMT1 and CMT2 (AUCs: 0.73-0.95).
Conclusions:
- Multiparametric qMRI effectively identifies distinct imaging signatures for demyelinating versus axonal hereditary polyneuropathies.
- The CMTIS shows significant potential as a non-invasive biomarker for disease monitoring and severity assessment.
- This approach aids in the accurate diagnosis and management of peripheral nerve disorders.
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