Related Experiment Video
Updated: Apr 30, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Comparison of Pediatric Demyelinating Diseases using Axonal and Myelin-Sensitive MRI
Fang Frank Yu1, Elayne Joe2, Niloufar Saadat2
1From the Department of Radiology (F.F.Y., N.S., P.S., K.R.), Advanced Imaging Research Center (F.F.Y., J.R.), Neurology (P.S., B.G.), UT Southwestern Medical Center, Dallas, TX, United States and UT Southwestern School of Medicine (E.J.), Dallas, TX, United States. FrankF.Yu@UTSouthwestern.edu.
Background And Purpose:
Demyelinating diseases constitute the most frequent cause of non-traumatic neurological disability in the pediatric population. Conventional MRI, while sensitive to focal white matter injury, lacks specificity to discern between edema, demyelination and axonal loss. This study aimed to employ advanced MRI biomarkers-specifically macromolecular tissue volume (MTV) and neurite orientation dispersion and density imaging (NODDI)-derived metrics-to assess myelin integrity (myelin volume fraction, MVF), axonal density (neurite density index, NDI), and the g-ratio in pediatric patients with multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
Materials And Methods:
Thirty-nine pediatric patients (MS, n = 15; NMOSD, n = 6; MOGAD, n = 11), including 7 age-matched heathy controls, underwent 3 Tesla MRI as part of a cross-sectional study. Multi-echo gradient echo and multi-shell diffusion sequences were acquired to compute MTV and NODDI metrics. Lesional and normal-appearing white matter (NAWM) were segmented, and imaging metrics (MVF, NDI, and g-ratio) were compared across groups. Correlations between imaging biomarkers and clinical measures were also examined.
Results:
MS demonstrated significantly higher lesional g-ratio than MOGAD (p = 0.02) and NMOSD (p = 0.02) and lower MVF than NMOSD (p = 0.006), indicating greater relative myelin loss. NAWM partitioning identified higher deep-NAWM ODI in MS patients than controls (p = 0.04). Within the MS cohort, 25ftW was associated with g-ratio, MVF, and NDI measures for both whole-brain and deep NAWM.
Conclusion:
Advanced MRI biomarkers provide a more nuanced characterization of microstructural alterations in pediatric demyelinating diseases. The distinct imaging profiles-highlighting greater demyelination in MS versus MOGAD and NMOSD-support the utility of these metrics for targeted clinical management and therapeutic stratification. Future longitudinal studies are warranted to further validate their role in monitoring disease progression and treatment response.
Insights
Advanced MRI biomarkers reveal distinct microstructural changes in pediatric demyelinating diseases. Multiple sclerosis (MS) shows greater myelin loss compared to MOGAD and NMOSD, aiding in diagnosis and treatment.
Area of Science:
- Neuroimaging
- Neurology
- Biomarkers
Background:
- Pediatric demyelinating diseases cause significant neurological disability.
- Conventional MRI lacks specificity in differentiating white matter pathologies.
- Advanced MRI techniques offer potential for improved characterization.
Purpose of the Study:
- To utilize advanced MRI biomarkers, macromolecular tissue volume (MTV) and neurite orientation dispersion and density imaging (NODDI), to assess myelin integrity (MVF), axonal density (NDI), and g-ratio.
- To differentiate microstructural alterations in pediatric multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
Main Methods:
- Cross-sectional study of 39 pediatric patients (MS, NMOSD, MOGAD) and 7 healthy controls using 3 Tesla MRI.
- Acquisition of multi-echo gradient echo and multi-shell diffusion sequences to compute MTV and NODDI metrics.
- Segmentation of lesional and normal-appearing white matter (NAWM) for comparison of imaging metrics (MVF, NDI, g-ratio) and correlation with clinical data.
Main Results:
- Multiple sclerosis (MS) exhibited a significantly higher lesional g-ratio and lower myelin volume fraction (MVF) compared to MOGAD and NMOSD, indicating greater demyelination.
- Increased deep-NAWM orientation dispersion index (ODI) was observed in MS patients compared to controls.
- Within the MS cohort, clinical measures correlated with g-ratio, MVF, and NDI in both whole-brain and deep NAWM.
Conclusions:
- Advanced MRI biomarkers provide nuanced characterization of microstructural changes in pediatric demyelinating diseases.
- Distinct imaging profiles support the use of these metrics for clinical management and therapeutic stratification.
- Longitudinal studies are needed to validate their role in monitoring disease progression and treatment response.
More Related Videos
12:23Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
Published on: April 14, 2014
08:17Author Spotlight: Unveiling the Pathway Linking Obesity to Autoimmune Inflammation in Multiple Sclerosis
Published on: February 23, 2024