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Published on: July 19, 2019
Assessment of Cortical Myelination in Patients with MS via T1-Weighted/FLAIR Ratio: A Longitudinal Follow-up Study
Junsung Kim1,2, Da-Young Seo3, Eunseon Jeong1
1From the Department of Radiology and Research Institute of Radiology (J.K., E.J., Y.C.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Background And Purpose:
The T1-weighted (T1W)/FLAIR ratio may reflect cortical myelin integrity in patients with MS (PwMS). This study aimed to investigate the longitudinal significance of the cortical T1W/FLAIR ratio in PwMS.
Materials And Methods:
Brain MRI data were obtained from PwMS and patients with clinically isolated syndrome (CIS) between September 2021 and December 2023. 3D T1W and FLAIR images were preprocessed to calculate gray matter and superficial white matter T1W/FLAIR ratios across cerebral regions. Baseline and follow-up MRI scans were analyzed for T1W/FLAIR ratio changes and correlations with clinical parameters (Expanded Disability Status Scale [EDSS] and disease duration). Cortical T1W/FLAIR ratio changes were compared with WM lesion changes (new, developing, or decreased lesions) on follow-up MRI scans.
Results:
In total, 63 patients with MS and 5 patients with CIS (mean age: 40.5 years; 73.5% women) were evaluated. The median baseline EDSS score was 1.5, and median MRI interval was 13.5 months. GM T1W/FLAIR ratio changes were negatively correlated with EDSS changes in superficial GM of the whole brain (r = -0.201, P = .02, positive false discovery rate [pFDR] =0.1) and occipital cortex (r = -0.269, P = .002, pFDR =0.01). Patients with stable or improved EDSS scores exhibited significant GM T1W/FLAIR ratio increases (P = .04 and P < .001, respectively). T1W/FLAIR ratio changes were positively correlated with disease duration (r = 0.285, P = .02) but not WM lesion changes.
Conclusions:
Longitudinal GM T1W/FLAIR ratio changes were associated with disease severity in PwMS, supporting its potential role as a potential biomarker for cortical myelination and disease monitoring.
Insights
The T1-weighted (T1W)/FLAIR ratio in gray matter may track disease severity in patients with multiple sclerosis (MS). Longitudinal changes in this ratio correlate with disability progression, suggesting its use as a biomarker.
Area of Science:
- Neuroimaging
- Neurology
- Biomarker Discovery
Background:
- Cortical demyelination is a key feature of multiple sclerosis (MS).
- The T1-weighted (T1W)/FLAIR ratio may serve as an indicator of cortical myelin integrity.
- Longitudinal assessment of this ratio's significance in MS is crucial.
Purpose of the Study:
- To investigate the longitudinal significance of the cortical T1W/FLAIR ratio in patients with MS (PwMS).
- To explore the relationship between T1W/FLAIR ratio changes and clinical parameters in PwMS.
Main Methods:
- Acquired brain MRI data (3D T1W and FLAIR) from PwMS and patients with clinically isolated syndrome (CIS).
- Calculated gray matter (GM) and superficial white matter (WM) T1W/FLAIR ratios.
- Analyzed longitudinal changes and correlations with Expanded Disability Status Scale (EDSS) and disease duration.
Main Results:
- GM T1W/FLAIR ratio changes negatively correlated with EDSS changes in superficial GM (r = -0.201, P = .02) and occipital cortex (r = -0.269, P = .002).
- Increased GM T1W/FLAIR ratios were observed in patients with stable or improved EDSS scores.
- T1W/FLAIR ratio changes positively correlated with disease duration (r = 0.285, P = .02) but not WM lesion changes.
Conclusions:
- Longitudinal GM T1W/FLAIR ratio changes are associated with disease severity in PwMS.
- The cortical T1W/FLAIR ratio shows potential as a biomarker for cortical myelination and disease monitoring in MS.
