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Updated: Jun 4, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Structural MRI signature of late- versus adult-onset multiple sclerosis: a multiparametric study
Nicolò Tedone1,2, Paolo Preziosa1,3,2, Elisabetta Pagani1
1Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Background:
Structural MRI differences between late-onset multiple sclerosis (LOMS; onset ≥ 50 years) and adult-onset MS (AOMS) patients remain incompletely characterized, particularly regarding tissue damage distribution and relationship with clinical and cognitive outcomes.
Objectives:
To compare the structural MRI profile of LOMS and AOMS patients within a multiparametric framework including age-matched healthy control (HC) groups, and to examine MRI-clinical associations.
Methods:
Forty LOMS patients, 195 sex- and disease duration (DD)-matched AOMS patients, and 175 age-matched HC (HC-LO = 50; HC-AO = 125) underwent 3 T MRI and clinical-cognitive assessment. Analyses included white matter (WM) lesion volume (T2-LV) and distribution, volumetric measures, tract-based spatial statistics, and voxel-based morphometry. Voxel-wise analyses assessed group differences and associations with DD, Expanded Disability Status Scale (EDSS), and Symbol Digit Modalities Test (SDMT) (p < 0.05, FWE-corrected).
Results:
Both MS groups showed higher T2-LV, widespread WM microstructural abnormalities. and lower total, gray matter (GM), and deep GM volumes than age-matched HC (pFDR ≤ 0.015). LOMS patients showed higher lesion frequency in the left superior longitudinal fasciculus (SLF) than AOMS patients (pFWE = 0.003). Onset category × disease status interaction revealed higher T2-LV (pFDR = 0.005) and more pronounced regional GM atrophy in motor-insular-subcortical regions in the LOMS versus AOMS groups (pFWE ≤ 0.040). In LOMS patients, longer DD correlated with higher lesion frequency in the left SLF and mean diffusivity in several WM tracts (pFWE < 0.05). In AOMS patients, higher EDSS and lower SDMT scores related to higher lesion frequency in commissural tracts and thalamic-hippocampal atrophy (pFWE ≤ 0.040).
Conclusion:
LOMS patients exhibit higher T2-hyperintense WM lesion burden and more pronounced regional GM atrophy than AOMS patients, despite similar DD and no detectable global GM differences, potentially reflecting combined MS-related damage and age-related processes shaping a more severe structural MRI profile.
Insights
Late-onset multiple sclerosis (LOMS) patients show greater white matter lesion burden and regional gray matter atrophy than adult-onset MS (AOMS) patients, despite similar disease duration. This suggests a more severe structural MRI profile in LOMS, potentially due to combined MS and aging effects.
Area of Science:
- Neuroimaging
- Neurology
- Multiple Sclerosis Research
Background:
- Structural MRI differences between late-onset multiple sclerosis (LOMS; onset ≥ 50 years) and adult-onset MS (AOMS) are not fully understood.
- Tissue damage distribution and its relationship with clinical and cognitive outcomes in LOMS versus AOMS require further characterization.
Purpose of the Study:
- To compare the structural MRI characteristics of LOMS and AOMS patients using a multiparametric approach.
- To include age-matched healthy control (HC) groups for comparison.
- To investigate the associations between MRI findings and clinical/cognitive measures.
Main Methods:
- 3 Tesla MRI and clinical-cognitive assessments were performed on 40 LOMS patients, 195 AOMS patients, and 175 age-matched HC.
- Analyses included white matter (WM) lesion volume (T2-LV) and distribution, volumetric measures, tract-based spatial statistics, and voxel-based morphometry.
- Voxel-wise analyses examined group differences and correlations with disease duration (DD), Expanded Disability Status Scale (EDSS), and Symbol Digit Modalities Test (SDMT).
Main Results:
- Both MS groups exhibited higher T2-LV, widespread WM abnormalities, and reduced total, gray matter (GM), and deep GM volumes compared to HC.
- LOMS patients showed significantly higher lesion frequency in the left superior longitudinal fasciculus (SLF) compared to AOMS patients.
- An interaction effect revealed higher T2-LV and more pronounced regional GM atrophy in motor-insular-subcortical areas in LOMS versus AOMS.
Conclusions:
- LOMS patients demonstrate a higher T2-hyperintense white matter lesion burden and more significant regional gray matter atrophy than AOMS patients.
- These differences persist despite similar disease duration and lack of global gray matter volume differences, suggesting a distinct structural MRI profile in LOMS.
- The findings may reflect a combination of MS-related damage and age-related processes contributing to a more severe structural MRI phenotype in LOMS.
Related Concept Videos
01:19Multiple Sclerosis l: Introduction
01:24Magnetic Resonance Imaging