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Updated: Jul 21, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Changes in the amount of diseased white matter over time in patients with relapsing-remitting multiple sclerosis
L A Stone1, P S Albert, M E Smith
1Neuroimmunology Branch, NINDS, NIH, Bethesda, MD 20892, USA.
Abstract:
MRI is a sensitive technique for assessing disease activity in MS. Diseased white matter (WM) can be identified on T2-weighted images, and active disease is reflected by abnormalities in the blood-brain barrier (BBB) shown on T1-weighted images after administration of paramagnetic contrast agents. Active disease may be demonstrated by contrast-enhanced MRI in patients with early, mild relapsing-remitting (RR) MS even during periods of clinical stability, which indicates that MS is an active process even during the early phase of the illness. To examine the amount of abnormal WM at frequent intervals over time, we studied seven mildly affected RRMS patients, all of whom had frequent contrast-enhancing lesions. These RRMS patients were imaged monthly for 26 to 36 months at 1.5 tesla; the area of abnormal increased WM signal was calculated by image-processing software that utilizes both the T2- and T1-weighted images. All patients showed fluctuations over time in amount of abnormal WM signal, which reflected factors such as the amount of BBB breakdown (measured by number or area of enhancing lesions) and measurement error. All seven RRMS patients, however, showed an overall increase in abnormal WM. Because of the fluctuations between individual measurements, the increase was most accurately reflected when the mean of the first 6 months' measurements was compared with the mean of the final 6 months' measurements, or when a linear regression model was applied.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Multiple Sclerosis (MS) disease activity can be tracked using MRI. Even in early stages, MS shows ongoing white matter (WM) damage and blood-brain barrier (BBB) abnormalities, indicating active disease progression.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Multiple Sclerosis (MS) is characterized by white matter (WM) lesions.
- Disease activity in MS can be assessed using Magnetic Resonance Imaging (MRI).
- Contrast-enhanced MRI reveals blood-brain barrier (BBB) abnormalities, indicative of active MS lesions.
Purpose of the Study:
- To longitudinally assess the volume of abnormal white matter (WM) in early, mild relapsing-remitting MS (RRMS) patients.
- To investigate the relationship between WM changes and blood-brain barrier (BBB) breakdown over time.
- To determine the most accurate method for quantifying WM changes in MS.
Main Methods:
- Monthly MRI scans (1.5 tesla) were performed on seven mildly affected RRMS patients over 26–36 months.
- Image-processing software analyzed T2- and T1-weighted images to quantify the area of abnormal WM signal.
- Blood-brain barrier (BBB) breakdown was assessed by the number and area of contrast-enhancing lesions.
Main Results:
- All patients exhibited fluctuations in abnormal WM signal over time.
- These fluctuations correlated with BBB breakdown and potential measurement errors.
- Despite fluctuations, all seven RRMS patients demonstrated an overall increase in abnormal WM.
- Comparing mean measurements from the first and last 6 months, or using linear regression, provided the most accurate reflection of WM increase.
Conclusions:
- Active MS disease, evidenced by WM abnormalities and BBB breakdown, occurs even in early, mild RRMS.
- Longitudinal MRI monitoring reveals disease progression despite periods of clinical stability.
- Averaging measurements or applying linear regression improves the accuracy of detecting WM changes in MS.
