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Microscopic disease in normal-appearing white matter on conventional MR images in patients with multiple sclerosis:
L A Loevner1, R I Grossman, J A Cohen
1Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA.
Purpose:
To assess for the presence of microscopic abnormalities in otherwise normal-appearing white matter on T2-weighted images in patients with multiple sclerosis (MS) by using magnetization-transfer (MT) measurements.
Materials And Methods:
Twenty-three patients with MS and nine healthy control subjects underwent magnetic resonance (MR) imaging with a 1.5-T system. MT ratios (MTRs) were measured in 16 areas of normal-appearing white matter identified on conventional T2-weighted images in patients with MS. MTRs in the same white-matter locations in control subjects were determined. The two groups were compared.
Results:
The mean whole-brain MTR of normal-appearing white matter in patients was 40.13% +/- 1.37 (standard deviation; range, 36.31%-42.09%); in control subjects, 42.93% +/- 0.95 (range, 41.62%-44.50%). The difference was statistically significant (P < or = .001). Except for the internal capsules, the difference in mean MTRs in each sublocation of the brain between patients and control subjects was statistically significant (P < or = .05).
Conclusion:
MT measurements are more sensitive than conventional MR imaging in the detection of abnormalities beyond the resolution of T2-weighted imaging.
Insights
Magnetization-transfer (MT) measurements detect microscopic abnormalities in normal-appearing white matter in multiple sclerosis (MS) patients, revealing subtle changes not visible on standard T2-weighted MRI scans.
Area of Science:
- Neuroimaging
- Radiology
- Biophysics
Background:
- Multiple sclerosis (MS) is a demyelinating disease affecting the central nervous system.
- Conventional MRI, including T2-weighted imaging, often shows normal-appearing white matter in early MS.
- Detecting subtle white matter abnormalities is crucial for early diagnosis and monitoring disease progression.
Purpose of the Study:
- To evaluate the sensitivity of magnetization-transfer (MT) measurements in identifying microscopic abnormalities in normal-appearing white matter in MS patients.
- To compare MT ratios (MTRs) between MS patients and healthy controls in normal-appearing white matter regions.
Main Methods:
- Magnetic resonance imaging (MRI) was performed on 23 MS patients and 9 healthy controls using a 1.5-T system.
- Magnetization-transfer ratios (MTRs) were quantified in 16 normal-appearing white matter regions on T2-weighted images.
- Statistical comparison of MTRs between MS patients and control subjects was conducted.
Main Results:
- Mean whole-brain MTR was significantly lower in MS patients (40.13% ± 1.37) compared to healthy controls (42.93% ± 0.95) (P ≤ .001).
- Statistically significant differences in MTRs were observed in most sublocations of the brain between the two groups (P ≤ .05), except for the internal capsules.
- These findings indicate widespread subtle white matter abnormalities in MS patients.
Conclusions:
- Magnetization-transfer (MT) measurements demonstrate higher sensitivity than conventional T2-weighted MRI for detecting abnormalities in normal-appearing white matter.
- MT imaging can reveal microscopic white matter changes in MS that are beyond the resolution of standard MRI techniques.
- This technique holds potential for improved early detection and characterization of MS pathology.