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Magnetisation transfer ratio measurement in the cervical spinal cord: a preliminary study in multiple sclerosis
N C Silver1, G J Barker, N A Losseff
1NMR Research Unit, Institute of Neurology, London, UK.
Abstract:
MRI readily detects the lesions of multiple sclerosis (MS) in the brain and spinal cord. Conventional MRI sequences do not, however, permit distinction between the various pathological characteristics (oedema, demyelination, axonal loss and gliosis) of lesions in MS. Magnetisation transfer (MT) imaging may be more specific in distinguishing the pathologies responsible for disability in MS, namely demyelination and axonal loss, and therefore may have a potential role in monitoring treatment. We have applied MT imaging to the cervical spinal cord to see if it is feasible to measure MT ratios (MTR) in this region where pathological changes may result in considerable disability. We studied 12 patients with MS and 12 age- and sex-matched normal controls using a sagittal T2-weighted fast spin-echo sequence with and without an MT pulse. The median value for cervical cord mean MTR measurement in normal controls was 19.30% units (interquartile range 19.05-19.55), whereas values were significantly lower in MS patients (median = 17.95% units, interquartile range 17.25-19.00, P = 0.0004). There was a low intrarater variability for repeated mean MTR measurements. We conclude that it is possible to measure MTR in the cervical spinal cord, that a significant reduction occurs in patients with MS, and that there may be a role for this measure in future MS treatment trials.
Insights
Magnetisation transfer (MT) imaging can measure changes in the cervical spinal cord of multiple sclerosis (MS) patients. This technique shows reduced MTR values in MS, indicating potential for monitoring disease progression and treatment effectiveness.
Area of Science:
- Neuroimaging
- Radiology
- Neurology
Background:
- Conventional MRI cannot differentiate specific pathologies in multiple sclerosis (MS) lesions.
- Magnetisation transfer (MT) imaging offers potential for distinguishing demyelination and axonal loss, key contributors to MS disability.
- The cervical spinal cord is a critical region where pathology can lead to significant disability.
Purpose of the Study:
- To assess the feasibility of measuring Magnetisation transfer ratios (MTR) in the cervical spinal cord.
- To determine if MTR values differ between patients with MS and healthy controls.
- To evaluate the potential role of cervical spinal cord MTR in monitoring MS and its treatments.
Main Methods:
- Applied MT imaging to the cervical spinal cord in 12 MS patients and 12 healthy controls.
- Utilized a sagittal T2-weighted fast spin-echo sequence with and without an MT pulse.
- Analyzed intrarater variability for repeated MTR measurements.
Main Results:
- Median MTR in the cervical spinal cord was significantly lower in MS patients (17.95%) compared to controls (19.30%).
- The difference in MTR values between MS patients and controls was statistically significant (P = 0.0004).
- Repeated MTR measurements showed low intrarater variability, indicating reliability.
Conclusions:
- Measuring MTR in the cervical spinal cord is feasible.
- A significant reduction in MTR is observed in MS patients.
- Cervical spinal cord MTR shows promise as a biomarker for MS treatment trials.