Search

Objectives: Conventional magnetic resonance imaging (MRI) is used to diagnose and monitor inflammatory disease in relapsing remitting (RR) multiple sclerosis (MS). In the less common primary progressive (PP) form of MS, in which focal inflammation is less evident, biomarkers are still needed to enable evaluation of novel therapies in clinical trials. Our objective was to characterize the association - across the brain and cervical spinal cord - between clinical disability measures in PPMS and two potential biomarkers (one for myelin, and one for atrophy, both resulting from the same imaging technique)., Methods: Multi-component driven equilibrium single pulse observation of T1 and T2 (mcDESPOT) MRI of the brain and cervical spinal cord were obtained for 15 PPMS patients and 11 matched controls. Data were analysed to estimate the signal related to myelin water (VFM), as well as volume measurements. MS disability was assessed using the Multiple Sclerosis Functional Composite score, which includes measures of cognitive processing (Paced Auditory Serial Addition Test), manual dexterity (9-Hole Peg Test) and ambulatory function (Timed 25-Foot Walk); and the Expanded Disability Status Scale., Results: Brain and spinal cord volumes were different in PPMS compared to controls, particularly ventricular (+ 46%, p = 0.0006) and cervical spinal cord volume (- 16%, p = 0.0001). Brain and spinal cord myelin (VFM) were also reduced in PPMS (brain: - 11%, p = 0.01; spine: - 19%, p = 0.000004). Cognitive processing correlated with brain ventricular volume (p = 0.009). Manual dexterity correlated with brain ventricular volume (p = 0.007), and both brain and spinal cord VFM (p = 0.01 and 0.06, respectively). Ambulation correlated with spinal cord volume (p = 0.04) and spinal cord VFM (p = 0.04)., Interpretation: In this study we demonstrated that mcDESPOT can be used to measure myelin and atrophy in the brain and spinal cord. Results correlate well with clinical disability scores in PPMS representing cognitive, fine motor and ambulatory disability.

The corticospinal tract (CST) appears hyperintense on both T2-weighted images and myelin water maps. Here, an extended multiecho T2 relaxation sequence with echoes out to 1120 ms was used to characterize the longer T2 times present in the CST. The T2 distribution from the CST was compared to other white matter structures in 14 healthy subjects. The intra-/extracellular T2 peak of the CST was broadened relative to other white matter structures and often split into two distinct peaks. In the CST, it appeared that the intracellular and extracellular water environments had unique T2 times, causing the intracellular water peak to be pushed down into the myelin water T2 regime and the extracellular peak to be pushed up to longer T2 times. The conventional myelin water T2 limits of 5-40 ms resulted in an artificial increase in myelin water fraction (MWF), causing the CST to be bright on myelin water images. When the upper limit for MWF was decreased to 25 ms, the CST regions exhibited MWF values similar to those found for adjacent anterior and posterior regions. The CST has unique magnetic resonance characteristics, which should be taken into consideration when being examined, especially when compared to pathological tissue., (Copyright © 2013 Elsevier Inc. All rights reserved.)