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Abstract:
Introduction: In patients with multiple sclerosis (MS), conventional magnetic
resonance imaging (MRI) provides only limited insights into the nature of brain
damage with modest clinic-radiological correlation. In this study, we applied
recent advances in MRI techniques to study brain microstructural alterations in
early relapsing-remitting MS (RRMS) patients with minor deficits. Further, we
investigated the potential use of advanced MRI to predict functional performances
in these patients. Methods: Brain relaxometry (T1, T2, T2*) and magnetization
transfer MRI were performed at 3T in 36 RRMS patients and 18 healthy
controls (HC). Multicontrast analysis was used to assess for microstructural alterations
in normal-appearing (NA) tissue and lesions. A generalized linear model
was computed to predict clinical performance in patients using multicontrast
MRI data, conventional MRI measures as well as demographic and behavioral
data as covariates. Results: Quantitative T2 and T2* relaxometry were significantly
increased in temporal normal-appearing white matter (NAWM) of patients
compared to HC, indicating subtle microedema (P = 0.03 and 0.004). Furthermore,
significant T1 and magnetization transfer ratio (MTR) variations in lesions
(mean T1 z-score: 4.42 and mean MTR z-score: 4.09) suggested substantial tissue
loss. Combinations of multicontrast and conventional MRI data significantly
predicted cognitive fatigue (P = 0.01, Adj-R2 = 0.4), attention (P = 0.0005,
Adj-R2 = 0.6), and disability (P = 0.03, Adj-R2 = 0.4). Conclusion: Advanced
MRI techniques at 3T, unraveled the nature of brain tissue damage in early MS
and substantially improved clinical–radiological correlations in patients with
minor deficits, as compared to conventional measures of disease.