MR Spectroscopic Imaging Improves Detection of Brain Pathologic Alterations in Multiple Sclerosis

MR spectroscopic imaging (MRSI) at 7.0T can detect pathologic alterations in normal-appearing white matter (NAWM) and cortical gray matter (CGM) in multiple sclerosis (MS), according to new findings published in Radiology.

“Focal white matter lesions (WML) of demyelination are the most readily detectable manifestation of multiple sclerosis (MS) at morphologic MRI. However, they represent only macroscopic tissue damage and are therefore unable to fully explain the topographic origin and severity of many clinical symptoms of MS, particularly in the progressive phase of the disease,” wrote Eva Heckova, MSc, High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria, and co-researchers.

Dr Heckova et al aimed to assess the ability of 7.0-T MRSI to detect pathologic alterations in NAWM and CGM.

Between January 2016 and December 2017, 65 participants with MS along and 20 healthy controls were recruited. Researchers obtained metabolic ratios in CGM, NAWM, and white matter lesions regions in addition to analyzing disabilities related to MS using the Expanded Disability Status Scale (EDSS).

There was an observed higher myo-inositol (ml) to N-acetylasperate (NAA) ratio in NAWM in participants with MS when compared to healthy controls. These ratios correlated with disability in frontal CGM, frontal NAWM, and NAWM of the centrum semiovale. In subgroups of participants with disabilities, a lower nAA to total creatine ratio was observed in NAWM and CGM.

“MR spectroscopic imaging at 7.0 T allowed in vivo visualization of multiple sclerosis pathologic findings not visible at T1- or T2-weighted MRI. Metabolic abnormalities in the normal-appearing white matter and cortical gray matter were associated with disability,” Dr Heckova et al concluded. 

Reference:

Heckova E, Dal-Bianco A, Strasser B, et al. Extensive Brain Pathologic Alterations Detected with 7.0-T MR Spectroscopic Imaging Associated with Disability in Multiple Sclerosis [published online ahead of print, 2022 Jan 4]. Radiology. 2022;210614. doi:10.1148/radiol.210614