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Magnetisation transfer ratio in the normal appearing white matter predicts progression of disability over one year in early primary progressive MS
  1. Zhaleh Khaleeli (z.khaleeli{at}
  1. Institute of Neurology, United Kingdom
    1. Jaume Sastre-Garriga (j.sastre-garriga{at}
    1. Institute of Neurology, United Kingdom
      1. Olga Ciccarelli (o.ciccarelli{at}
      1. Institution of Neurology, United Kingdom
        1. David H Miller (d.miller{at}
        1. Institute of Neurology, United Kingdom
          1. Alan J Thompson (a.thompson{at}
          1. Institute of Neurology, United Kingdom


            Background: Progression rates in primary progressive multiple sclerosis (PPMS) vary widely and brain magnetisation transfer imaging (MTI) has potential as an early prognostic indicator. We investigated the predictive value of MTI and the longitudinal changes developing over one year in early PPMS.

            Aims: To determine (1) whether baseline brain MTI parameters in early PPMS predict clinical changes over one year, independently of brain volume (2) whether change in MT parameters occurs over one year, independently of atrophy.

            Methods: Thirty patients with PPMS within five years of symptom onset and 15 controls underwent MT and volumetric imaging studies, at baseline and one year. Patients underwent clinical assessment using the Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC), including the timed walk subtest (TWT). Normalised MT histograms were generated for whole brain (WB), normal appearing brain tissue (NABT), and normal appearing white and grey matter (NAWM and NAGM) segments. Multiple regression analyses were performed to investigate whether baseline MTR parameters predicted clinical change over one year, adjusting for baseline brain volume. MTR changes over one year were assessed using paired t-tests.

            Results: In patients lower baseline NAWM MTR predicted greater deterioration in EDSS and MSFC, particularly in walking ability measured by the TWT, independently of NAWM baseline volume (p=0.001). NAGM MTR mean (p<0.001), and to a lesser extent, NAWM mean (p=0.011) and lesion MTR (p=0.03) decreased over one year.

            Conclusions: NAWM MTR may provide information on short-term clinical prognosis in early PPMS. MTI is sensitive to brain tissue changes over one year in early PPMS, which were primarily seen in the NAGM.

            • EDSS
            • disability
            • magnetization transfer ratio
            • normal appearing white matter
            • primary progresive multiple sclerosis

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