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 1 year in early PPMS.
Aims: To determine (1) whether baseline brain MTI parameters in early PPMS predict clinical changes over 1 year, independent of brain volume and (2) whether a change in magnetisation transfer (MT) parameters occurs over 1 year, independent of atrophy.
Methods: 30 patients with PPMS within 5 years of symptom onset and 15 controls underwent MT and volumetric imaging studies, at baseline and at 1 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, 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 1 year, adjusting for baseline brain volume. MTR changes over 1 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, independent 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 1 year.
Conclusions: NAWM MTR may provide information on short term clinical prognosis in early PPMS. MTI is sensitive to brain tissue changes over 1 year in early PPMS, which were primarily seen in the NAGM.
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Competing interests: None.
- 3D FSPGR
- three dimensional inversion prepared fast spoiled gradient recall
- brain parenchymal fraction
- Expanded Disability Status Scale
- grey matter
- multiple sclerosis
- Multiple Sclerosis Functional Composite
- magnetisation transfer
- magnetisation transfer imaging
- magnetisation transfer ratio
- normal appearing brain tissue
- normal appearing grey matter
- normal appearing grey matter fraction
- normal appearing white matter
- normal appearing white matter fraction
- nine hole peg test
- paced auditory serial addition test
- peak height
- peak location
- primary progressive multiple sclerosis
- per cent units
- timed walk test
- whole brain
- white matter
- z score for the nine hole peg test
- z score for the paced auditory serial addition test
- z score for the timed walk test