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Multiple sclerosis
Original research
Multiparametric quantitative MRI reveals progressive cortical damage over time in clinically stable relapsing-remitting MS
  1. Michelle Maiworm1,2,
  2. Celona Hamid1,2,
  3. Marlies Wagner2,
  4. Ulrike Nöth2,
  5. Ralf Deichmann2,
  6. Alexander Seiler1,2,
  7. René-Maxime Gracien1,2
  1. 1 Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany
  2. 2 Brain Imaging Center, Goethe University Frankfurt, Frankfurt am Main, Germany
  1. Correspondence to Dr Michelle Maiworm, Department of Neurology, University Hospital Frankfurt, Frankfurt am Main 60528, Germany; Michelle.Maiworm{at}kgu.de

Abstract

Background In relapsing-remitting multiple sclerosis (RRMS), cortical grey matter pathology relevantly contributes to long-term disability. Still, diffuse cortical inflammation cannot be detected with conventional MRI.

Objective We aimed to assess microstructural damage of cortical grey matter over time and the relation to clinical disability as well as relapse activity in patients with RRMS using multiparametric quantitative (q)MRI techniques.

Methods On 40 patients with RRMS and 33 age-matched and sex-matched healthy controls, quantitative T1, T2, T2* and proton density (PD) mapping was performed at baseline and follow-up after 2 years. Cortical qMRI parameter values were extracted with the FreeSurfer software using a surface-based approach. QMRI parameters, cortical thickness and white matter lesion (WML) load, as well as Expanded Disability Status Scale (EDSS) and relapse rate, were compared between time points.

Results Over 2 years, significant increases of T1 (p≤0.001), PD (p≤0.001) and T2 (p=0.005) values were found in the patient, but not in the control group. At decreased relapse rate over time (p=0.001), cortical thickness, WML volume and EDSS remained unchanged.

Conclusion Despite clinical stability, cortical T1, T2 and PD values increased over time, indicating progressive demyelination and increasing water content. These parameters represent promising surrogate parameters of diffuse cortical inflammation in RRMS.

  • multiple sclerosis
  • MRI
  • neuroimmunology

Data availability statement

Data are available on reasonable request. The data supporting the conclusion of the article will be made available on reasonable request.

https://doi.org/10.1136/jnnp-2022-330894

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    Data availability statement

    Data are available on reasonable request. The data supporting the conclusion of the article will be made available on reasonable request.

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    Footnotes

    • AS and R-MG contributed equally.

    • Contributors Conception of the study was developed by R-MG, RD and MW. The study was organised by R-MG, RD and MW. Data acquisition was performed by MM, CH and R-MG. Quantitative maps were calculated by RD and UN. MM, AS and R-MG analysed the data. MM, AS and R-MG wrote the first draft of the manuscript and all authors finalised the manuscript. All authors critically revised the manuscript. Submission of the final version was approved by all authors. The authors ensure the accuracy and integrity of the presented work. AS and R-MG contributed equally to this work, with R-MG being the guarantor of this study.

    • Funding The study was supported by the Else Kröner-Fresenius-Stiftung.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.