Magnetization transfer changes in the normal appering white matter precede the appearance of enhancing lesions in patients with multiple sclerosis
Abstract
Serial monthly magnetization transfer (MT) imaging was performed to evaluate whether a change of the normal appearing white matter (NAWM), which precedes the appearance of enhancing lesions, is seen in patients with multiple sclerosis (MS). Every 4 weeks for 3 months, 10 patients with relapsing-remitting MS were scanned with a T1-weighted sequence, 20 minutes after injection with 0.3 mmol/kg gadolinium-DTPA (Gd-DTPA). During each of the monthly sessions, MT and dual echo scans were also performed before Gd-DTPA injection. On coregistered images, the MT ratio (MTR) was measured in NAWM subsequently involved by enhancing lesions, in NAWM areas on the same slices but outside any present or future MR abnormality, and in enhancing lesions at the time of their appearance. Forty-eight new enhancing lesions with no corresponding abnormalities on previous scans were identified. Their average MTR was 33.1% (+/-8.4%). Three, 2, and 1 month before enhancement appearance, the mean MTR in NAWM, measured from areas corresponding to future enhancing lesions, was significantly lower than the mean MTR in NAWM outside enhancing areas; the MTR decreased steadily as the time when the enhanced lesion approached. These results suggest that changes in the NAWM of patients with MS occur before lesions become evident on conventional MRI scans.
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MRI changes suggestive of blood-brain barrier disruption were found in normally appearing white matter before enhancing lesions and in nonenhancing areas.
“Furthermore, MRI changes suggestive of BBB disruption were also found in normally appearing white matter before enhancing lesions (176), and in nonenhancing areas (626)”
From Blood-Brain Barrier: From Physiology to Disease and Back (2019) · cites this paper as [176]
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- Authors
- Filippi, M., Rocca, M. A., Martino, G., Horsfield, M. A., & Comi, G.
- Affiliations
- University of Milan (IT)
- University of Leicester (GB)
- Corresponding author
- Filippi, Massimo
- Venue
- Annals of Neurology
- Publisher
- Wiley
- Published
- 1998-06
- Volume
- 43
- Issue
- 6
- Pages
- 809-814
- ISSN
- 0364-5134 (ISSN-L)
- 1531-8249
- OpenAlex
- W2102993505
- Cited by
- 395
- References
- 31
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 8 · 2023: 11 · 2022: 9 · 2021: 10 · 2020: 10 · 2019: 4 · 2018: 7 · 2017: 11 · 2016: 12 · 2015: 15 · 2014: 14 · 2013: 16 · 2012: 10
- FWCI
- 18.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Neurology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Keywords
- multiple sclerosis, normal-appearing white matter, magnetization transfer ratio, enhancing lesions, lesion progression, relapsing-remitting multiple sclerosis, Gd-DTPA, white matter changes
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Magnetics, Male, Multiple Sclerosis, Myelin Sheath, Nerve Fibers, Protons, Disease Progression
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