Global loss of myelin water over 5 years in multiple sclerosis normal-appearing white matter

Abstract

Background:

Reduced myelin water fraction (MWF, a marker for myelin), increased geometric mean T₂ (ieGMT₂, reflecting intra/extracellular water properties), and increased T₁ (related to total water content) have been observed in cross-sectional studies of multiple sclerosis (MS) normal-appearing white matter (NAWM).

Objective:

To assess longitudinal changes of magnetic resonance (MR) measures in relapsing-remitting MS (RRMS) brain NAWM.

Methods:

A total of 11 subjects with RRMS and 4 controls were scanned on a 3T MRI at baseline and long-term follow-up (LTFU; 3.2–5.8 years) with a 32-echo T₂ relaxation and an inversion recovery T₁ sequence. For every voxel, MWF, ieGMT₂, and T₁ were obtained. Mean, peak height, and peak location from NAWM mask-based histograms were determined.

Results:

In MS subjects, NAWM MWF mean decreased by 8% (p = 0.0016). No longitudinal changes were measured in T₁ or ieGMT₂. There was no relationship between change in any MR metric and change in EDSS. Control white matter showed no differences over time in any metric.

Conclusion:

The decreases we observed in MWF suggest that changes in myelin integrity and loss of myelin may be occurring diffusely and over long time periods in the MS brain. The timescale of these changes indicates that chronic, progressive myelin damage is an evolving process occurring over many years.

Keywords

Multiple sclerosis normal-appearing white matter myelin water fraction longitudinal

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