T1 and T2 Mapping Improves Correlation of Disability and Brain Atrophy Beyond Lesional Measures in Patients with Multiple Sclerosis
Manuela Vaneckova1, Matej Kudrna1, Veronica Ravano3, Vaclav Capek1, Jiri Lindner1, Dominika Stastna4, Michaela Andelova2, Dana Horakova2, Gian Franco Piredda3, Tom Hilbert3, Johannes Disselhorst3, Benedicte Marechal3, Tobias Kober3, Tomas Uher2
1Radiology, 2Neurology, General University Hospital, First Faculty of Medicine, Charles University, 3Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland, 4General University Hospital in Prague
Objective:
To assess the incremental predictive value for disability, measured by Expanded Disability Status Scale (EDSS) and normalized brain volume (nBV), of evaluating pathology in normal-appearing white matter (NAWM) using mapping of T1 and T2 Z-scores (T1M, T2M) along with T2 lesion volume (T2LV) in patients with multiple sclerosis (pwMS).
Background:
T2LV is typically used to quantify the radiological disease burden of pwMS, but other pathophysiological processes occurring in NAWM remain underexplored.
Design/Methods:
In this cross-sectional observational study, we investigated 140 pwMS (74% relapsing-remitting and 26% progressive; mean disease duration: 9.4±9.2 years; 70.1% females; median EDSS: 2.8). All examinations were performed on a single 3T MRI scanner (MAGNETOM Skyra, Siemens Healthineers, Forchheim, Germany). The protocol included 3D MPRAGE, FLAIR, MP2RAGE, and 2D GRAPPATINI research application sequences for T2M. T1 and T2 deviations from reference values from 92 healthy controls were estimated using Z-score-derived metrics computed for each individual patient’s NAWM. NBV and T2LV were derived from MPRAGE and FLAIR, respectively, using research applications. PwMS were stratified into four groups based on medians of T2LV and T1M/T2M Z-scores. Kruskal-Wallis was used to compare differences between the subgroups.
Results:
We found differences between the groups (EDSS: p<0.001, e2 = 0.150 in T1M; p<0.001, e2=0.161 in T2M; BV: p<0.001, e2=0.218 in T1M; p<0.001, e2=0.315 in T2M). Patients with high T1M/T2M Z-scores and high T2LV exhibited the lowest nBV compared to other subgroups. Patients with high T2LV and high T1M/T2M Z-scores had lower nBV compared to patients with high T2LV but low T1M/T2M Z-scores (p<0.05 and p<0.001, respectively).
Conclusions:
The combination of T1 and T2 mapping with T2LV correlated to brain atrophy in pwMS. These findings may inform future research, supporting the potential use of T1M and T2M as complementary MRI markers in routine practice for a more comprehensive assessment of disease burden.
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