Quantitative Assessment of Remyelination by Q-space Myelin Map and its Association With Functionality and Quality of Life in Multiple Sclerosis
Vitória Pimentel1, Liliana Daissy Mora Cuervo2, Rafael Canani Sommer2, Alessandra Jahn Gallo3, Pedro Rodrigues Neves3, Douglas Sato4
1Department of Neurology, 2Postgraduate Program in Medicine and Health Sciences, 3School of Medicine, Pontifical Catholic University of Rio Grande do Sul, 4Department of Neurology, Federal University of Rio Grande do Sul
Objective:
To assess qMM-derived myelin changes and their relationship with therapy initiation, clinical outcomes, and quality of life in relapsing remitting multiple sclerosis (RRMS).
Background:
Remyelination in multiple sclerosis (MS) is a key repair process that may help restore neural conduction and protect against progressive neurodegeneration. Conventional MRI, however, cannot reliably distinguish remyelinated tissue from chronic demyelination, limiting in vivo assessment of myelin repair. The q-Space Myelin Map (qMM) is a diffusion-based MRI technique sensitive to myelin content, allowing noninvasive quantification of remyelination.
Design/Methods:
We conducted a 6-month observational study using qMM in 21 RRMS patients who initiated or switched to natalizumab or other disease-modifying therapies (DMTs). We examined whether qMM-detected myelin increases were associated with clinical improvement and quality-of-life outcomes. Participants underwent baseline and 6-month brain MRI with qMM to quantify myelin within lesions and normal-appearing white matter (NAWM), alongside clinical assessments (EDSS, MSFC, MSQOL-54).
Results:
Among 1,125 lesions analyzed, approximately one-third (34.1%) showed increased myelin content consistent with remyelination, with 71.4% of these lesions occurring in natalizumab-treated patients. Overall remyelination rates after 6 months were comparable between treatment groups. Remyelination was more frequent in male patients (OR 6.44, p = 0.03), in gadolinium-enhancing lesions at baseline (OR 31.9, p < 0.0001), and in those with confirmed EDSS improvement (OR 11.33, p = 0.02). Higher NAWM myelin content correlated with better baseline physical quality-of-life, and greater lesional myelin gains predicted higher MSFC Z-scores at follow-up.
Conclusions:
In summary, qMM appears to be a promising noninvasive biomarker of remyelination. Imaging evidence of myelin restoration was associated with improved disability and quality-of-life measures, supporting the potential of qMM to inform clinical decision-making and advance myelin repair research.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.