Quantitative susceptibility mapping of both ring and non-ring white matter lesions in relapsing remitting multiple sclerosis

Abstract

Background: Recent evidence suggests that the presence of magnetic susceptibility changes in MS lesions correlates with patients' expanded disability status scale (EDSS).

Purpose: This study evaluated the presence of ring lesions (RLs) and non-RLs, as well as changes in lesion susceptibility and lesion volume over a two-year time period in relapsing-remitting multiple sclerosis (RRMS) patients and compared these measures to the EDSS.

Study type: Longitudinal cohort.

Materials and methods: A total of forty-three (43) patients with RRMS were recruited for this study. All subjects underwent 3 T MRI at baseline and forty-one (41) subjects had follow-up scans over a two-year period. The protocol included T2 fluid attenuated inversion recovery (FLAIR), pre- and post-contrast 2D T1-weighted gradient echo imaging and susceptibility weighted imaging (SWI) sequences. All data were acquired prior to gadolinium-based contrast agent injection except for SWI and post-contrast T1-weighted data. Mean and peak susceptibilities of lesions were measured using quantitative susceptibility mapping (QSM). For the RLs, inner-/outer-diameters from SWI data and absolute intensity from the FLAIR data were measured. The susceptibility and volumes of RLs and non-RLs were correlated with EDSS.

Results: The number of RLs correlated positively with EDSS (p-value = 0.04), but the RL volumes did not show a correlation with EDSS. Measurements of the annular ring and regions with high susceptibility remained constant over time (p = 0.2). For non-ring QSM-positive (QSM+) lesions, the average susceptibility was significantly correlated to EDSS (p < 0.01.) This was also the case for lesion volume, as well as the product of volume and susceptibility when compared to EDSS (p < 0.01 for both).

Conclusions: The susceptibility distribution and lesion volumes for the RLs remained almost constant over time, suggesting that the changes in pathophysiology of the RLs is a gradual process. On the other hand, the presence of more than one RL along with both volume and susceptibility of non-RL QSM+ lesions were significantly associated with increased disability as measured by EDSS. These findings may strengthen the role of QSM in assessing MS patients radiologically.

Keywords: Enhancing white matter lesions; Quantitative susceptibility mapping; Relapsing-remitting multiple sclerosis; Susceptibility weighted imaging; White matter ring lesions.