Longitudinal analysis of T1w/T2w ratio in patients with multiple sclerosis from first clinical presentation


  • G. Cooper
  • C. Chien
  • H. Zimmermann
  • J. Bellmann-Strobl
  • K. Ruprecht
  • J. Kuchling
  • S. Asseyer
  • A.U. Brandt
  • M. Scheel
  • C. Finke
  • F. Paul


  • Multiple Sclerosis Journal


  • Mult Scler J 27 (14): 2180-2190


  • BACKGROUND: Cross-sectional studies suggest normal appearing white matter (NAWM) integrity loss may lead to cortical atrophy in late-stage relapsing-remitting multiple sclerosis (MS). OBJECTIVE: To investigate the relationship between NAWM integrity and cortical thickness from first clinical presentation longitudinally. METHODS: NAWM integrity and cortical thickness were assessed with 3T magnetic resonance imaging (MRI) in 102 patients with clinically isolated syndrome or early MS (33.2 (20.1–60.1) years old, 68% female) from first clinical presentation over 2.8 ± 1.6 years. Fifty healthy controls (HCs) matched for age and sex were included. NAWM integrity was evaluated using the standardized T1w/T2w ratio (sT1w/T2w). The association between sT1w/T2w and cortical thickness was assessed using linear mixed models. The effect of disease activity was investigated using the No Evidence of Disease Activity (NEDA-3) criteria. RESULTS: At baseline, sT1w/T2w (p = 0.152) and cortical thickness (p = 0.489) did not differ from HCs. Longitudinally, decreasing sT1w/T2w was associated with cortical thickness and increasing lesion burden (marginal R(2) = 0.061). The association was modulated by failing NEDA-3 (marginal R(2) = 0.097). CONCLUSION: sT1w/T2w may be a useful MRI biomarker for early MS, detecting relevant NAWM damage over time using conventional MRI scans, although with less sensitivity compared to quantitative measures.