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Validation of Rapid Magnetic Resonance Myelin Imaging in Multiple Sclerosis
Author(s) -
Ouellette Russell,
Mangeat Gabriel,
Polyak Ildiko,
Warntjes Marcel,
Forslin Yngve,
Bergendal Åsa,
Plattén Michael,
Uppman Martin,
Treaba Constantina Andrada,
CohenAdad Julien,
Piehl Fredrik,
Kristoffersen Wiberg Maria,
Fredrikson Sten,
Mainero Caterina,
Granberg Tobias
Publication year - 2020
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25705
Subject(s) - multiple sclerosis , myelin , magnetic resonance imaging , medicine , relaxometry , expanded disability status scale , biomarker , white matter , imaging biomarker , proteolipid protein 1 , luxol fast blue stain , pathology , nuclear medicine , myelin basic protein , radiology , central nervous system , immunology , biology , spin echo , biochemistry
Objective Magnetic resonance imaging (MRI) is essential for multiple sclerosis diagnostics but is conventionally not specific to demyelination. Myelin imaging is often hampered by long scanning times, complex postprocessing, or lack of clinical approval. This study aimed to assess the specificity, robustness, and clinical value of Rapid Estimation of Myelin for Diagnostic Imaging, a new myelin imaging technique based on time‐efficient simultaneous T 1 /T 2 relaxometry and proton density mapping in multiple sclerosis. Methods Rapid myelin imaging was applied using 3T MRI ex vivo in 3 multiple sclerosis brain samples and in vivo in a prospective cohort of 71 multiple sclerosis patients and 21 age/sex‐matched healthy controls, with scan–rescan repeatability in a subcohort. Disability in patients was assessed by the Expanded Disability Status Scale and the Symbol Digit Modalities Test at baseline and 2‐year follow‐up. Results Rapid myelin imaging correlated with myelin‐related stains (proteolipid protein immunostaining and Luxol fast blue) and demonstrated good precision. Multiple sclerosis patients had, relative to controls, lower normalized whole‐brain and normal‐appearing white matter myelin fractions, which correlated with baseline cognitive and physical disability. Longitudinally, these myelin fractions correlated with follow‐up physical disability, even with correction for baseline disability. Interpretation Rapid Estimation of Myelin for Diagnostic Imaging provides robust myelin quantification that detects diffuse demyelination in normal‐appearing tissue in multiple sclerosis, which is associated with both cognitive and clinical disability. Because the technique is fast, with automatic postprocessing and US Food and Drug Administration/CE clinical approval, it can be a clinically feasible biomarker that may be suitable to monitor myelin dynamics and evaluate treatments aiming at remyelination. ANN NEUROL 2020;87:710–724