title: Multimodal quantitative MRI assessment of cortical damage in relapsing-remitting multiple sclerosis.
abstract: To investigate magnetization transfer ratio (MTR), T1relaxation time, and proton density (PD) as indicators of gray matter damage in relapsing-remitting multiple sclerosis (RRMS), reflecting different aspects of microstructural damage and as imaging correlates of clinical disability. We aimed to determine which of these parameters may optimally quantify cortical damage, and serve as an imaging surrogate of clinical disability. In this study, cortical values of MTR, a surrogate for demyelination in MS, of PD, reflecting replacement of neural tissue by water, and of T1, indicating a complex array of microstructural changes, were assessed in a group of RRMS patients in comparison to healthy controls (HC).
  
  
  
  22 RRMS patients with varying disease duration (4.0 ± 6.54 years) and 10 HC received quantitative 3T magnetic resonance imaging (MRI) with MTR, T1, and PD mapping. We tested for differences in cortical measurements between patients and HC. Additionally, correlation with disability as quantified by the Expanded Disability Status Scale was investigated.
  
  
  
  Cortical parameter values were significantly altered in the RRMS group, with increased values of T1(P = 0.008) and PD (P = 0.028) and reduced values of MTR (P = 0.043). Only cortical T1was correlated with clinical disability measurements (P = 0.001, r = 0.65). Receiver operating characteristic analysis demonstrated the best discriminatory power for T1(area under the curve 0.79, PD: 0.75, MTR 0.73).
  
  
  
  Out of the parameters studied, cortical T1is best suited to detect cortical damage as an imaging surrogate of clinical disability in RRMS. J. Magn. Reson. Imaging 2016;44:1600-1607.
authors.affiliation: Department of Neurology, Goethe University, Frankfurt/Main, Germany.|Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: René-Maxime
authors.initials: RM
authors.lastname: Gracien
authors.affiliation: Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany.|Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: Alina
authors.initials: A
authors.lastname: Jurcoane
authors.affiliation: Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany.|Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: Marlies
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Department of Neurology, Goethe University, Frankfurt/Main, Germany.|Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Reitz
authors.affiliation: Department of Neurology, Goethe University, Frankfurt/Main, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Mayer
authors.affiliation: Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Volz
authors.affiliation: Department of Neurology, Goethe University, Frankfurt/Main, Germany.|Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: Stephanie-Michelle
authors.initials: SM
authors.lastname: Hof
authors.affiliation: Department of Neurology, Johannes Gutenberg University, Mainz, Germany.|Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Fleischer
authors.affiliation: Department of Neurology, Johannes Gutenberg University, Mainz, Germany.|Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Amgad
authors.initials: A
authors.lastname: Droby
authors.affiliation: Department of Neurology, Goethe University, Frankfurt/Main, Germany.
authors.forename: Helmuth
authors.initials: H
authors.lastname: Steinmetz
authors.affiliation: Department of Neurology, Johannes Gutenberg University, Mainz, Germany.|Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Sergiu
authors.initials: S
authors.lastname: Groppa
authors.affiliation: Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany.|Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: Elke
authors.initials: E
authors.lastname: Hattingen
authors.affiliation: Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Deichmann
authors.affiliation: Department of Neurology, Goethe University, Frankfurt/Main, Germany.|Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.|Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Klein
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: MTR; T1 relaxation time; cortical gray matter; multiple sclerosis; proton density; quantitative MRI