Abstract
Objectives
This study aimed to explore the microstructural heterogeneity of different white matter
(WM) tissues in relapsing-remitting multiple sclerosis (RRMS) patients by diffusion
magnetic resonance imaging (dMRI) and its correlation with disability and cognitive
status.
Materials and Methods
A total of 337 iron rim lesions (IRLs), 337 perilesional white matters of IRLs (IRLs-PLWMs),
330 non-iron rim lesions (non-IRLs), 330 non-IRLs-PLWMs, 42 normal-appearing white
matters (NAWMs) in 42 RRMS patients, and 30 white matters in healthy controls (WMs
in HCs) were enrolled in the lesion-wise analysis. Diffusion kurtosis imaging (DKI)
parameters including kurtosis fractional anisotropy (KFA) and mean kurtosis (MK),
and diffusion tensor imaging (DTI) parameters including fractional anisotropy (FA)
and mean diffusivity (MD) were measured in the six types of tissues. Subgroup analysis
was performed between non-IRLs with QSM hyperintense (non-IRLs-H) and non-IRLs with
QSM isointense or hypointense (non-IRLs-I), as well as between non-IRLs-H-PLWMs and
non-IRLs-I-PLWMs. Thirty-four out of forty-two patients were enrolled in patient-wise
analysis. The relationships between these diffusion metrics of patients and their
Kurtzke Expanded Disability Status Scale (EDSS) score and Symbol Digit Modalities
Test (SDMT) score were analyzed separately by partial correlation analysis with age
and disease duration (DD) as covariates.
Results
The KFA, FA, MK, and MD values were significantly different among the six types of
tissues. The lowest KFA, FA, and MK values and the highest MD values were revealed
in IRLs. There were significant differences in all the enrolled diffusion metrics
between IRLs and non-IRLs, as well as between IRLs-PLWMs and non-IRLs-PLWMs (p < 0.05). There were no significant differences between NAWMs and WMs in HCs (p = 1.000 for all enrolled diffusion metrics). For all the enrolled diffusion metrics,
no significant differences were found in the subgroup analysis. The FA, MK, and MD
values of total lesions (including IRLs and non-IRLs) (r = -0.420, p = 0.017; r = -0.472, p = 0.006; r = -0.475, p = 0.006) and the MK values of IRLs (r = -0.438, p = 0.012) were correlated with the EDSS scores. There was no significant correlation
between the diffusion parameter values and the SDMT scores.
Conclusion
Our findings demonstrate that IRLs are more destructive than non-IRLs. Similarly,
IRLs-PLWMs are more destructive than non-IRLs-PLWMs. Additionally, diffusion parameter
values of MS lesions can reflect the disability degree. These findings contribute
to a better understanding of the different evolution of MS lesions and the relationship
between the disability level of patients and focal lesion damage degree.
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Article info
Publication history
Published online: July 26, 2022
Accepted:
July 22,
2022
Received in revised form:
June 4,
2022
Received:
April 19,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
