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Whole-Brain T1 Mapping in Multiple Sclerosis: Global Changes of Normal-appearing Gray and White Matter¹

¹ From the Departments of Radiology (H.V., J.J.G.G., L.N.v.D., J.A.C., F.B.), Clinical Epidemiology and Biostatistics (D.L.K.), Neurology (B.J., C.H.P.), and Physics and Medical Technology (R.A.v.S., P.J.W.P.), VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; and Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Italy (V.D.). Received April 6, 2005; revision requested June 7; revision received September 9; accepted October 14; final version accepted November 1. Supported by the Dutch MS Research Foundation, Voorschoten, the Netherlands, through a program grant and specific project grants to H.V. (grant 98-371 MS) and J.J.G.G. (grant 00-427 MS). Address correspondence to H.V.

Purpose: To prospectively investigate whether T1 changes in normal-appearing white matter (WM) and normal-appearing gray matter (GM) in multiple sclerosis (MS) are global or regional and their relationship to disease type.

Materials and Methods: The institutional ethics review board approved study; written informed consent was obtained. Whole-brain T1 maps were obtained in 67 patients with MS and 24 healthy control subjects with three-dimensional fast low-angle shot flip angle–array method, with correction for B₁ imperfections. Analysis of variance was performed on T1 histogram parameters of global normal-appearing WM and GM. Regional mean T1 values were analyzed with a multilevel approach. Multiple linear regression analysis was performed to investigate associations with clinical disability and overall atrophy. For patients, T2 lesion load was determined.

Results: T1 histograms of normal-appearing WM had significantly higher peak positions for patients with MS (792 msec ± 36 in secondary progressive [SP] MS) than for control subjects (746 msec ± 23) and were significantly broader and lower (all P < .001). Histograms for cortical normal-appearing GM were significantly shifted (peak positions, 1263 msec ± 44 in control subjects and 1355 msec ± 62 in patients with SP MS) (P < .001). Histogram peak positions were significantly higher in SP MS than in relapsing-remitting (RR) and primary progressive MS (P < .05). In SP disease, at least 31% of normal-appearing WM and 20% of cortical normal-appearing GM were affected. In MS, T1 was significantly elevated in all normal-appearing WM and cortical normal-appearing GM regions (all P < .01) but was elevated only in the thalamus in deep GM (P < .05). Cortical T1 histogram peak position was associated with clinical disability; T2 lesion load was not.

Conclusion: Results suggest that a global disease process affects large parts of both normal-appearing WM and GM in MS and effects are worse for SP MS than for RR MS.

© RSNA, 2006