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Celia Oreja-Guevara, MD; Arnaud Charil, MSc; Domenico Caputo, MD; Rosella Cavarretta, MD; Maria Pia Sormani, PhD; Massimo Filippi, MD

Arch Neurol. 2006;63:736-740.

Background  Magnetization transfer (MT) magnetic resonance imaging (MRI) can provide in vivo quantitative estimates of microscopic tissue damage in normal-appearing white matter (NAWM) and gray matter (GM) from patients with multiple sclerosis (MS).

Objective  To determine whether a onetime MT MRI can provide markers of short-term disease evolution in patients with relapsing-remitting MS.

Design  Eighteen-month observational study.

Setting  Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele.

Patients  Twenty-two patients with untreated relapsing-remitting MS.

Main Outcome Measures  Relapse rate; disability according to the Expanded Disability Status Scale (EDSS); dual-echo, 2-dimensional gradient echo with and without a saturation MT pulse and T1-weighted MRIs of the brain; and MT ratio (MTR) histograms for NAWM and GM.

Results  During the study period, 13 patients (59%) experienced 25 relapses. The median EDSS score was 1.25 (range, 0-3.5) at study entry and 1.75 (range, 0-3) at study exit. Significant, although moderate, correlations were found between average GM MTR values at baseline and EDSS changes during the study period (r = –0.44; P = .04). A trend was observed for the correlation between NAWM MTR values at baseline and the EDSS changes throughout 18 months (r = –0.42; P = .05). For the relation between EDSS changes and baseline GM MTR, the slope of the regression line was –0.5 (95% confidence interval, –1.0 to 0.0), indicating that a decrease in the baseline GM MTR of 1% predicted an increase in the EDSS score of 0.5 point throughout the 18 months.

Conclusion  This study indicates that a "snapshot" MT MRI assessment detects subtle brain tissue changes that are associated with short-term disability accumulation in patients with relapsing-remitting MS.

Author Affiliations: Neuroimaging Research Unit, Department of Neurology, Scientific Institute and University Ospedale San Raffaele (Drs Oreja-Guevara, Sormani, and Filippi and Mr Charil), and Department of Neurology (Drs Caputo and Cavarretta) and MRI Research Group (Dr Filippi), Fondazione Don Gnocchi, Milan, Italy; and Dipartimento di Scienze della Salute, Biostatistics Unit, University of Genoa, Genoa, Italy (Dr Sormani).

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