Multiple sclerosis and related disorders · 2026
Spatially heterogeneous T1w/T2w ratio alterations in relapsing-remitting multiple sclerosis: associations with cognitive impairment.
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Ru Xiaoshuang, Li Xuesong, Zhao Shilong, Xiang Rongjia, Wang Wenjia, He Mengqi, Hu Dehai, Han Qingyue, Ma Deliang, Sun Yan, Duan Yunyun, Song Yang
Аннотация
OBJECTIVE: The T1w/T2w ratio has been proposed as a feasible MRI biomarker reflecting tissue microstructural integrity. This study investigated its alterations across brain tissue types and regions in relapsing-remitting MS (RRMS) and its association with cognition and disability.
METHODS: 72 RRMS patients and 70 matched healthy controls underwent neuropsychological testing and EDSS assessment. T1w/T2w ratio mapping was performed using MRTool. Mean ratio values were extracted from cortical GM, deep GM, WMH lesions, perilesional WM, and NAWM. Regional analyses used the JHU-ICBM-DTI-81 WM, Desikan-Killiany cortical, and Harvard-Oxford subcortical atlases. Lesion voxels were excluded from ROI averages. Between-group differences were assessed, and multiple linear regressions examined associations with EDSS and cognitive Z-scores, adjusting for demographics, disease covariates, lesion burden, and TIV, with FDR correction.
RESULTS: Compared to the controls, RRMS patients showed significantly lower T1w/T2w ratios in WMH lesions (p < 0.001), perilesional WM (p = 0.029), bilateral caudate (p = 0.025), fornix, sagittal stratum, and stria terminalis (all FDR-corrected p < 0.01), but higher ratios in the putamen, pallidum, accumbens (p < 0.05), cerebral peduncle, and anterior/posterior limb of internal capsule (p < 0.001). Learning and memory performance (CVLT-III, BVMT-R) was positively associated with T1w/T2w ratio in the left entorhinal cortex, bilateral caudate, and lesional segments of the left posterior thalamic radiation and sagittal stratum (β = 1.397-3.505, all FDR-corrected p < 0.05).
CONCLUSION: The T1w/T2w ratio demonstrates spatially heterogeneous alterations across brain regions in RRMS, reflecting underlying pathological complexity and may serve as a promising neuroimaging biomarker for cognitive impairment.
METHODS: 72 RRMS patients and 70 matched healthy controls underwent neuropsychological testing and EDSS assessment. T1w/T2w ratio mapping was performed using MRTool. Mean ratio values were extracted from cortical GM, deep GM, WMH lesions, perilesional WM, and NAWM. Regional analyses used the JHU-ICBM-DTI-81 WM, Desikan-Killiany cortical, and Harvard-Oxford subcortical atlases. Lesion voxels were excluded from ROI averages. Between-group differences were assessed, and multiple linear regressions examined associations with EDSS and cognitive Z-scores, adjusting for demographics, disease covariates, lesion burden, and TIV, with FDR correction.
RESULTS: Compared to the controls, RRMS patients showed significantly lower T1w/T2w ratios in WMH lesions (p < 0.001), perilesional WM (p = 0.029), bilateral caudate (p = 0.025), fornix, sagittal stratum, and stria terminalis (all FDR-corrected p < 0.01), but higher ratios in the putamen, pallidum, accumbens (p < 0.05), cerebral peduncle, and anterior/posterior limb of internal capsule (p < 0.001). Learning and memory performance (CVLT-III, BVMT-R) was positively associated with T1w/T2w ratio in the left entorhinal cortex, bilateral caudate, and lesional segments of the left posterior thalamic radiation and sagittal stratum (β = 1.397-3.505, all FDR-corrected p < 0.05).
CONCLUSION: The T1w/T2w ratio demonstrates spatially heterogeneous alterations across brain regions in RRMS, reflecting underlying pathological complexity and may serve as a promising neuroimaging biomarker for cognitive impairment.