Annals of clinical and translational neurology · 2026
T1 Over Squared Proton Density Ratio to Characterize Multiple Sclerosis Lesions.
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Wright Sarah J, McKay Scotty G, Bou Jean Ramos, Bao Fen, Truong Vivian B, Li Chenyang, Jiang Li, Memon Anza B, Haacke E Mark, Ge Yulin, Chen Yongsheng
Аннотация
OBJECTIVE: Differentiating remyelinated from demyelinated lesions in MS remains challenging without histological confirmation. This study introduces the T1-to-PD2 ratio (TPR) imaging approach and evaluates its ability to characterize MS lesions alongside other quantitative MRI (qMRI) metrics.
METHODS: Thirty individuals with MS (mean age: 47.5 ± 11.5 years) underwent 3 T MRI using 3D gradient-echo qMRI sequences to generate quantitative maps of T1, proton density (PD), T2*, quantitative susceptibility mapping (QSM), magnetization transfer ratio (MTR), and MT saturation index (MTsat). TPR images were derived from B1-corrected T1 and PD maps. White matter hyperintense lesions on T2-weighted FLAIR were classified as hyper-, hypo-, or iso-intense relative to normal-appearing white matter on TPR. Lesion-specific qMRI values were analyzed, and simulated signal intensities based on empirical T1 and PD values were used to illustrate TPR contrast. Statistical analyses included Wilcoxon rank-sum tests and Spearman correlations (p < 0.05).
RESULTS: We found that hyperintense lesions on TPR exhibited significantly higher T1 (1566 ms), PD (0.96 a.u.), and T2* (92 ms) values but lower MTR (37.3%) and MTsat (1.57%) compared to hypointense lesions (1085 ms; 0.88 a.u.; 64 ms; 46%; 2.48%, respectively). QSM values varied across lesion types.
INTERPRETATION: In summary, TPR imaging visually differentiates MS lesions into hyper-, hypo-, and iso-intense categories, whereas all lesions appear hyperintense on FLAIR. Hyperintense TPR lesions correspond to increased water and reduced myelin content, as confirmed by quantitative T1, PD, and MT metrics, consistent with demyelination. In contrast, hypointense lesions may reflect tissue changes associated with repair processes such as remyelination.
METHODS: Thirty individuals with MS (mean age: 47.5 ± 11.5 years) underwent 3 T MRI using 3D gradient-echo qMRI sequences to generate quantitative maps of T1, proton density (PD), T2*, quantitative susceptibility mapping (QSM), magnetization transfer ratio (MTR), and MT saturation index (MTsat). TPR images were derived from B1-corrected T1 and PD maps. White matter hyperintense lesions on T2-weighted FLAIR were classified as hyper-, hypo-, or iso-intense relative to normal-appearing white matter on TPR. Lesion-specific qMRI values were analyzed, and simulated signal intensities based on empirical T1 and PD values were used to illustrate TPR contrast. Statistical analyses included Wilcoxon rank-sum tests and Spearman correlations (p < 0.05).
RESULTS: We found that hyperintense lesions on TPR exhibited significantly higher T1 (1566 ms), PD (0.96 a.u.), and T2* (92 ms) values but lower MTR (37.3%) and MTsat (1.57%) compared to hypointense lesions (1085 ms; 0.88 a.u.; 64 ms; 46%; 2.48%, respectively). QSM values varied across lesion types.
INTERPRETATION: In summary, TPR imaging visually differentiates MS lesions into hyper-, hypo-, and iso-intense categories, whereas all lesions appear hyperintense on FLAIR. Hyperintense TPR lesions correspond to increased water and reduced myelin content, as confirmed by quantitative T1, PD, and MT metrics, consistent with demyelination. In contrast, hypointense lesions may reflect tissue changes associated with repair processes such as remyelination.