Quantitative Susceptibility Mapping and R2* Measured Changes during White Matter Lesion Development in Multiple Sclerosis: Myelin Breakdown, Myelin Debris Degradation and Removal, and Iron Accumulation

Y. Zhang; S.A. Gauthier; A. Gupta; W. Chen; J. Comunale; G.C.-Y. Chiang; D. Zhou; G. Askin; W. Zhu; D. Pitt; Y. Wang

doi:10.3174/ajnr.A4825

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Fig 1.
Example of ROIs of an MS lesion and reference at normal-appearing WM in a 44-year-old woman with MS. A, T2WI 8 months before the appearance of the enhancing lesion. B, T2WI, and C, T1WI + Gd image of 1 enhancing MS lesion. D, T2WI, E, QSM, and F, R2* images with ROIs of the enhancing lesion (left side) and the normal-appearing WM (right side). The vein inside the selected normal-appearing WM is excluded.
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Fig 2.
MR images of a nodular-enhancing lesion in a 43-year-old man with MS. A, T1WI + Gd. B, T2WI. C, QSM. D, R2*. A nodular-enhancing lesion (arrows) is found on the T1WI + Gd and appears QSM isointense (C, box).
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Fig 3.
MR images of a shell-enhancing lesion in a 51-year-old man with MS. A, T1WI + Gd. B, T2WI. C, QSM. D, R2*. A shell-enhancing lesion (arrows) is found on the T1WI + Gd and appears slightly QSM hyperintense (C, box).
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Fig 4.
MR images of new T2 nonenhancing lesions (< 0.7 years old) in a 42-year-old man with MS. A, T1WI + Gd. B, T2WI. C, QSM. D, R2*. More than 3 new nonenhancing lesions (arrows) are found by comparing with the former MR imaging 0.7 years ago. All of them appear QSM hyperintense (C, box) and have hyperintense rims on R2*.
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Fig 5.
MR images of a nonenhancing lesion that is 1.2 years old in a 48-year-old woman with MS. A, T1WI + Gd. B, T2WI. C, QSM. D, R2*. One lesion appears hyperintense with a thick rim on QSM and hypointense on R2*.
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Fig 6.
Scatterplot of susceptibility relative to normal-appearing WM measured on A, QSM and B, R2*. ppb indicates parts per billion.

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Table 1:

Quantitative susceptibility and R2* values for nodular-enhancing, shell-enhancing, nonenhancing < 1 year, and nonenhancing 1–3 years old lesions

	Nodular	Shell	Nonenhancing < 1 Year	Nonenhancing 1–3 Years
No. of lesions	77	32	48	41
No. of patients	32	21	27	20
Susceptibility relative to NAWM, ppb	0.5 ± 4.4	10.2 ± 5.4	20.2 ± 7.8	33.2 ± 8.2
R2* values relative to NAWM, Hz	−5.6 ± 2.9	−8.0 ± 2.6	−3.1 ± 2.3	−2.0 ± 2.6

Note:—NAWM indicates normal-appearing white matter; ppb, parts per billion.

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Table 2:

Statistical comparison of relative susceptibility from 4 groups of lesions^{^a}

Comparison	Nodular	Shell	<1 year
Shell	−9.8621, (−11.7759, −7.9484), P < .0001	–	–
<1 year	−20.3123, (−23.0288, −17.5959), P < .0001	−10.4502, (−13.6101, −7.2903), P < .0001	–
1–3 years	−32.6287, (−35.9416, −29.3159), P < .0001	−22.7666, (−26.2751, −19.2581), P < .0001	−12.3164, (−16.3345, −8.2983), P < .0001

↵a Data given as relative parameter estimates (β), (95% confidence limits), P value. Parameter estimates, 95% CI, and SE from multivariable generalized estimating equation, controlling for age, Expanded Disability Status Scale score, and disease duration. β estimates were obtained by setting the reference category to different lesion group.

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Table 3:

Statistical comparison of relative R2* from 4 groups of lesions^{^a}

Comparison	Nodular	Shell	<1 year
Shell	2.3409, (1.4980, 3.1837), P < .0001	–	–
< 1 year	−2.4309, (−3.1174, −1.7443), P < .0001	−4.7717, (−5.7643, −3.7792), P < .0001	–
1–3 years	−3.6385, (−4.6191, −2.6578), P < .0001	−5.9793, (−7.0956, −4.863.), P < .0001	−1.2076, (−2.0439, −0.3712), P = .0047

↵a Data given as relative parameter estimates (β), (95% confidence limits), P value. Parameter estimates, 95% CI, and SE from multivariable generalized estimating equation, controlling for age, Expanded Disability Status Scale, and disease duration. β estimates were obtained by setting the reference category to different lesion group.