Background In multiple sclerosis (MS), pathological changes have been found both in macroscopic lesions and normal appearing tissue.
Magnetisation transfer ratio (MTR) and T1 relaxation time are abnormal in normal appearing tissues in established MS. This
study used these MR techniques in early MS to study normal appearing tissues and lesions. The purpose was to determine whether
abnormalities are already detectable in normal appearing tissues in early MS, and if so how they correlate with lesion characteristics.
Methods Twenty two patients with early relapsing remitting (RR) MS (median disease duration 2 years, range 7 months–3 years) and
11 age-matched controls were studied. MTR and T1 relaxation times were measured in 9 regions of normal appearing white matter
(NAWM) and 7 of normal appearing grey matter (NAGM). Gadolinium enhancing, T1-hypointense and T2 lesion loads were measured
in all patients.
Results When all regions were combined, there was a significant difference between patient and control NAWM for both T1 and MTR;
T1 was abnormal in 6/9 and MTR in 3/9 NAWM regions. Global assessment of NAGM revealed a significant difference between patients
and controls for T1 but not for MTR; T1 was significantly abnormal only in frontal NAGM. There was no significant correlation
between NAWM T1 or MTR and any of the lesion load measurements.
Conclusions This study reveals quantitative MR abnormalities in both NAWM and NAGM in early RR MS, with more extensive changes in the
former. The lack of correlation between NAWM and lesion abnormalities suggests that they have developed by at least partly
independent mechanisms. T1 may be more sensitive than MTR in detecting subtle pathological changes in NAWM and NAGM.
Key words early relapsing remitting MS - MRI - normal appearing brain tissue
Received: 3 April 2001, Received in revised form: 15 June 2001, Accepted: 18 June 2001