Distinct microstructural white matter alterations in demyelinating diseases: Insights from myelin- and axon-sensitive MRI

IF 3 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2026-05-01 Epub Date: 2026-02-16 DOI:10.1016/j.msard.2026.107078

Yasunobu Hoshino , Akifumi Hagiwara , Yuji Tomizawa , Naohisa Hara , Moto Nakaya , Junko Kikuta , Satoru Kamio , Hanna Okada , Koji Kamagata , Shigeki Aoki , Nobutaka Hattori

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引用次数: 0

Abstract

Objectives

We aimed to compare microstructural white matter alterations in multiple sclerosis (MS), anti–aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders (AQP4-NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) using advanced quantitative MRI.

Methods

This retrospective study included 84 participants (24 MS, 18 AQP4-NMOSD, 20 MOGAD, and 22 healthy controls). Quantitative MR relaxometry and multi-shell diffusion-weighted imaging were acquired at 3 T to derive myelin volume fraction (MVF), axonal volume fraction, g-ratio, and diffusion tensor metrics. Normal-appearing white matter (NAWM) was analyzed in all patients, and plaque-based analyses were performed in patients with focal white matter lesions (20 MS, 8 AQP4-NMOSD, 8 MOGAD). Diagnostic performance was assessed using receiver operating characteristic (ROC) analyses.

Results

In NAWM, MS showed significantly lower fractional anisotropy than MOGAD or controls (P < 0.05), and AQP4-NMOSD exhibited lower MVF than MOGAD (P < 0.05). Among patients with lesions, plaques in MS had significantly lower MVF and higher g-ratio than those in AQP4-NMOSD (P < 0.0001) and MOGAD (P < 0.05). Plaques in AQP4-NMOSD showed a lower g-ratio than MOGAD (P < 0.01). Univariate ROC analyses revealed that plaque g-ratio distinguished AQP4-NMOSD from MS (AUC 0.92 [95%CI, 0.82–1.00], sensitivity 100.0%, specificity 75.0%) and from MS + MOGAD (AUC 0.88 [0.77–0.99], sensitivity 100.0%, specificity 75.0%). A multivariate model combining NAWM and plaque metrics further improved discrimination (AUC 0.95 [0.88–1.00], sensitivity 75.0%, specificity 95.0%, and AUC 0.91 [0.81–1.00], sensitivity 50.0%, specificity 92.9%).

Conclusion

Quantitative MRI metrics—especially MVF and g-ratio—demonstrate distinct microstructural profiles among MS, AQP4-NMOSD, and MOGAD, enabling improved disease differentiation.

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脱髓鞘疾病中明显的微结构白质改变：髓磷脂和轴突敏感MRI的见解。

目的：我们旨在利用先进的定量MRI比较多发性硬化症（MS）、抗水通道蛋白-4抗体阳性的视神经脊髓炎谱系障碍（AQP4-NMOSD）和髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）的微结构白质改变。方法：回顾性研究共纳入84例受试者（MS 24例，AQP4-NMOSD 18例，MOGAD 20例，健康对照22例）。在3 T时进行定量MR松弛测量和多壳扩散加权成像，得出髓磷脂体积分数（MVF）、轴突体积分数、g比和扩散张量指标。对所有患者进行外观正常的白质（NAWM）分析，对局灶性白质病变患者（20 MS, 8 AQP4-NMOSD, 8 MOGAD）进行基于斑块的分析。采用受试者工作特征（ROC）分析评估诊断表现。结果：在NAWM中，MS的分数各向异性明显低于MOGAD和对照组（P < 0.05）， AQP4-NMOSD的MVF明显低于MOGAD （P < 0.05）。病变患者中，MS斑块的MVF明显低于AQP4-NMOSD (P < 0.0001)， g-ratio明显高于MOGAD （P < 0.05）。AQP4-NMOSD斑块的g比值低于MOGAD （P < 0.01）。单因素ROC分析显示，斑块g-ratio将AQP4-NMOSD与MS （AUC 0.92 [95%CI, 0.82-1.00]，敏感性100.0%，特异性75.0%）和MS + MOGAD （AUC 0.88[0.77-0.99]，敏感性100.0%，特异性75.0%）区分开来。结合NAWM和斑块指标的多变量模型进一步提高了识别能力（AUC为0.95[0.88-1.00]，灵敏度为75.0%，特异性为95.0%；AUC为0.91[0.81-1.00]，灵敏度为50.0%，特异性为92.9%）。结论：定量MRI指标-特别是MVF和g-ratio-显示MS， AQP4-NMOSD和MOGAD之间不同的微观结构特征，有助于改善疾病分化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.