A specialised non-invasive imaging technique has detected metabolic abnormalities in areas of brain white matter that appeared normal on conventional MRI scans in people with early relapsing-remitting multiple sclerosis (RRMS).
The study, published in Acta Neurologica Belgica, investigated whether proton magnetic resonance spectroscopy (1H-MRS) could identify subtle abnormalities that may not be visible using standard MRI. The researchers analysed 51 adults with early RRMS and relatively mild disability, alongside 44 healthy controls. All patients with MS were receiving interferon-beta treatment.
The researchers used 1H-MRS to examine six regions of white matter that appeared normal on conventional MRI. In four regions, the ratio of N-acetylaspartate to creatine (NAA/Cr), an indicator associated with nerve fibre health, differed between people with MS and healthy controls.
Lower NAA/Cr levels were found in the left frontal, deep and parietal white matter of people with RRMS, consistent with reduced neuronal health. The researchers also identified increased choline-to-creatine ratios in four of the six regions, suggesting changes associated with cell membrane breakdown and myelin loss.
Changes in myo-inositol-to-creatine ratios varied between brain regions, indicating that metabolic abnormalities were not uniform throughout the brain. The researchers also found that the normal regional pattern of NAA/Cr was significantly altered in the MS group.
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Although some metabolic measures initially appeared to correlate with cognitive performance, these associations were not independent after adjustment for other factors. Stronger associations were observed between NAA/Cr and the Multiple Sclerosis Functional Composite, which incorporates walking, arm and hand function, and cognitive processing.
The researchers described the findings as evidence that metabolic injury in normal-appearing white matter is a feature of early RRMS, but emphasised that the study was small and assessed participants at only one time point. Larger, longitudinal studies will be needed to establish whether these measures could eventually serve as biomarkers of disease activity or progression.
This news item has been summarised using AI and checked by humans before publication.
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