A longitudinal study of MR diffusion changes in normal appearing white matter of patients with early multiple sclerosis

Francesca Caramia, Patrizia Pantano, Silvia Di Legge, Maria Cristina Piattella, Delia Lenzi, Andrea Paolillo, Walter Nucciarelli, Gian Luigi Lenzi, Luigi Bozzao, Carlo Pozzilli

Research output: Contribution to journalArticlepeer-review


Background and purpose: The stage at which normal appearing white matter (NAWM) abnormalities first appear in multiple sclerosis (MS) is not clear. The aim of our study was to monitor water diffusion changes over time in NAWM of patients with early MS. Methods: Out of a consecutive series of patients enrolled in a MR study on clinically isolated syndrome (CIS), we selected 19 subjects who had completed a one year follow-up. The MR scans obtained at baseline and at 12 months were reviewed according to the new criteria on the diagnosis of MS. Lesion load on T2 and T1 weighted images and the trace of the apparent diffusion coefficient in NAWM were measured both at baseline and at 12 months in patients and in 12 healthy controls. Results: In three patients the diagnosis of MS was done at baseline based on MR. Thirteen patients developed MS during the study and in three patients the diagnosis remained "possible MS." TADC in NAWM in patients was significantly higher than in controls at the 12 months' follow-up but not at baseline (controls mean tADC ± sd = 0.745 ± 0.02 mm2/sec × 10-3; patients mean tADC12 ± sd = 0.767 ± 0.02 mm2/sec × 10-3; p <0.02). TADC and T2 lesion load at 12 months were significantly correlated (p <0.01). Patients exhibiting tADC12 above a confidence interval had a significantly greater EDSS score at the same time period (EDSS12 ± sd = 1.9 ± 0.5 and = 1.1 ± 0.4 respectively; p <0.01). Conclusions: This study suggests that diffusion MR cannot detect alterations in NAWM of patients with a CIS suggestive of MS. After one year, when most patients develop MS, diffusion MR abnormalities in NAWM become apparent. These abnormalities are correlated with T2 lesion load and may contribute to neurological impairment.

Original languageEnglish
Pages (from-to)383-388
Number of pages6
JournalMagnetic Resonance Imaging
Issue number5
Publication statusPublished - Jun 2002


  • Diffusion MR
  • Longitudinal study
  • Multiple sclerosis
  • Normal appearing white matter

ASJC Scopus subject areas

  • Biophysics
  • Clinical Biochemistry
  • Structural Biology
  • Radiology Nuclear Medicine and imaging
  • Condensed Matter Physics


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