Age independently affects myelin integrity as detected by magnetization transfer magnetic resonance imaging in multiple sclerosis

• Magnetization transfer MRI was used in a cohort of 40 MS subjects differing by age.
• MTR metrics were different between MS groups and controls, as expected.
• MTR in normal appearing tissue did not differ between age-stratified MS groups.
• MTR in white matter lesions was strongly different between age-stratified MS groups.
• Results imply an age-related effect in tissue integrity in MR-visible lesions.

BackgroundMultiple sclerosis (MS) is a heterogeneous disorder with a progressive course that is difficult to predict on a case-by-case basis. Natural history studies of MS have demonstrated that age influences clinical progression independent of disease duration.ObjectiveTo determine whether age would be associated with greater CNS injury as detected by magnetization transfer MRI.Materials and methodsForty MS patients were recruited from out-patient clinics into two groups stratified by age but with similar clinical disease duration as well as thirteen controls age-matched to the older MS group. Images were segmented by automated programs and blinded readers into normal appearing white matter (NAWM), normal appearing gray matter (NAGM), and white matter lesions (WMLs) and gray matter lesions (GMLs) in the MS groups. WML and GML were delineated on T2-weighted 3D fluid-attenuated inversion recovery (FLAIR) and T1 weighted MRI volumes. Mean magnetization transfer ratio (MTR), region volume, as well as MTR histogram skew and kurtosis were calculated for each region.ResultsAll MTR measures in NAGM and MTR histogram metrics in NAWM differed between MS subjects and controls, as expected and previously reported by several studies, but not between MS groups. However, MTR measures in the WML did significantly differ between the MS groups, in spite of no significant differences in lesion counts and volumes.ConclusionsDespite matching for clinical disease duration and recording no significant WML volume difference, we demonstrated strong MTR differences in WMLs between younger and older MS patients. These data suggest that aging-related processes modify the tissue response to inflammatory injury and its clinical outcome correlates in MS.