MRI-Based Lesion Differentiation in Older Patients With Multiple Sclerosis

N/ANot Yet RecruitingNCT07444047

Oslo University Hospital1,000 enrolled

Overview

This study investigates whether an advanced MRI technique called Quantitative Susceptibility Mapping (QSM) can improve the differentiation of white matter lesions in people aged 50-70 years with multiple sclerosis (MS). In older individuals with MS, white matter changes seen on MRI may be related to MS or to other types of white matter changes, most commonly age-related changes or chronic small vessel disease. These conditions can appear similar on conventional MRI scans, making interpretation challenging. Participants will undergo routine clinical MRI, including a short additional QSM sequence, as well as brief cognitive and physical assessments. A comparison group with cerebral small vessel disease will also be included. The goal of the study is to determine whether QSM can provide more precise lesion characterization and support more accurate clinical interpretation of MRI findings in older patients with MS.

Magnetic resonance imaging (MRI) is central to the diagnosis and monitoring of multiple sclerosis (MS). In individuals above 50 years of age, interpretation of white matter lesions becomes increasingly complex because lesions visible on conventional T2-weighted and FLAIR MRI may reflect MS-related demyelination, chronic cerebral small vessel disease (cSVD), or nonspecific age-related white matter changes. Conventional MRI has limited specificity in differentiating between these entities, which may complicate assessment of disease activity and progression. Quantitative Susceptibility Mapping (QSM) is an advanced MRI technique that quantifies tissue magnetic susceptibility and provides complementary information to conventional imaging. Differences in susceptibility characteristics may reflect underlying tissue composition and microstructural properties, potentially allowing improved differentiation between demyelinating and vascular white matter lesions. This prospective observational cohort study includes individuals aged 50-70 years with established MS undergoing routine clinical MRI follow-up, as well as an age-comparable cohort with clinical and radiological evidence of cSVD. MRI examinations include standard clinical sequences with the addition of a short QSM acquisition. Clinical assessment includes brief standardized measures of cognitive processing speed, executive function, and physical function performed in conjunction with clinical visits. Imaging analyses will focus on lesion-level and participant-level susceptibility characteristics and their distribution patterns across cohorts. Associations between QSM-derived measures and clinical function will be explored. The study is designed to evaluate the diagnostic utility and clinical relevance of QSM-based lesion characterization in older individuals with MS.

Eligibility

Sex: ALLMin age: 50 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria Multiple Sclerosis (MS) cohort (AgeMS): * Age 50-70 years * Clinically confirmed diagnosis of multiple sclerosis * Participation in the AgeMS study at Oslo University Hospital Inclusion Criteria Cerebral Small Vessel Disease (cSVD) control cohort: * Age 50-80 years * Radiological evidence of hypertensive small vessel disease on MRI * Good clinical recovery following transient ischemic attack (TIA), minor stroke, or stroke mimic diagnosis Exclusion Criteria Multiple Sclerosis (MS) cohort: * MRI contraindications * Severe psychiatric comorbidity * Major functional disability unrelated to MS or CSVD Exclusion Criteria Cerebral Small Vessel Disease (cSVD) control cohort: * MRI contraindications * Probable or definite cerebral amyloid angiopathy according to Boston criteria 2.0 * Genetic or inflammatory vasculopathies * Persistent neurological deficits * Severe psychiatric comorbidity * Major functional disability unrelated to CSVD

Outcomes

Primary Outcomes

Lesion-Level Quantitative Susceptibility (ppb) Within T2 FLAIR Hyperintense White Matter Lesions at Baseline

Quantitative susceptibility (ppb) will be measured using QSM within each segmented T2 FLAIR hyperintense white matter lesion. Lesion-level susceptibility values will be compared between lesions from the MS cohort and the cSVD cohort. Statistical analyses will account for clustering of multiple lesions within individual participants.

Time frame: Baseline MRI (single MRI session for both cohorts)

Secondary Outcomes

Change From Baseline in Mean Lesion-Level Quantitative Susceptibility (ppb) Within T2 FLAIR Hyperintense White Matter Lesions in the MS Cohort

Quantitative susceptibility (ppb) will be measured within each segmented lesion at each time point. The outcome is change from baseline in lesion-level susceptibility over time. Analyses will account for clustering of multiple lesions within participants.

Time frame: From baseline through December 2030

Association Between QSM-Derived Lesion Burden and Cognitive Composite z-Score

Cognitive function will be summarized at each visit as a composite z-score derived from standardized tests of processing speed and executive function. QSM-derived lesion characteristics will be summarized at the participant level (e.g., burden of QSM-positive vs QSM-negative lesions and lesion volume metrics). Associations between participant-level QSM-derived lesion burden and cognitive composite z-score will be analyzed using regression models.

Time frame: Baseline; repeated assessments in the MS cohort through December 2030

Association Between QSM-Derived Lesion Burden and Physical Function Composite z-Score

Physical function will be summarized at each visit as a composite z-score derived from standardized mobility and balance assessments. QSM-derived lesion characteristics will be summarized at the participant level (e.g., burden of QSM-positive vs QSM-negative lesions and lesion volume metrics). Associations between participant-level QSM-derived lesion burden and physical function composite z-score will be analyzed using regression models.

Time frame: Baseline; repeated assessments through December 2030

Association Between QSM-Derived Lesion Burden and Change From Baseline in Expanded Disability Status Scale (EDSS) Score

Disability progression will be assessed as change from baseline in Expanded Disability Status Scale (EDSS) score during follow-up. QSM-derived lesion characteristics will be summarized at the participant level (e.g., burden of QSM-positive vs QSM-negative lesions and lesion volume metrics). Associations between participant-level QSM-derived lesion burden and EDSS change over time will be analyzed using mixed-effects models.