Griffin, Colette; (2003) Early relapsing remitting multiple sclerosis: A magnetic resonance imaging study investigating normal appearing brain tissue and lesion changes and their relationship to clinical disability. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The aim of this thesis is to study patients with early relapsing remitting multiple sclerosis (MS) using radiological and clinical methods. I have studied a cohort of patients with early disease (within three years of neurological symptom onset). I have used various MR imaging sequences in order to assess both lesions and normal appearing brain tissue (NABT). I have used quantitative techniques such as magnetisation transfer imaging (MTI) and T1 relaxation times that provide a sensitive measure of abnormalities in lesions and NABT. I have also used Gadolinium (Gd-DTPA) enhancement of T1 weighted images in order to assess lesion inflammation at this early stage. Diffusion tensor imaging (DTI) measurements also give an indication of changes in diffusivity and fibre tract integrity both within lesions and NABT. I have used these techniques both in isolation and in combination to assess early changes in this cohort of patients. In addition to using different MR sequences, I have compared region of interest (ROI) and histogram techniques in detecting change. I have assessed the relationship between MR parameters of disease activity and clinical scales (both well established and more novel scores). I have examined the relationship between MTR and T1 relaxation times in lesions and normal appearing white matter (NAWM) and found that this relationship differs between the different tissue types. I have detected NAWM and NAGM changes in this group of patients with early disease using DTI, MTR and T1 relaxation times. The most sensitive MR technique appears to be that of T1 relaxation times using a histogram approach and DTI using a ROI approach appears to be the least sensitive method for detecting changes in NABT in this cohort of patients.

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