BACKGROUND AND PURPOSE: Long-range connections are more severely damaged and relevant for cognition in long-standing MS. However, the evolution of such coordinated network damage in patients with MS is unclear. We investigated whether short-and long-range structural connections sustained equal damage in early-stage MS.
MATERIALS AND METHODS:Sixteen patients with early-stage MS and 17 healthy controls were scanned by high-resolution, multishell diffusion imaging on 7T MR imaging and assessed cognitively. We investigated macrostructural properties in short-and longrange fibers and of microstructural metrics derived from 2 quantitative diffusion MR imaging models: DTI and neurite orientation dispersion and density imaging.RESULTS: Patients had significant WM integrity damage-that is, higher radial diffusivity and a lower intracellular volume fraction in the focal WM lesions. Compared with the healthy controls, the patients had noticeable microstructure changes in both short-and long-range fibers, including increased radial diffusivity, mean diffusivity, and axial diffusivity. Z scores further indicated greater damage in the short-range fibers than in the long-range fibers.
CONCLUSIONS:Our findings demonstrate that more severe demyelination preceding axonal degeneration occurs in short-range connections but not in long-range connections in early-stage MS, suggesting the possibility that there are cortical lesions that are undetectable by current MR imaging.ABBREVIATIONS: AD ¼ axial diffusivity; EDSS ¼ Expanded Disability Status Scale; FA ¼ fractional anisotropy; f icvf ¼ intracellular volume fraction; HC ¼ healthy control; MD ¼ mean diffusivity; NODDI ¼ neurite orientation dispersion and density imaging; ODI ¼ Orientation Dispersion Index; RD ¼ radial diffusivity M S has been histologically characterized by the aggregation of inflammation, demyelination, gliosis, and axonal transection that ultimately leads to neurologic disability in young adults. MS can present with highly variable symptoms such as loss of vision, limb weakness, sensory loss, ataxia, and cognitive impairment. 1,2 Neuroimaging studies have helped to define the pathologic substrates and microstructure (eg, demyelination) alternations of this disorder in focal lesions and diffusely abnormal tissue. 3,4 While the specific WM fiber changes remain elusive, these local abnormalities in tissue microstructure are not enough to explain the clinically observed functional impairment. 5,6 Nevertheless, there is growing evidence that neurologic impairment in MS is determined more by specific large-scale functional network alterations than by local tissue microstructural alterations. 7,8 The subtle balance between short-and long-range connections contributes to the integration and segregation of the brain connectome. Connections of different lengths are found in different locations across the brain; short-range fibers are more abundant than their long-range counterparts, and the short-range fibers connect adjacent anatomic gyri that integrate multimodal informati...