Fulford, JonathanAl-shaari, Hussein2024-06-272024-06-272024-06-26https://hdl.handle.net/20.500.14154/72392Rationale: Multiple sclerosis (MS) is a complex inflammatory autoimmune disease of the central nervous system (CNS) characterized by inflammation, demyelination, and axonal damage. Magnetic resonance imaging (MRI) is a non-invasive technique that has become integral to the clinical management of MS over the past 20 years. While conventional MRI has played an important role in MS diagnosis and disease progression, its relationship with clinical signs remains limited, because of a lack of specificity. Recognizing this limitation, new advances in MRI technology present exciting opportunities for more accurate insights into MS pathophysiology. Techniques like diffusion tensor imaging (DTI) and magnetization transfer imaging (MTI) have emerged as effective tools. Unlike conventional MRI, these advanced methods have a better association with the subtle pathology alterations associated with MS. DTI allows for the visualization of microstructural abnormalities in white matter tracts, providing more detailed information of demyelination and axonal integrity. On the other hand, MTI offers novel insights into the dynamics of bound and free water, offering information on the underlying pathophysiology. Research on techniques such as DTI and MTI, typically focuses on imaging of the brain and its findings frequently do not have a direct application to the spinal cord. Thus, there is currently a lack of knowledge regarding spinal cord changes in patients with MS using these techniques. Aims: The aim of this thesis was to evaluate the potential of DTI and MTI for determining cervical spinal cord (CSC) changes when using automated data processing software such as spinal cord toolbox (SCT) in assessing changes in the CSC in patients with relapsing remitting multiple sclerosis (RRMS). Method: The assessment of the cervical spinal cord (CSC) using these MRI techniques was investigated for each inter-vertebral level, spanning four vertebral segments between the upper limit of the vertebral body of C2 and lower limit of the vertebral body of C5 over the regions of interest within the whole cord white matter (WM), ventral column (VC), lateral column (LC), and dorsal column (DC). This thesis was developed to explore two parts. The first part focused on the assessment of the reliability of DTI and MTI in the CSC. A total of 20 healthy participants were recruited and scanned on two separate visits. The second part focused on the potential of DTI and MTI to evaluate changes in tissue structure in relapsing-remitting multiple sclerosis (RRMS) patients in comparison to the same healthy participants recruited for the reliability study. For this, 13 patients with RRMS were recruited through the MS clinic. Expanded disability status scale (EDSS) was used as a clinical measure to examine the correlation with DTI and MTI parameters. Results: The reliability assessment of both DTI and MTI in the CSC found that the relative within-participants reliability varied depending on location of the ROIs. There was difference in the mean values of the DTI measures magnetic transfer ratio (MTR) value between the RRMS group and controls, however the significance of these differences differed depending on the ROI location. The correlation between DTI and MTI metrics and EDSS did not reach significant levels. Conclusion: This thesis has demonstrated the potential of DTI and MTI to identify alterations in RRMS patients. The results will be helpful in guiding diagnosis as well as future research into MS disease therapies and patient monitoring.226enAdvanced MRIdiffusion tensor imagingmagnetization transfer imagingDTIMTIspinal cordrelapsing -remitting multiple sclerosisMSspinal cord toolboxSCTcervical spinal cordCSCThesis