White matter changes in multiple sclerosis: Correlation of q-space diffusion MRI and ¹H MRS

Objective: To explore the diagnostic usefulness of high b-value diffusion magnetic resonance brain imaging ("q-space" imaging) in multiple sclerosis (MS). More specifically, we aimed at evaluating the ability of this methodology to identify tissue damage in the so-called normal-appearing white matter (NAWM). Design: In this study we examined the correlation between q-space diffusion imaging and magnetic resonance spectroscopy (MRS)-based two-dimensional ¹H chemical shift imaging. Eight MS patients with different degree of disease severity and seven healthy subjects were scanned in a 1.5-T magnetic resonance imaging (MRI) scanner. The MRI protocol included diffusion tensor imaging (DTI) (with b_max of 1000 s/mm²), high b-value diffusion-weighted imaging (with b_max of 14,000 s/mm²) and 2D chemical shift imaging. The high b-value data set was analyzed using the q-space methodology to produce apparent displacement and probability maps. Results: We found that the q-space diffusion displacement and probability image intensities correlated well with N-acetylaspartate levels (r=.61 and .54, respectively). Furthermore, NAWM that was abnormal on MRS was also found to be abnormal using q-space diffusion imaging. In these areas, the q-space displacement values increased from 3.8±0.2 to 4.6±0.6 μm (P<.02), the q-space probability values decreased from 7.4±0.3 to 6.8±0.3 (P<.002), while DTI revealed only a small, but still significant, reduction in fractional anisotropy values from 0.40±0.02 to 0.37±0.02 (P<.05). Conclusion: High b-value diffusion imaging can detect tissue damage in the NAWM of MS patients. Despite the theoretical limitation of this method, in practice it provides additional information which is clinically relevant for detection of tissue damage not seen in conventional imaging techniques.