Monitoring Remyelination and Its Association With Disability Improvement in Multiple Sclerosis Using APART-QSM: A Longitudinal Cohort Study.

Authors

Zhuo Wang, Mingsong Tang, Junye Yao, Kai Ai, Yujing Li, Jun Wang, Xia Xu, Wenjing Ren, Wenzhu Dang, Guangyao Liu, Yanli Jiang, Siru Kang, Wenxia Yang, Hao Li, Dan Yang, Yuping Han, Jinrui Liu, Fei Jia, Jingqi Jiang, Yucheng Ding, Jing Zhang

Published in

Journal of magnetic resonance imaging : JMRI. Oct 27, 2026. Epub Oct 27, 2026.

Abstract

Conventional MRI has limited specificity for myelin quantification. IterAtive magnetic suscePtibility sources sepARaTion quantitative susceptibility mapping (APART-QSM) quantifies myelin-sensitive (χ_dia) and iron-sensitive (χ_para) susceptibility components, but its value for longitudinal assessment of remyelination in multiple sclerosis (MS) remains unclear.
To characterize longitudinal χ_dia in MS and assess its associations with clinical characteristics.
Prospective, longitudinal.
One hundred forty-five patients with MS and 65 healthy controls (HCs).
3.0T; 3D T1-weighted, 3D FLAIR, 3D DIR, and multi-echo gradient-echo imaging sequences.
APART-QSM generated χ_dia and χ_para maps, with susceptibility quantified in lesions and non-lesional regions, and the Expanded Disability Status Scale (EDSS) assessed at baseline and follow-up.
Chi-square, Mann-Whitney U, Wilcoxon signed-rank, Friedman tests, linear mixed-effects models, linear and nonlinear regression. A p value < 0.05 was considered significant.
One hundred one patients with MS and 20 HCs completed follow-up after a median (IQR) interval of 1.0 (0.8) and 1.25 (0.2) years, respectively. At baseline, white matter lesions (WMLs) exhibited lower χ_dia (0.0131 [IQR 0.0087] ppm) and higher χ_para (0.0058 [IQR 0.0049] ppm) than corresponding normal-appearing white matter (NAWM) (0.0191 [0.0088] ppm; 0.0036 [0.0038] ppm; both p < 0.001). Over 1 year, χ_dia in WMLs increased (0.0122 [IQR 0.0069] vs. 0.0152 [IQR 0.0065] ppm, p < 0.001), particularly in ofatumumab-treated patients (0.0114 [IQR 0.0085] vs. 0.0158 [IQR 0.0081] ppm, p < 0.001). Greater increases in χ_dia were significantly associated with female sex, ofatumumab treatment, relapsing-remitting phenotype, and EDSS improvement (all Bonferroni correction p < 0.01). Δχ_dia showed a nonlinear decline with increasing disease duration (effective degrees of freedom (edf) = 1.83, p = 0.002).
APART-QSM may enable longitudinal monitoring of remyelination-related changes in MS, with declining Δχ_dia over disease duration potentially informing individualized treatment strategies.
2.

PMID:
42946532
Bibliographic data and abstract were imported from PubMed on 28 Oct 2026.

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