Saturation-Transfer-Based MRI of the Brain in Multiple Sclerosis Patients at 3T

Ziyan Wang; Yingying Lin; Peng Cao; Pei Cai; Jiawen Wang; Huabin Zhang; Shihao Zeng; Chi Yan Lee; Chia-Wei Lee; Elaine Y. P. Lee; Kyongtae T. Bae; Henry K. F. Mak; Kannie W. Y. Chan; Koon Ho Chan; Jianpan Huang

doi:10.1002/jmri.70147

Saturation-Transfer-Based MRI of the Brain in Multiple Sclerosis Patients at 3T

Ziyan Wang
, Yingying Lin
, Peng Cao
, Pei Cai
, Jiawen Wang
, Huabin Zhang
, Shihao Zeng
, Chi Yan Lee
, Chia-Wei Lee
, Elaine Y. P. Lee
, Kyongtae T. Bae
, Henry K. F. Mak
, Kannie W. Y. Chan
, Koon Ho Chan^*
, Jianpan Huang^*

^*Corresponding author for this work

Department of Biomedical Engineering

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

2 Citations (Scopus)

Abstract

Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease that attacks myelin. MRI is an important imaging modality for diagnosis and monitoring in MS. However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes.
Purpose: To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients.
Study Type: Prospective.
Population: Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males).
Field Strength/Sequence 3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T.
Assessment Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes.
Statistical Tests: Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant.
Results: CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). MS patients showed a significant decrease (-6.57%) in brain tissue and an increase (+20.73%) in CSF volume ratios compared to HCs. Data Conclusion The saturation-transfer-based MRI framework can effectively evaluate molecular changes and CSF-tissue water exchange in the brains of MS patients. Evidence Level 2. Technical Efficacy Stage 3.
© 2025 International Society for Magnetic Resonance in Medicine.

Original language	English
Number of pages	13
Journal	Journal of Magnetic Resonance Imaging
DOIs	https://doi.org/10.1002/jmri.70147
Publication status	Online published - 13 Oct 2025

Funding

This work was supported by the National Natural Science Foundation of China (82402225), Research Grants Council (27100725), University of Hong Kong (109000487, 109001694), Li Ka Shing Faculty of Medicine, University of Hong Kong (204610401, and 204610519), Health and Medical Research Fund (21222621), Innovation and Technology Fund (MHP/076/23), Research Fund for Neuroimmunological Diseases from Mr. Joseph CS Ma.

Research Keywords

brain atrophy
cerebrospinal fluid
chemical exchange saturation transfer
magnetic resonance imaging
magnetization transfer indirect spin labeling
multiple sclerosis

RGC Funding Information

RGC-funded

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10.1002/jmri.70147

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Cite this

@article{96312c126c144b208221fe237a5826af,

title = "Saturation-Transfer-Based MRI of the Brain in Multiple Sclerosis Patients at 3T",

abstract = "Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease that attacks myelin. MRI is an important imaging modality for diagnosis and monitoring in MS. However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes. Purpose: To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients. Study Type: Prospective. Population: Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males). Field Strength/Sequence 3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T. Assessment Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes. Statistical Tests: Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant. Results: CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95\% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). MS patients showed a significant decrease (-6.57\%) in brain tissue and an increase (+20.73\%) in CSF volume ratios compared to HCs. Data Conclusion The saturation-transfer-based MRI framework can effectively evaluate molecular changes and CSF-tissue water exchange in the brains of MS patients. Evidence Level 2. Technical Efficacy Stage 3. {\textcopyright} 2025 International Society for Magnetic Resonance in Medicine.",

keywords = "brain atrophy, cerebrospinal fluid, chemical exchange saturation transfer, magnetic resonance imaging, magnetization transfer indirect spin labeling, multiple sclerosis",

author = "Ziyan Wang and Yingying Lin and Peng Cao and Pei Cai and Jiawen Wang and Huabin Zhang and Shihao Zeng and Lee, \{Chi Yan\} and Chia-Wei Lee and Lee, \{Elaine Y. P.\} and Bae, \{Kyongtae T.\} and Mak, \{Henry K. F.\} and Chan, \{Kannie W. Y.\} and Chan, \{Koon Ho\} and Jianpan Huang",

year = "2025",

month = oct,

day = "13",

doi = "10.1002/jmri.70147",

language = "English",

journal = "Journal of Magnetic Resonance Imaging",

issn = "1053-1807",

publisher = "John Wiley \& Sons",

}

TY - JOUR

T1 - Saturation-Transfer-Based MRI of the Brain in Multiple Sclerosis Patients at 3T

AU - Wang, Ziyan

AU - Lin, Yingying

AU - Cao, Peng

AU - Cai, Pei

AU - Wang, Jiawen

AU - Zhang, Huabin

AU - Zeng, Shihao

AU - Lee, Chi Yan

AU - Lee, Chia-Wei

AU - Lee, Elaine Y. P.

AU - Bae, Kyongtae T.

AU - Mak, Henry K. F.

AU - Chan, Kannie W. Y.

AU - Chan, Koon Ho

AU - Huang, Jianpan

PY - 2025/10/13

Y1 - 2025/10/13

N2 - Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease that attacks myelin. MRI is an important imaging modality for diagnosis and monitoring in MS. However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes. Purpose: To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients. Study Type: Prospective. Population: Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males). Field Strength/Sequence 3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T. Assessment Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes. Statistical Tests: Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant. Results: CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). MS patients showed a significant decrease (-6.57%) in brain tissue and an increase (+20.73%) in CSF volume ratios compared to HCs. Data Conclusion The saturation-transfer-based MRI framework can effectively evaluate molecular changes and CSF-tissue water exchange in the brains of MS patients. Evidence Level 2. Technical Efficacy Stage 3. © 2025 International Society for Magnetic Resonance in Medicine.

AB - Background: Multiple sclerosis (MS) is an autoimmune demyelinating disease that attacks myelin. MRI is an important imaging modality for diagnosis and monitoring in MS. However, the current standard MRI protocol for MS lacks sequences capable of detecting molecular changes. Purpose: To present a saturation-transfer-based MRI protocol, including chemical exchange saturation transfer (CEST) and magnetization transfer indirect spin labeling (MISL) sequences, for quantifying molecular changes and water exchange in the brain of MS patients. Study Type: Prospective. Population: Fifty-two participants including 31 healthy controls (HC) (18 females and 13 males) and 21 MS patients (18 females and 3 males). Field Strength/Sequence 3D inversion-prepared gradient echo T1w, 3D fast spin echo T2w, 3D CUBE CEST and MISL at 3.0 T. Assessment Multiple CEST contrasts between HC and MS groups were analyzed using double-step multi-pool Lorentzian fitting (DMPLF) and Lorentzian difference analysis (LDA) to evaluate and compare their diagnostic performance. MISL signals at -20 and -10 ppm were quantified by the normalized signal reduction in cerebrospinal fluid (CSF). T1w MRI was used to quantify brain volumes. Statistical Tests: Unpaired Student's t-test, receiver operating characteristic (ROC) curve, area under the curve (AUC), and binary logistic regression analysis. p < 0.05 was considered statistically significant. Results: CEST detected decreased signals in the brain of MS patients using both DMPLF and LDA, with DMPLF demonstrating superior performance in differentiating MS from HC (AUC, 0.93; 95% CI: 0.86, 1.00). MS patients showed significantly lower whole brain MISL signals than HCs at both -20 ppm (0.04 ± 0.01 vs. 0.06 ± 0.02) and -10 ppm (0.06 ± 0.02 vs. 0.08 ± 0.02). MS patients showed a significant decrease (-6.57%) in brain tissue and an increase (+20.73%) in CSF volume ratios compared to HCs. Data Conclusion The saturation-transfer-based MRI framework can effectively evaluate molecular changes and CSF-tissue water exchange in the brains of MS patients. Evidence Level 2. Technical Efficacy Stage 3. © 2025 International Society for Magnetic Resonance in Medicine.

KW - brain atrophy

KW - cerebrospinal fluid

KW - chemical exchange saturation transfer

KW - magnetic resonance imaging

KW - magnetization transfer indirect spin labeling

KW - multiple sclerosis

UR - https://www.scopus.com/pages/publications/105018700399

UR - https://www.scopus.com/record/pubmetrics.uri?eid=2-s2.0-105018700399&origin=recordpage

UR - https://www.webofscience.com/wos/woscc/full-record/WOS:001592246000001

U2 - 10.1002/jmri.70147

DO - 10.1002/jmri.70147

M3 - RGC 21 - Publication in refereed journal

SN - 1053-1807

JO - Journal of Magnetic Resonance Imaging

JF - Journal of Magnetic Resonance Imaging

ER -

Saturation-Transfer-Based MRI of the Brain in Multiple Sclerosis Patients at 3T

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Saturation-Transfer-Based MRI of the Brain in Multiple Sclerosis Patients at 3T

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Funding

Research Keywords

RGC Funding Information

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ITF: Artificial Intelligence-empowered Molecular Magnetic Resonance Imaging for the Brain

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