The following is a summary of “Diffusion basis spectrum imaging, and diffusion tensor imaging predicts persistent black hole formation in multiple sclerosis,” published in the February 2024 issue of Neurology by Wooliscroft et al.

Diffusion basis spectrum imaging (DBSI), which goes beyond diffusion tensor imaging (DTI) for multiple sclerosis (MS) by revealing more tissue details, could help understand the impact of persistent black holes (PBH) on MS disability.

Researchers conducted a prospective study to assess how well DBSI and DTI predict which acute lesions would become PBHs after one year.

They involved relapsing MS patients with at least one CEL. They underwent monthly MRI scans for 4 to 6 months until gadolinium resolution while quantifying DBSI and DTI metrics at the CEL’s peak visibility. Subsequently, a follow-up MRI was conducted at least 12 months after the final monthly scan to determine if the CEL evolved into a PBH.

The results showed that 20 MS patients with a median age of 33 years (13 women) had 164 CELs, and 36% (59 CELs) developed into PBHs. At Gd-max, DTI RD and AD of all CELs increased, with significant elevation in CELs turning into PBHs versus NBHs. DTI RD > 0.74 and AD > 1.22 predicted a CEL becoming a PBH with ORs of 7.76 (CI 3.77–15.98) and 7.32 (CI 3.38–15.86), respectively. DBSI RD and AD did not predict PBH development in a multivariable model. At Gd-max, the DBSI restricted fraction decreased, and the DBSI non-restricted fraction increased in all CELs, with significant differences in CELs that became PBHs compared to NBHs. The ORs for a CEL becoming a PBH were 4.77 (CI 2.35–9.66) for DBSI non-restricted fraction > 0.45 and 9.58 (CI 4.59–20.02) for DBSI restricted fraction < 0.07.

Investigators concluded that higher isotropic non-restricted fraction on DBSI, indicative of greater edema, in acute CELs, predicted the development of PBHs.

Source: msard-journal.com/article/S2211-0348(24)00073-7/abstract#%20