Background: The research of primary progressive multiple sclerosis (PPMS) has not been able to capitalize on recent progresses in advanced magnetic resonance imaging (MRI) protocols. Objective: The presented cross-sectional study evaluated the utility of four different MRI relaxation metrics and diffusion-weighted imaging in PPMS. Methods: Conventional free precession T1 and T2, and rotating frame adiabatic T1ρ and T2ρ in combination with diffusion-weighted parameters were acquired in 13 PPMS patients and 13 age- and sex-matched controls. Results: T1ρ, a marker of crucial relevance for PPMS due to its sensitivity to neuronal loss, revealed large-scale changes in mesiotemporal structures, the sensorimotor cortex, and the cingulate, in combination with diffuse alterations in the white matter and cerebellum. T2ρ, particularly sensitive to local tissue background gradients and thus an indicator of iron accumulation, concurred with similar topography of damage, but of lower extent. Moreover, these adiabatic protocols outperformed both conventional T1 and T2 maps and diffusion tensor/kurtosis approaches, methods previously used in the MRI research of PPMS. Conclusion: This study introduces adiabatic T1ρ and T2ρ as elegant markers confirming large-scale cortical gray matter, cerebellar, and white matter alterations in PPMS invisible to other in vivo biomarkers.

1st Department of Neurology Faculty of Medicine University Hospital of St Anne Masaryk University Brno Czechia

Center for Magnetic Resonance Research University of Minnesota Minneapolis MN United States

Central European Institute of Technology Masaryk University Neuroscience Centre Brno Czechia

Department of Neurology 1st Faculty of Medicine and General University Hospital Charles University Prague Czechia

Department of Neurology School of Medicine University of Minnesota Minneapolis MN United States

Faculty of Medicine Institute of Biostatistics and Analyses Masaryk University Brno Czechia

Institute of Biostatistics and Analyses Ltd Masaryk University Spin Off Brno Czechia

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