Cortical quantitative MRI parameters are related to the cognitive status in patients with relapsing-remitting multiple sclerosis

  • Alexandra van Wijnen
  • Franca Petrov
  • Michelle Maiworm
  • Stefan Frisch
  • Christian Foerch
  • Elke Hattingen
  • Helmuth Steinmetz
  • Johannes C. Klein
  • Ralf Deichmann
  • Marlies Wagner
  • René-Maxime GracienEmail author
Magnetic Resonance



We aimed to assess cortical damage in patients with relapsing-remitting multiple sclerosis (RRMS)/clinically isolated syndrome (CIS) with a multiparametric, surface-based quantitative MRI (qMRI) approach and to evaluate the correlation of imaging-derived parameters with cognitive scores, hypothesizing that qMRI parameters are correlated with cognitive abilities.


Multiparametric qMRI-data (T1, T2 and T2* relaxation times and proton density (PD)) were obtained from 34 patients/24 matched healthy control subjects. Cortical qMRI values were analyzed on the reconstructed cortical surface with Freesurfer. We tested for group differences of cortical microstructural parameters between the healthy and patient collectives and for partial Pearson correlations of qMRI parameters with cognitive scores, correcting for age.


Cortical T2-/T2*-/PD values and four cognitive parameters differed between groups (p ≤ 0.046). These cognitive scores, reflecting information processing speed, verbal memory, visuospatial abilities, and attention, were correlated with cortical T2 (p ≤ 0.02) and T2* (p ≤ 0.03). Cortical changes appeared heterogeneous across the cortex and their distribution differed between the parameters. Vertex-wise correlation of T2 with neuropsychological parameters revealed specific patterns of cortical damage being related to distinct cognitive deficits.


Microstructural changes are distributed heterogeneously across the cortex in RRMS/CIS. QMRI has the potential to provide surrogate parameters for the assessment of cognitive impairment in these patients for clinical studies. The characteristics of cognitive impairment in RRMS might depend on the distribution of cortical changes.

Key Points

• The goal of the presented study was to investigate cortical changes in RRMS/CIS and their relation to the cognitive status, using multiparametric quantitative MRI.

• Cortical T2, T2*, and PD increases observed in patients appeared heterogeneous across the cortex and their distribution differed between the parameters.

• Vertex-wise correlation of T2 with neuropsychological scores revealed specific patterns of cortical changes being related to distinct cognitive deficits.


Multiple sclerosis Relapsing-remitting Magnetic resonance imaging Cognition Demyelinating diseases 





Clinically isolated syndrome


Central nervous system


Expanded Disability Status Scale


Field of view


Gradient echo


Gray matter


Leistungsprüfsystem Subtest 3


Multiple sclerosis


Paced Auditory Serial Addition Test


Quantitative MRI


Rey Complex Figure Test


Radio frequency


Symbol Digit Modalities Test


Trail Making Test


Verbaler Lern- und Merkfähigkeitstest


Funding information

This work was supported by the Clinician Scientists program at Goethe University and by the State of Hesse with a LOEWE-Grant to the CePTER-Consortium ( The sponsors did not influence the study design or the collection, analysis or interpretation of data.

Compliance with ethical standards


The scientific guarantor of this publication is René-Maxime Gracien.

Conflict of interest

The authors report no conflicts of interest relevant to this study. Dr H Steinmetz has received speaker’s honoraria from Bayer, Sanofi, and Boehringer Ingelheim.

Dr JC Klein received speaker honoraria and travel reimbursement from Medtronic, AstraZeneca, Abbott Laboratories, and AbbVie.

Dr Elke Hattingen has received speaker’s honoraria from BRACCO.

Dr R Deichmann received compensation as a Consultant for MR scanner procurement by the Wellcome Trust Centre for Neuroimaging, UCL, London, UK.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional ethics committee approval was obtained.

Study subjects or cohorts overlap

Eleven patients overlap with a previous neuropsychological study: Yalachkov Y, Soydaş D, Bergmann J, Frisch S, Behrens M, Foerch C et al (2019) Determinants of quality of life in relapsing-remitting and progressive multiple sclerosis. Multiple sclerosis and related disorders 30:33–7


• prospective

• cross-sectional study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Alexandra van Wijnen
    • 1
    • 2
    • 3
  • Franca Petrov
    • 1
    • 3
  • Michelle Maiworm
    • 1
    • 2
    • 3
  • Stefan Frisch
    • 4
  • Christian Foerch
    • 1
  • Elke Hattingen
    • 2
  • Helmuth Steinmetz
    • 1
  • Johannes C. Klein
    • 5
  • Ralf Deichmann
    • 3
  • Marlies Wagner
    • 2
  • René-Maxime Gracien
    • 1
    • 3
    Email author
  1. 1.Department of NeurologyGoethe UniversityFrankfurt/MainGermany
  2. 2.Department of NeuroradiologyGoethe UniversityFrankfurt/MainGermany
  3. 3.Brain Imaging CenterGoethe UniversityFrankfurt/MainGermany
  4. 4.Institute of PsychologyGoethe UniversityFrankfurt/MainGermany
  5. 5.Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK

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