Perilesional myelin damage around multiple sclerosis spinal cord lesions predicts change in disability over 5 years in progressive MS.

Motivation: Multiple sclerosis lesions contribute to progression of disability. Spinal cord lesions are of particular importance due to the small cross-sectional area of the cord and presence of important tracts. Goal(s): Determine if myelin damage in lesions could be used as a potential prognostic biomarker of disease progression. Approach: Use myelin water imaging to determine myelin content in lesional, perilesional and white matter tissue, and correlate with change in clinical tests over 5 years. Results: We determine a gradient of myelin damage beyond what is visible on conventional imaging. We strongly correlated myelin damage in the lesion and surrounding tissue to accrual of disability. Impact: Spinal cord myelin imaging of lesional and perilesional tissue may be useful as a prognostic biomarker for monitoring patients with progressive multiple sclerosis (MS) especially in clinical trials for progressive MS, for which therapies are lacking.