Periventricular Gradient of Tissue Microstructure in Patients with MS, NMOSD, and MOGAD

Motivation: Periventricular microstructural changes of Multiple sclerosis (MS), NMOSD, and MOGAD remain poorly characterized. Goal(s): To elucidate periventricular gradients of myelin and axonal integrity across MS, NMOSD, and MOGAD. Approach: We analyzed periventricular gradients of myelin volume fraction (MVF), axon volume fraction (AVF), and g-ratio in 106 patients (88 RRMS, 18 SPMS, 30 NMOSD, 23 MOGAD) and 23 controls using synthetic MRI and 2-shell DWI. Results: MS showed significantly steeper MVF gradients than healthy controls correlating with clinical disability, while NMOSD and MOGAD did not, demonstrating the unique pathophysiological features of MS, where demyelination preferentially affects periventricular regions. Impact: Periventricular gradient of myelin content in MS is distinct from NMOSD and MOGAD. The correlation between myelin gradients and clinical measures in MS provides insights into disease progression and may guide personalized treatment strategies.