, Volume 59, Issue 7, pp 655–664 | Cite as

Magnetic resonance imaging perfusion is associated with disease severity and activity in multiple sclerosis

  • Piotr SowaEmail author
  • Gro Owren Nygaard
  • Atle Bjørnerud
  • Elisabeth Gulowsen Celius
  • Hanne Flinstad Harbo
  • Mona Kristiansen Beyer
Diagnostic Neuroradiology



The utility of perfusion-weighted imaging in multiple sclerosis (MS) is not well investigated. The purpose of this study was to compare baseline normalized perfusion measures in subgroups of newly diagnosed MS patients. We wanted to test the hypothesis that this method can differentiate between groups defined according to disease severity and disease activity at 1 year follow-up.


Baseline magnetic resonance imaging (MRI) including a dynamic susceptibility contrast perfusion sequence was performed on a 1.5-T scanner in 66 patients newly diagnosed with relapsing-remitting MS. From the baseline MRI, cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were generated. Normalized (n) perfusion values were calculated by dividing each perfusion parameter obtained in white matter lesions by the same parameter obtained in normal-appearing white matter. Neurological examination was performed at baseline and at follow-up approximately 1 year later to establish the multiple sclerosis severity score (MSSS) and evidence of disease activity (EDA).


Baseline normalized mean transit time (nMTT) was lower in patients with MSSS >3.79 (p = 0.016), in patients with EDA (p = 0.041), and in patients with both MSSS >3.79 and EDA (p = 0.032) at 1-year follow-up. Baseline normalized cerebral blood flow and normalized cerebral blood volume did not differ between these groups.


Lower baseline nMTT was associated with higher disease severity and with presence of disease activity 1 year later in newly diagnosed MS patients. Further longitudinal studies are needed to confirm whether baseline-normalized perfusion measures can differentiate between disease severity and disease activity subgroups over time.


Disease activity Disease severity Magnetic resonance imaging Mean transit time Multiple sclerosis Perfusion-weighted imaging 



Cerebral blood flow


Cerebral blood volume


Disease-modifying treatment


Evidence of disease activity


Expanded disability status scale


Magnetic resonance imaging


Multiple sclerosis


Multiple sclerosis severity score


Mean transit time




Normal-appearing white matter


No evidence of disease activity


Partial volume effect


Perfusion-weighted imaging


White matter lesions



The authors would like to thank Paulina Due-Tønnessen, Soheil Damangir, Gabriela Spulber and Kyrre Emblem for assistance.

Compliance with ethical standards


This study was funded by South-Eastern Norway Regional Health Authority (Grant nr 39569). MRI scans and clinical tests were performed within a previous project financed by the same institution (Grant nr 2011059).

Conflict of interest

PS has received speaker honoraria from Novartis, Genzyme and Biogen. GON has received unrestricted research grants from Novartis Norway and from the Odd Fellow’s Foundation for Multiple Sclerosis Research. AB consults for NordicNeuroLab AS, Bergen, Norway. EGC has received support for travelling and speaker honoraria from Biogen, Genzyme, Merck, Novartis, Sanofi-Aventis and Teva, and unrestricted research grants from Biogen, Genzyme and Novartis. HFH has received an unrestricted research grant from Novartis, and support for travelling and speaker honoraria from Biogen, Novartis, Sanofi-Aventis and Teva. MKB has received speaker honoraria from Novartis and Biogen.

Ethical approval

All procedures involving human participants performed in this study were in accordance with the ethical standards of the institutional and national research committee (data inspectorate representative at the hospital and the Regional Committee for Medical and Health Research Ethics for South-Eastern Norway) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

234_2017_1849_MOESM1_ESM.docx (16 kb)
Supplementary Table 1 (DOCX 15 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Piotr Sowa
    • 1
    • 2
    Email author
  • Gro Owren Nygaard
    • 3
  • Atle Bjørnerud
    • 4
    • 5
  • Elisabeth Gulowsen Celius
    • 3
    • 6
  • Hanne Flinstad Harbo
    • 2
    • 3
  • Mona Kristiansen Beyer
    • 1
    • 7
  1. 1.Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Department of NeurologyOslo University HospitalOsloNorway
  4. 4.Intervention Center, Oslo University HospitalOsloNorway
  5. 5.Department of PhysicsUniversity of OsloOsloNorway
  6. 6.Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway
  7. 7.Department of Life Sciences and HealthOslo and Akershus University College of Applied SciencesOsloNorway

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