MRI-Based Lesion Differentiation in Older Patients With Multiple Sclerosis

Quantitative Susceptibility Mapping for Lesion Differentiation in Aging Multiple Sclerosis

This study investigates whether an advanced MRI technique called Quantitative Susceptibility Mapping (QSM) can improve the differentiation of white matter lesions in people aged 50-70 years with multiple sclerosis (MS). In older individuals with MS, white matter changes seen on MRI may be related to MS or to other types of white matter changes, most commonly age-related changes or chronic small vessel disease. These conditions can appear similar on conventional MRI scans, making interpretation challenging.

Participants will undergo routine clinical MRI, including a short additional QSM sequence, as well as brief cognitive and physical assessments. A comparison group with cerebral small vessel disease will also be included.

The goal of the study is to determine whether QSM can provide more precise lesion characterization and support more accurate clinical interpretation of MRI findings in older patients with MS.

Study Overview

• Status: Recruiting
• Conditions: Cerebral Small Vessel Diseases; Multiple Sclerosis (MS)

Detailed Description

Magnetic resonance imaging (MRI) is central to the diagnosis and monitoring of multiple sclerosis (MS). In individuals above 50 years of age, interpretation of white matter lesions becomes increasingly complex because lesions visible on conventional T2-weighted and FLAIR MRI may reflect MS-related demyelination, chronic cerebral small vessel disease (cSVD), or nonspecific age-related white matter changes. Conventional MRI has limited specificity in differentiating between these entities, which may complicate assessment of disease activity and progression.

Quantitative Susceptibility Mapping (QSM) is an advanced MRI technique that quantifies tissue magnetic susceptibility and provides complementary information to conventional imaging. Differences in susceptibility characteristics may reflect underlying tissue composition and microstructural properties, potentially allowing improved differentiation between demyelinating and vascular white matter lesions.

This prospective observational cohort study includes individuals aged 50-70 years with established MS undergoing routine clinical MRI follow-up, as well as an age-comparable cohort with clinical and radiological evidence of cSVD. Participants with MS will undergo longitudinal follow-up through routine clinical MRI and clinical assessments, whereas participants in the cSVD cohort will undergo a single study visit including MRI and standardized clinical testing. MRI examinations include standard clinical sequences with the addition of a short QSM acquisition. Clinical assessment includes brief standardized measures of cognitive processing speed, executive function, and physical function performed in conjunction with clinical visits.

Imaging analyses will focus on lesion-level and participant-level susceptibility characteristics and their distribution patterns across cohorts. Associations between QSM-derived measures and clinical function will be explored. The study is designed to evaluate the diagnostic utility and clinical relevance of QSM-based lesion characterization in older individuals with MS.

• Study Type: Observational
• Enrollment (Estimated): 1000

Contacts and Locations

• Study Contact: Name: Anna Therese Bjerkreim, MD PhD; Phone Number: 004797000219; Email: anthbj@ous-hf.no
• Study Contact Backup: Name: Lars Skattebøl, MD; Phone Number: 004747299995; Email: lars@skattebol.com

Study Locations

• Norway
  • Oslo
    • Oslo, Oslo, Norway, 0450
      • Recruiting
      • Oslo University Hospital
      • Contact: Anna Therese Bjerkreim, MD PhD; Phone Number: 004797000219; Email: anthbj@ous-hf.no
      • Principal Investigator: Anna Therese Bjerkreim, MD PhD
      • Sub-Investigator: Lars Skattebøl, MD
      • Sub-Investigator: Elisabeth Gulowsen Celius, MD PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of two cohorts recruited at Oslo University Hospital.

The multiple sclerosis (MS) cohort includes participants aged 50-70 years with a clinically confirmed MS diagnosis enrolled in the AgeMS study, an ongoing longitudinal study of older individuals with MS. Eligible participants are invited to participate by letter. Participants undergo semiannual MRI examinations and standardized neurological, cognitive, and patient-reported assessments through 2030.

The cerebral small vessel disease (cSVD) control cohort includes patients aged 50-80 years with radiological evidence of hypertensive small vessel disease identified on MRI and recruited from the Stroke Unit. Eligible participants are approached during hospital admission and invited to participate. Eligible participants are approached during hospital admission and invited to participate. These participants undergo a single MRI session and standardized clinical testing.

Description

Inclusion Criteria Multiple Sclerosis (MS) cohort (AgeMS):

• Age 50-70 years
• Clinically confirmed diagnosis of multiple sclerosis
• Participation in the AgeMS study at Oslo University Hospital

Inclusion Criteria Cerebral Small Vessel Disease (cSVD) control cohort:

• Age 50-80 years
• Radiological evidence of hypertensive small vessel disease on MRI
• Good clinical recovery following transient ischemic attack (TIA), minor stroke, or stroke mimic diagnosis

Exclusion Criteria Multiple Sclerosis (MS) cohort:

• MRI contraindications
• Severe psychiatric comorbidity
• Major functional disability unrelated to MS or CSVD

Exclusion Criteria Cerebral Small Vessel Disease (cSVD) control cohort:

• MRI contraindications
• Probable or definite cerebral amyloid angiopathy according to Boston criteria 2.0
• Genetic or inflammatory vasculopathies
• Persistent neurological deficits
• Severe psychiatric comorbidity
• Major functional disability unrelated to CSVD

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Aging Multiple Sclerosis (MS); Individuals aged 50-70 years with established multiple sclerosis undergoing routine clinical MRI follow-up including an additional QSM sequence.
Cerebral Small Vessel Disease (cSVD); Age-comparable individuals with clinical and radiological evidence of cerebral small vessel disease undergoing MRI including an additional QSM sequence.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lesion-Level Quantitative Susceptibility (ppb) Within T2 FLAIR Hyperintense White Matter Lesions at Baseline	Quantitative susceptibility (ppb) will be measured using QSM within each segmented T2 FLAIR hyperintense white matter lesion. Lesion-level susceptibility values will be compared between lesions from the MS cohort and the cSVD cohort. Statistical analyses will account for clustering of multiple lesions within individual participants.	Baseline MRI (single MRI session for both cohorts)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Mean Lesion-Level Quantitative Susceptibility (ppb) Within T2 FLAIR Hyperintense White Matter Lesions in the MS Cohort	Quantitative susceptibility (ppb) will be measured within each segmented lesion at each time point. The outcome is change from baseline in lesion-level susceptibility over time. Analyses will account for clustering of multiple lesions within participants.	From baseline through December 2030
Association Between QSM-Derived Lesion Burden and Cognitive Composite z-Score	Cognitive function will be summarized at each visit as a composite z-score derived from standardized tests of processing speed and executive function. QSM-derived lesion characteristics will be summarized at the participant level (e.g., burden of QSM-positive vs QSM-negative lesions and lesion volume metrics). Associations between participant-level QSM-derived lesion burden and cognitive composite z-score will be analyzed using regression models.	Baseline; repeated assessments in the MS cohort through December 2030
Association Between QSM-Derived Lesion Burden and Physical Function Composite z-Score	Physical function will be summarized at each visit as a composite z-score derived from standardized mobility and balance assessments. QSM-derived lesion characteristics will be summarized at the participant level (e.g., burden of QSM-positive vs QSM-negative lesions and lesion volume metrics). Associations between participant-level QSM-derived lesion burden and physical function composite z-score will be analyzed using regression models.	Baseline; repeated assessments through December 2030
Association Between QSM-Derived Lesion Burden and Change From Baseline in Expanded Disability Status Scale (EDSS) Score	Disability progression will be assessed as change from baseline in Expanded Disability Status Scale (EDSS) score during follow-up. QSM-derived lesion characteristics will be summarized at the participant level (e.g., burden of QSM-positive vs QSM-negative lesions and lesion volume metrics). Associations between participant-level QSM-derived lesion burden and EDSS change over time will be analyzed using mixed-effects models.	From baseline through December 2030

Collaborators and Investigators

• Sponsor: Oslo University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): May 11, 2026
• Primary Completion (Estimated): December 31, 2030
• Study Completion (Estimated): December 31, 2031

Study Registration Dates

• First Submitted: February 19, 2026
• First Submitted That Met QC Criteria: February 25, 2026
• First Posted (Actual): March 2, 2026

Study Record Updates

• Last Update Posted (Actual): June 1, 2026
• Last Update Submitted That Met QC Criteria: May 28, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: MRI; Aging; Neuroimaging; QSM; White Matter Lesions; Demyelination; Quantitative Susceptibility Mapping; Lesion Differentiation; Small vessel Disease
• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Autoimmune Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Multiple Sclerosis; Demyelinating Diseases; Cerebral Small Vessel Diseases
• Other Study ID Numbers: 952017; OUS Project ID 25/27215 (Other Identifier: Oslo University Hospital)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared. The study involves sensitive clinical and neuroimaging data collected under specific ethical approvals and data protection regulations. In accordance with institutional policies and regulatory requirements, individual-level data cannot be made publicly available.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No