CEST MRI with distribution-based analysis for assessment of early stage disease activity in a mouse model of multiple sclerosis: An initial study

Imaging biomarkers that can detect pathological changes at an early stage of multiple sclerosis (MS) may allow earlier therapeutic intervention with an improved outcome. Using a mouse model of MS, termed as experimental autoimmune encephalomyelitis (EAE), we performed chemical exchange saturation transfer (CEST) MRI at a very early stage before symptom onset (6 days post-induction) for assessment of changes in tissues that appear "normal" with conventional MRI. The collected CEST Z-spectra signals (S-sat/S-0) were analyzed using a histogram-guided method to determine the contributions from various offset frequencies. Histogram analysis showed that EAE mice exhibit a more heterogeneous distribution with lower peak heights in the hindbrain compared with naive mice at saturation offsets of 1 and 2 ppm. At these two offsets, both the mean S-sat/S-0 and the mean MTRasym values in the cerebellum and brain stem are significantly different between EAE and naive mice (P < 0.05). Immunofluorescent staining validated the presence of neuroinflammation, with IBA1-positive cells detected throughout the hindbrain including the cerebellum and brain stem. Follow-up MRI at the symptom onset (score = 1.5-2.5, 13 days post-induction) confirmed gadolinium-enhanced periventricular lesions. CEST Z-spectra signals also changed by this time. The proposed three-level histogram-oriented analysis is simple to execute and robust for detecting subtle changes in Z-spectra signals, which does not require a priori knowledge of damage locations or contributing offset components. CEST MRI signals at 1 and 2 ppm were sensitive to the subtle pathological changes at an early stage in EAE mice, and have potential as novel imaging biomarkers complementary to functional and physiological MRI measures.