q‐Space Myelin Map: A new myelin‐specific imaging technique for treatment monitoring of multiple sclerosis

In multiple sclerosis (MS) patients, hyperintense signals on T2‐weighted images by magnetic resonance imaging are signs of demyelination; however, T2 signals lack specificity and fail to detect remyelination. For more precise monitoring of MS, a new magnetic resonance imaging technique, q‐space Myelin Map (qMM), which specifically identifies myelin, has been developed. This study aimed to explore clinical factors associated with remyelination for different disease‐modifying drugs, and to examine the utility and feasibility of qMM in clinical practice.Data from sequential patients with relapsing–remitting MS initiating disease‐modifying drugs at our center were collected. After treatment initiation, qMM was carried out at 6‐month intervals and the resulting images analyzed for evidence of remyelination.A total of 48 patients with relapsing–remitting MS were included: 22 with dimethyl fumarate, 14 with fingolimod, four with glatiramer acetate and eight with natalizumab. qMM showed qMM‐remyelination in 22 patients (45.8%). In natalizumab patients, baseline ages were 33.6 ± 6.9 years (n = 5) and 47.3 ± 5.8 years (n = 3) in patients with or without qMM remyelination, respectively. In dimethyl fumarate patients, the proportion of women was 100% (n = 10) and 50% (n = 12) in patients with or without qMM myelination, respectively.This exploratory study suggested the potential clinical utility of qMM for visualizing remyelination in MS patients and fine‐tuning their pharmacotherapy. Two potential clinical factors promoting qMM‐remyelination were identified: female sex with dimethyl fumarate and younger baseline age with natalizumab; a larger prospective study is warranted to confirm these results.