Multi-Parametric Phase-Cycled Balanced Steady-State Free Precession Brain Tissue Characterization in Relapsing-Remitting Multiple Sclerosis

Quantitative MRI enables the detection of subtle microstructural alterations in normal-appearing white matter (NAWM) associated with pathological conditions such as multiple sclerosis. Quantitative metrics including R1, R2, and the bSSFP asymmetry index (AI) were evaluated in the WM of 20 relapsing-remitting multiple sclerosis (RRMS) patients and 10 healthy controls (HC). A multi-parametric frame-work based on a phase-cycled balanced steady-state free precession (pc-bSSFP) sequence was used. Diffusion tensor imaging-derived measures, including fiber-to-field angle, number of fiber orientations, and fractional anisotropy, were incorporated to assess parameter anisotropy. Statistical analysis was performed using linear mixed-effects models to test for group, ROI, and group-by-ROI effects for each metric, with ROI-specific group comparisons derived from the model. Significant main effects of group, ROI, and group-by-ROI interaction were observed for both R1 and R2, whereas for AI only the ROI effect reached significance (group p= 0.462; group-by-ROI p = 0.786). Fourteen of sixteen ROIs demonstrated significantly lower R1 and R2 values in RRMS compared with HC. No ROI showed significant differences in AI. In conclusion, pc-bSSFP-based relaxometry reveals predominantly white matter alterations in RRMS, while enabling a comprehensive whole-brain assessment that also encompasses gray matter.