Quantitative MRI-based assessment of the ultrastructural compactness of myelin lamellae

Efficient neuronal communication relying on rapid saltatory conduction depends not only on the amount of myelin wrapping axons but also on myelin compact organisation. Yet, current quantitative MRI myelin imaging methods, such as Myelin Water Imaging (MWI) and quantitative Magnetization Transfer (qMT), are designed to estimate myelin content and are often treated as interchangeable, overlooking myelin organisation. We introduce Structural Myelin Integrity (SMI), a quantitative MRI metric designed to distinguish myelin compact organisation from content. SMI combines the distinct biophysical sensitivities of MWI and qMT to separate the water confined between myelin layers from the total myelin membrane mass. We evaluated SMI in two rodent models of myelin decompaction and one remyelination model, validating our findings with synchrotron small-angle X-ray scattering and electron microscopy. SMI detected myelin layers decompaction despite largely preserved myelin membranes, revealing structural abnormalities that were not explained by myelin content alone. During remyelination, SMI returned closer to healthy values at early timepoints than myelin-content metrics, consistent with the formation of thin-but-compact sheaths. These findings indicate that myelin content and organisation can dissociate and establish SMI as a non-invasive marker of myelin organisation, compatible with existing clinical MRI approaches for studying white matter changes not detected today.