“…39,40 Such pathological abnormalities modify the relative proportions of mobile and immobile protons of the diseased tissue, and so it is not surprising that MT-MRI is able to show microscopic damage in NAWM that conventional imaging fails to detect. [25][26][27] Decreased MTR values have been found, using ROI and histogram analysis, in normal-appearing brain tissue (NABT) and NAWM of MS patients, 24,29,30,[41][42][43][44][45][46][47] which can precede new lesion formation. 48 -51 NABT and NAWM MTR abnormalities have been detected in patients with CIS suggestive of MS, 29,44,46 increase progressively in early RRMS 45 and early PPMS, 47 and are more pronounced in SPMS and PPMS patients than in patients with the other main disease phenotypes.…”