STUDY DESIGN:Cross-sectional study. OBJECTIVES:To assess the knowledge, attitudes, and practices (KAP) of Lebanese healthcare professionals toward multidisciplinary spinal cord injury (SCI) rehabilitation. SETTING:Lebanon. METHODS:A cross-sectional study was conducted between April and June 2024 among physicians, nurses, and rehabilitation professionals involved in SCI care in Lebanon. Participants completed an anonymous online questionnaire assessing sociodemographic characteristics and KAP related to SCI rehabilitation. Data were analyzed using descriptive statistics, bivariate analyses, and multiple linear regression. RESULTS:A total of 110 healthcare professionals participated; 61.8% were aged ≤35 years and 62.7% held postgraduate degrees. The mean knowledge score was 58.5 (SD 13.0), with 88.1% scoring below the adequate threshold. Attitudes were generally positive, with a mean score of 70.1 (SD 19.5), and 68.8% scored above the threshold. Practice scores were low (mean 42.5, SD 23.2), with only 32.1% demonstrating adequate practices. Higher knowledge and practice scores were associated with postgraduate education, longer experience, and working in rehabilitation settings. Lower attitude scores were observed among males and professionals managing acute referrals. CONCLUSION:Lebanese healthcare professionals demonstrated positive attitudes but insufficient knowledge and practices regarding multidisciplinary SCI rehabilitation, highlighting the need for targeted training and stronger interdisciplinary rehabilitation systems.

Background: Spinal cord injury (SCI) requires long-term, multidisciplinary rehabilitation to optimize functioning and participation. In fragile health systems, however, rehabilitation services are often fragmented, under-resourced, and inconsistently accessible. This Current Debate paper examines SCI rehabilitation in Lebanon as an example of how health system fragility constrains rehabilitation delivery and disability inclusion.Methods: Using an International Classification of Functioning, Disability and Health (ICF)-informed approach, we developed a multi-level conceptual framework through structured narrative synthesis of 35 studies, contextual analysis of 10 policy documents, and iterative expert interpretation by a multidisciplinary team. The framework integrates evidence from rehabilitation systems literature with contextual analysis of the Lebanese healthcare system; its structure and prioritization reflect the authors' interpretive synthesis and professional experience rather than a fully systematic or validated methodology.Results: The proposed framework is organized across three interconnected levels: macro-level governance and financing, meso-level health system organization and workforce capacity, and micro-level functioning, self-management, and community participation. Health system fragility is conceptualized as a cross-cutting determinant influencing rehabilitation access, continuity of care, implementation capacity, and long-term outcomes. We argue that rehabilitation in crisis-affected settings cannot rely solely on incremental service expansion. Instead, rehabilitation should be reframed as a systems-level, disability-inclusive intervention addressing structural and contextual determinants of functioning.Conclusion: The framework provides a context-sensitive starting point for strengthening rehabilitation systems in comparable low- and middle-income settings; its broader scalability and generalizability beyond Lebanon remain conceptual at this stage and require empirical and stakeholder validation.

OBJECTIVE:This study assessed whether upper cervical cord area (UCCA) measured on routine brain MRI can serve as a biomarker of conversion to SPMS. METHODS:This is a single-center retrospective cohort study of RRMS patients with cross-sectional and longitudinal analyses of clinical and MRI data. Future SPMS converters were matched by age, sex, and disease duration with non-converters. UCCA at C1-C3 was measured at a pre-conversion visit in converters and at the first available visit in non-converters. Analysis was performed using Pearson's correlation and multivariable logistic regression. Longitudinal analyses included patients with ≥ 6 months MRI interval (mean follow-up 3.38 ± 1.88 years). RESULTS:97 patients (32 converters, 65 non-converters) were included. Cross-sectionally, reduced C2 and C3 area was associated with conversion (C2: OR 1.09, p = 0.01; C3: OR 1.09, p = 0.014). Lower UCCA correlated with higher EDSS (C2: r = -0.496, p < 0.001), worse T25-FWT (C2: r = -0.388, p < 0.001) and 9-HPT (C2: r = -0.312, p = 0.003), and reduced white matter and thalamic volumes (p ≤ 0.006). Longitudinal analysis (n = 50; 16 converters, 34 non-converters) demonstrated atrophy in converters at C1, C2 and C3 (C1: OR 1.70, p = 0.014; C2: OR 1.74, p = 0.003; C3: OR 1.75, p = 0.002), with mean annual percent reductions of 5.0%, 5.2%, and 6.0%, respectively. INTERPRETATION:Reduced UCCA and accelerated upper cervical cord atrophy were associated with conversion to SPMS and worsening disability, supporting UCCA as an accessible imaging biomarker of MS progression.

BACKGROUND:spinal cord injury (SCI) results in permanent disability and secondary complications, requiring long-term healthcare management. Globally, individuals with SCI face barriers to healthcare access; in Lebanon, data on these challenges are limited. OBJECTIVE:To assess healthcare and rehabilitation accessibility for individuals with SCI in Lebanon, focusing on facility accessibility, service utilization, coverage, patient satisfaction, and community reintegration. METHODS:A cross-sectional survey was conducted with 70 individuals with SCI receiving outpatient care in Lebanese rehabilitation and medical centers (January-March 2025). Data included sociodemographic and clinical profiles, facility accessibility audits, healthcare access and use, and patient satisfaction. RESULTS:Participants' mean age was 42.1 ± 14.9 years; 64.3% were male. Physical barriers were prevalent, with over 90% of Obstetrics & Gynecology and 85% of Family and Physical Medicine clinics lacking accessible imaging and restrooms. Only 53.3% had partial health coverage, and 59.2% cited unaffordability as the main barrier to care. All received rehabilitation, mostly physical therapy (93.5%), while access to occupational and psychological therapies was limited (29% each). Though satisfaction was high, 51.6% lacked post-rehabilitation follow-up. Major reintegration challenges included inaccessible public spaces (38.6%) and financial hardship (25.7%). CONCLUSION:Significant physical, financial, and systemic barriers hinder healthcare and rehabilitation access for individuals with SCI in Lebanon. Coordinated efforts are needed to improve infrastructure, insurance coverage, and continuity of care, enhancing outcomes and community inclusion for this population.

Idiopathic generalized epilepsy (IGE) is a complex epilepsy syndrome with various subtypes that appear normal on conventional magnetic resonance imaging (MRI). However, advanced quantitative MRI techniques have revealed subtle structural abnormalities. This study aims to identify specific cerebral regions with structural and volumetric alterations in IGE patients. A retrospective study was conducted on 38 IGE patients and 38 age and sex-matched healthy control subjects. MRI images were processed and segmented semi-automatically to extract volumes of cortical and subcortical brain regions. Statistical analysis was performed to compare volumes between IGE patients and controls. IGE patients exhibited significantly increased volumes in the precuneus (p = 0.002), and the pallidum (p < 0.001) compared to control subjects. No significant differences were observed in other regions, such as the precentral gyrus and frontal gyri. This study highlights conflicting results in the literature regarding radiologic volumetric data in IGE. While our findings imply the potential utility of incorporating volumetric analysis in the radiologic diagnosis of IGE patients to enhance targeted treatment approaches, it is important to exercise caution in interpreting these results, especially since these are primarily based on group-wise comparison. The increased volumes of the precuneus and pallidum in IGE patients suggest possible diagnostic implications. However, the extent of their clinical significance necessitates further investigation. Further research should investigate the clinical significance of these volumetric alterations and their potential role in guiding personalized treatment strategies for IGE patients.

Research on public community knowledge regarding spinal cord injury (SCI) and its rehabilitation within Lebanon is lacking. The present study aimed to evaluate the level of public knowledge among the Lebanese population concerning SCI and its needed multidisciplinary rehabilitation. In addition, we sought to evaluate the factors associated with the knowledge level. An online cross-sectional study was conducted among 1200 Lebanese persons aged 18 years and older. The survey included socio-demographic questions and knowledge levels regarding SCI and rehabilitation. A total of 1200 participants from the Lebanese community participated in the study, with a mean age of 32.99 ± 11.51 years, and 63.91

ABSTRACT Objective We aimed to investigate the comparative effectiveness of standard versus personalized extended interval dosing of anti‐CD20 therapy on clinical and sub‐clinical outcomes in multiple sclerosis. Methods Clinical information was collected prospectively on Research Electronic Data Capture. Patients with age ≥ 18 years old, confirmed diagnosis of multiple sclerosis, treatment with B‐cell depleting drug (Rituximab and Ocrelizumab), and minimum follow‐up of 12 months with at least 3 clinical visits and at least 3 infusions of medication were included and divided into an extended interval dosing group, a standard interval dosing group, and a converters group who switched from standard to extended interval dosing. Retinal measures were obtained using spectral domain Optical Coherence Tomography. Magnetic resonance imaging acquisitions were performed in two centers using a standardized conventional imaging protocol for multiple sclerosis. Results Patients had a median clinical follow‐up of 3.5 (0.44–7.3) years, retinal OCT follow‐up of 2.6 (1.4) years, and MRI follow‐up of 2.6 (1.1) years. Annualized changes in clinical measures, retinal measures, and brain volumetric measures were similar between the 3 groups. Multivariate regression analyses also showed no differences. Interpretation We found no differences in clinical or sub‐clinical outcomes between patients treated with standard interval dosing, patients converting from standard to extended interval dosing, and patients on extended interval dosing of B‐cell depleting drugs.

Brain age estimation is an emerging biomarker for assessing neurodegeneration in multiple sclerosis (MS). However, MS-related lesions can distort structural measurements, potentially leading to inaccuracies in age prediction models. Lesion filling has been proposed as a corrective step, but its impact on brain age estimation and its associations with clinical and structural markers remains unclear. We analyzed 571 relapsing-remitting MS patients using the BrainAgeR pipeline to estimate brain age from both non-lesion-filled and lesion-filled T1-weighted images. Bias correction was applied to remove age-related prediction bias. Brain Age Gap (BAG) was computed as the difference between corrected predicted brain age and chronological age. Multivariable linear regression models were used to assess associations between BAG and clinical outcomes (EDSS, 9HPT, SDMT, 25FWT) and volumetric measures. Non-lesion-filled and lesion-filled brain age estimates showed excellent agreement (r = 0.97; ICC = 0.962), with a mean difference of 1.23 years and slightly lower mean absolute error for lesion-filled predictions (8.12 vs. 9.40 years). Both BAG measures were significantly associated with EDSS, 9HPT, and SDMT, though effect sizes were modest. Lesion-filled BAG showed stronger and more consistent associations with gray matter, thalamic, and hippocampal volumes, and these associations remained significant after Bonferroni correction. Lesion filling modestly improves structural interpretability of brain age estimates in MS but has limited effect on clinical correlations. The high concordance between lesion-filled and non-lesion-filled estimates confirms the robustness of brain age as a biomarker, while supporting the use of lesion correction when structural precision is essential.

AIM: To assess the burden of white matter (WM) damage in the cerebrum and cerebellum of spinocerebellar ataxia type 2 (SCA2) patients in an attempt to identify key regions affected by the neurodegenerative processes using diffusion tensor imaging (DTI). MATERIALS AND METHODS: Nine SCA2 patients and 16 age-matched healthy controls were examined twice (SCA2 patients 3.6 +/- 0.7 years and controls 3.3 +/- 1.0 years apart) on the same 1.5 T scanner by acquiring T1-weighted and diffusion-weighted (b-value = 1,000 s/mm2) images. Using tract-based spatial statistics, DTI analysis on fractional anisotropy (FA), mean diffusivity (MD), axial (AD)/radial (RD) diffusivity was performed. RESULTS: At baseline magnetic resonance imaging (MRI), FA was significantly decreased in SCA2 patients in the corticospinal tracts, inferior and superior cerebellar peduncles, middle cerebellar peduncles, cerebral peduncles, right superior and posterior corona radiata. RD was only significantly increased in SCA2 patients in the middle cerebellar peduncles. No significant AD and MD changes were observed. Tract-based spatial statistics (TBSS) analysis between SCA2 patients at baseline and at follow-up showed no significant changes in any of the DTI metrics. CONCLUSIONS: DTI is a sensitive tool for following the progression of WM neuro-degeneration and severity assessment in patients with SCA2. These findings add to a better understanding of the neurological underpinnings of the symptoms experienced by SCA2 patients. (c) 2023 Published by Elsevier Ltd on behalf of The Royal College of Radiologists.

Background/Objective(s) Multiple sclerosis (MS) is a neurodegenerative disorder characterized by demyelination, axonal loss, and brain atrophy, leading to progressive disability. Differentiating patients who convert from relapsing-remitting MS (RRMS) to secondary progressive MS (SPMS) remains a critical challenge, as early identification of converters can significantly impact treatment strategies. This study explores specific brain regions associated with disconnection probabilities and volume reductions, aiming to identify potential MRI biomarkers predictive of conversion. Material(s) and Method(s) We conducted a retrospective analysis of 47 RRMS patients (17 Converters and 30 non-converters) who underwent baseline and follow-up MRI scans approximately 1.5 years apart. Mixed-effects models were employed to evaluate the interaction between conversion status (converters vs. non-converters) and time across various brain regions, focusing on disconnection probabilities and volumetric changes measured using the Vol2Brain tool. Result(s) Converters exhibited significant disconnection in several key white matter tracts, including the uncinate fasciculus (left), corticobulbar tract (left), superior longitudinal fasciculus (left), and cingulum parahippocampal parietal (right). These disconnections are linked to the neural circuits involved in cognitive, emotional, and motor functions, suggesting that their disruption may contribute to the clinical progression observed in SPMS. Additionally, converters showed increased disconnection in the corticostriatal tract superior (right) and corpus callosum forceps minor, highlighting the widespread impact of MS on interhemispheric communication and motor coordination.Grey matter atrophy was also more pronounced in converters, particularly in the precentral gyrus, temporal lobe, and thalamus, regions critical for motor and cognitive functions. The reduction in grey matter volume was paralleled by significant decreases in the volumes of the caudate, amygdala, and thalamus, suggesting a broad impact on brain structures essential for motor control, emotion regulation, and executive function.Interestingly, lesion burden and volume, especially in juxtacortical areas, were significantly greater in converters, reinforcing the relationship between lesion load and disease progression. Increased third ventricle volume in converters further indicated a higher degree of global brain atrophy, reflecting overall disease severity. Notably, the corpus callosum forceps major showed increased disconnection, pointing to its role in the advanced stages of MS as a critical area for interhemispheric integration. Conclusion(s) The findings highlight that specific patterns of white matter disconnection and regional brain atrophy are strongly associated with conversion from RRMS to SPMS. These MRI biomarkers provide valuable insights into the mechanisms of disease progression and offer potential targets for therapeutic interventions aimed at preserving neural connectivity and delaying the onset of progressive MS. Future research should focus on validating these biomarkers in larger cohorts and exploring their integration into clinical practice for more personalized MS management.

Introduction: This study aims to use diffusion tensor imaging (DTI) in conjunction with brain graph techniques to define brain structural connectivity and investigate its association with personal income (PI) in individuals of various ages and intelligence quotients (IQ).Methods: MRI examinations were performed on 55 male subjects (mean age: 40.1 +/- 9.4 years). Graph data and metrics were generated, and DTI images were analyzed using tract-based spatial statistics (TBSS). All subjects underwent the Wechsler Adult Intelligence Scale for a reliable estimation of the full-scale IQ (FSIQ), which includes verbal comprehension index, perceptual reasoning index, working memory index, and processing speed index. The performance score was defined as the monthly PI normalized by the age of the subject.Results: The analysis of global graph metrics showed that modularity correlated positively with performance score (p = 0.003) and negatively with FSIQ (p = 0.04) and processing speed index (p = 0.005). No significant correlations were found between IQ indices and performance scores. Regional analysis of graph metrics showed modularity differences between right and left networks in sub-cortical (p = 0.001) and frontal (p = 0.044) networks. TBSS analysis showed greater axial and mean diffusivities in the high-performance group in correlation with their modular brain organization.Conclusion: This study showed that PI performance is strongly correlated with a modular organization of brain structural connectivity, which implies short and rapid networks, providing automatic and unconscious brain processing. Additionally, the lack of correlation between performance and IQ suggests a reduced role of academic reasoning skills in performance to the advantage of high uncertainty decision-making networks. Impact Statement The research presented on the correlation between brain network modularity and personal income (PI) performance provides crucial insights into the neurological underpinnings of human achievements. By revealing a significant link between PI performance and modular brain connectivity, we challenge conventional beliefs by emphasizing the importance of intuitive and automatic decision-making networks over traditional academic reasoning abilities. These findings have the potential to reshape our perceptions of achievement and intelligence, as they highlight the significance of rapid, unconscious processing in real-world success. This study opens new avenues for investigating the brain's impact on performance, offering novel perspectives in neuroscience and psychology.

The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.

PURPOSE:To cross-culturally adapt and validate the Radboud Dysarthria Assessment (RDA) and the speech component of the Radboud Oral Motor inventory for Parkinson's disease (ROMP-speech) into the Arabic language among Lebanese subjects with dysarthria. MATERIALS AND METHODS:This study included 50 participants with dysarthria. The Arabic versions of the RDA (A-RDA) and the ROMP-speech (A-ROMP-speech) were administered in addition to the Arabic Speech Intelligibility test, the Lebanese Voice Handicap Index-10 (VHI-10lb) and semantic verbal fluency tasks. The maximum performance tasks were analyzed using the Praat software. The A-RDA qualitative recording form and the A-ROMP-speech were assessed for construct validity and internal consistency. The convergent validity of the maximum performance tasks, the severity scale, and the A-ROMP-speech were evaluated. RESULTS:Exploratory factor analysis of the qualitative recording form extracted 3 factors explaining 82.973% of the total variance, and it demonstrated high internal consistency (α = 0.912). The maximum performance tasks of the RDA correlated significantly with the corresponding Praat scores. The severity scale and the A-ROMP-speech correlated fairly to strongly with the Arabic Speech Intelligibility test (rs=-0.695 and -0.736, p < 0.001) and the VHI-10lb (r = 0.539 and 0.640, p < 0.001). CONCLUSION:The A-RDA and the A-ROMP-speech are valid and reliable dysarthria tools among Lebanese subjects.

Background and Objectives There is no report on the long-term outcomes of ataxia with antibodies against Delta and Notch-like epidermal growth factor–related (DNER). We aimed to describe the clinical-immunologic features and long-term outcomes of patients with anti-DNER antibodies. Methods Patients tested positive for anti-DNER antibodies between 2000 and 2020 were identified retrospectively. In those with available samples, immunoglobulin G (IgG) subclass analysis, longitudinal cerebellum volumetry, human leukocyte antigen isotyping, and CSF proteomic analysis were performed. Rodent brain membrane fractionation and organotypic cerebellar slices were used to study DNER cell-surface expression and human IgG binding to the Purkinje cell surface. Results Twenty-eight patients were included (median age, 52 years, range 19–81): 23 of 28 (82.1%) were male and 23 of 28 (82.1%) had a hematologic malignancy. Most patients (27/28, 96.4%) had cerebellar ataxia; 16 of 28 (57.1%) had noncerebellar symptoms (cognitive impairment, neuropathy, and/or seizures), and 27 of 28 (96.4%) became moderately to severely disabled. Half of the patients (50%) improved, and 32.1% (9/28) had no or slight disability at the last visit (median, 26 months; range, 3–238). Good outcome significantly associated with younger age, milder clinical presentations, and less decrease of cerebellar gray matter volumes at follow-up. No human leukocyte antigen association was identified. Inflammation-related proteins were overexpressed in the patients9 CSF. In the rodent brain, DNER was enriched in plasma membrane fractions. Patients9 anti-DNER antibodies were predominantly IgG1/3 and bound live Purkinje cells in vitro. Discussion DNER ataxia is a treatable condition in which nearly a third of patients have a favorable outcome. DNER antibodies bind to the surface of Purkinje cells and are therefore potentially pathogenic, supporting the use of B-cell–targeting treatments.

Background and Objectives There is no report on the long-term outcomes of ataxia with antibodies against Delta and Notch-like epidermal growth factor-related (DNER). We aimed to describe the clinical-immunologic features and long-term outcomes of patients with anti-DNER antibodies. Methods Patients tested positive for anti-DNER antibodies between 2000 and 2020 were identified retrospectively. In those with available samples, immunoglobulin G (IgG) subclass analysis, longitudinal cerebellum volumetry, human leukocyte antigen isotyping, and CSF proteomic analysis were performed. Rodent brain membrane fractionation and organotypic cerebellar slices were used to study DNER cell-surface expression and human IgG binding to the Purkinje cell surface. Results Twenty-eight patients were included (median age, 52 years, range 19-81): 23 of 28 (82.1%) were male and 23 of 28 (82.1%) had a hematologic malignancy. Most patients (27/28, 96.4%) had cerebellar ataxia; 16 of 28 (57.1%) had noncerebellar symptoms (cognitive impairment, neuropathy, and/or seizures), and 27 of 28 (96.4%) became moderately to severely disabled. Half of the patients (50%) improved, and 32.1% (9/28) had no or slight disability at the last visit (median, 26 months; range, 3-238). Good outcome significantly associated with younger age, milder clinical presentations, and less decrease of cerebellar gray matter volumes at follow-up. No human leukocyte antigen association was identified. Inflammation-related proteins were overexpressed in the patients' CSF. In the rodent brain, DNER was enriched in plasma membrane fractions. Patients' anti-DNER antibodies were predominantly IgG1/3 and bound live Purkinje cells in vitro. Discussion DNER ataxia is a treatable condition in which nearly a third of patients have a favorable outcome. DNER antibodies bind to the surface of Purkinje cells and are therefore potentially pathogenic, supporting the use of B-cell-targeting treatments.

Most of motor recovery usually occurs within the first 3 months after stroke. Herein is reported a remarkable late recovery of the right upper-limb motor function after a left middle cerebral artery stroke. This recovery happened progressively, from two to 12 years post-stroke onset, and along a proximo-distal gradient, including dissociated finger movements after 5 years. Standardized clinical assessment and quantified analysis of the reach-to-grasp movement were repeated over time to characterize the recovery. Twelve years after stroke onset, diffusion tensor imaging (DTI), functional magnetic resonance imaging (fMRI), and transcranial magnetic stimulation (TMS) analyses of the corticospinal tracts were carried out to investigate the plasticity mechanisms and efferent pathways underlying motor control of the paretic hand. Clinical evaluations and quantified movement analysis argue for a true neurological recovery rather than a compensation mechanism. DTI showed a significant decrease of fractional anisotropy, associated with a severe atrophy, only in the upper part of the left corticospinal tract (CST), suggesting an alteration of the CST at the level of the infarction that is not propagated downstream. The finger opposition movement of the right paretic hand was associated with fMRI activations of a broad network including predominantly the contralateral sensorimotor areas. Motor evoked potentials were normal and the selective stimulation of the right hemisphere did not elicit any response of the ipsilateral upper limb. These findings support the idea that the motor control of the paretic hand is mediated mainly by the contralateral sensorimotor cortex and the corresponding CST, but also by a plasticity of motor-related areas in both hemispheres. To our knowledge, this is the first report of a high quality upper-limb recovery occurring more than 2 years after stroke with a genuine insight of brain plasticity mechanisms.

Background and Purpose The aim of this study is to determine whether cerebral white matter (WM) microstructural damage, defined by decreased fractional anisotropy (FA) and increased axial (AD) and radial (RD) diffusivities, could be detected as accurately by measuring the T1/T2 ratio, in relapsing-remitting multiple sclerosis (RRMS) patients compared to healthy control (HC) subjects. Methods Twenty-eight RRMS patients and 24 HC subjects were included in this study. Region-based analysis based on the ICBM-81 diffusion tensor imaging (DTI) atlas WM labels was performed to compare T1/T2 ratio to DTI values in normal-appearing WM (NAWM) regions of interest. Lesions segmentation was also performed and compared to the HC global WM. Results A significant 19.65% decrease of T1/T2 ratio values was observed in NAWM regions of RRMS patients compared to HC. A significant 6.30% decrease of FA, as well as significant 4.76% and 10.27% increases of AD and RD, respectively, were observed in RRMS compared to the HC group in various NAWM regions. Compared to the global WM HC mask, lesions have significantly decreased T1/T2 ratio and FA and increased AD and RD (p < . 001). Conclusions Results showed significant differences between RRMS and HC in both DTI and T1/T2 ratio measurements. T1/T2 ratio even demonstrated extensive WM abnormalities when compared to DTI, thereby highlighting the ratio's sensitivity to subtle differences in cerebral WM structural integrity using only conventional MRI sequences.