The interplay between axonal and myelin damage in multiple sclerosis (MS) is poorly understood. This study aimed to evaluate the concomitant presence of axonal and myelin injury in living MS patients by using myelin and multi-shell diffusion MRI. Confirming neuropathological findings, our results show that (i) axonal and myelin damage exists in MS lesions and spreads out from the lesions in a centrifugal way, (ii) the extent of myelin and axonal damage differs among lesion subtypes and according to lesion anatomical locations and (iii) axonal (and not myelin) damage differs between relapsing-remitting and progressive MS patients.
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