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A multi\u2010metric approach involving multiple quantitative measures may improve our understanding of healthy tissue and pathology. Previous work shows myelin water fraction (MWF) is related to fractional anisotropy (FA), but this relationship is complicated by confounding factors that may be resolved using tensor\u2010valued diffusion imaging, which yields measurements of microscopic FA (\u03bcFA) and tissue heterogeneity (C<jats:sub>MD<\/jats:sub>). Our aims were to better understand how measures from myelin water and tensor\u2010valued diffusion imaging relate to one another, and to demonstrate how these measures can be used to characterize microstructure in both healthy white matter and pathological changes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed the relationship between MWF, FA, \u03bcFA, and C<jats:sub>MD<\/jats:sub> from 25 healthy individuals through atlas comparison, correlation analysis, and tract profiling. We also applied z\u2010score analysis and tract profiling in five people with multiple sclerosis (MS) to evaluate the multi\u2010metric utility of these measures in assessing pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Although correlation analysis showed moderate, but potentially misleading relationships between metrics, tract profiling showed consistent tract\u2010specific pattern differences between metrics in healthy tissue. In MS, MWF, \u03bcFA, and C<jats:sub>MD<\/jats:sub> were the most sensitive to pathological changes, showing regions of abnormality even in normal\u2010appearing white matter and along lesional tracts, and highlighting different types of damage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using MWF, \u03bcFA, and C<jats:sub>MD<\/jats:sub> to separately assess myelination, anisotropy, and tissue heterogeneity enhances our ability to investigate development, aging, disease, and injury.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mrm.30620","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T01:15:37Z","timestamp":1751418937000},"page":"2038-2056","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Myelin water and tensor\u2010valued diffusion imaging: (How) are they related?"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-8488","authenticated-orcid":false,"given":"Sharada","family":"Balaji","sequence":"first","affiliation":[{"name":"Physics and Astronomy University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6107-5610","authenticated-orcid":false,"given":"Adam V.","family":"Dvorak","sequence":"additional","affiliation":[{"name":"Physics and Astronomy University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neale","family":"Wiley","sequence":"additional","affiliation":[{"name":"Physics and Astronomy University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8515-5858","authenticated-orcid":false,"given":"Erin L.","family":"MacMillan","sequence":"additional","affiliation":[{"name":"MR Clinical Science, Philips Canada  Mississauga Ontario Canada"},{"name":"Radiology University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Traboulsee","sequence":"additional","affiliation":[{"name":"Medicine (Neurology) University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene M.","family":"Vavasour","sequence":"additional","affiliation":[{"name":"Physics and Astronomy University of British Columbia  Vancouver British Columbia Canada"},{"name":"Radiology University of British Columbia  Vancouver British Columbia Canada"},{"name":"International Collaboration on Repair Discoveries University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Gilbert","sequence":"additional","affiliation":[{"name":"MR Clinical Science, Philips Canada  Mississauga Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. 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