{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:43:12Z","timestamp":1788453792765,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deanship of Scientific Research at King Saud University","award":["ORF-2026-2130"],"award-info":[{"award-number":["ORF-2026-2130"]}]},{"award":["ORF-2026-2130"],"award-info":[{"award-number":["ORF-2026-2130"]}],"id":[{"id":"https:\/\/ror.org\/02f81g417","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Normal-appearing white matter (NAWM) in relapsing\u2013remitting multiple sclerosis (RR-MS) may contain abnormalities not visible on conventional MRI. This study evaluated whether intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) detects regional NAWM abnormalities and differentiates non-lesional white matter from lesion tissue in RR-MS. Methods: This retrospective cross-sectional single-center study included 189 patients with RR-MS and 26 healthy controls. Apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) were measured in the genu, splenium, frontal white matter, and posterior white matter. Regional MS NAWM was compared with the anatomically corresponding control white matter. Tissue-compartment analysis compared averaged control white matter, averaged MS NAWM, and lesion-averaged MS tissue. Results: Posterior white matter showed the strongest abnormalities, with lower ADC, D, D*, and f in RR-MS than in controls (all p &lt; 0.001); ADC, D, and D* showed large effects (Cohen\u2019s d: \u22120.81 to \u22121.07). In the splenium, ADC and D were higher, whereas D* was lower in RR-MS. After age and sex adjustment, posterior white matter ADC, D, and D* and splenial D* remained significant, whereas posterior f and splenial ADC\/D were attenuated. No clear IVIM-DWI abnormality was detected in the sampled frontal white matter. Lesion-averaged MS tissue showed higher ADC, D, and D* than averaged MS NAWM and control white matter (all p &lt; 0.001). Conclusions: Regional IVIM-DWI identified region-specific NAWM abnormalities in RR-MS, most robustly in posterior white matter, within an exploratory imaging framework. Larger matched longitudinal cohorts are required before clinical or prognostic utility can be established.<\/jats:p>","DOI":"10.3390\/jcm15145493","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T02:34:44Z","timestamp":1783996484000},"page":"5493","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Regional IVIM-DWI Abnormalities in Normal-Appearing White Matter and Lesion Tissue in Relapsing\u2013Remitting Multiple Sclerosis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9769-2514","authenticated-orcid":false,"given":"Othman I.","family":"Alomair","sequence":"first","affiliation":[{"name":"Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6404-8762","authenticated-orcid":false,"given":"Sami A.","family":"Alghamdi","sequence":"additional","affiliation":[{"name":"Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 145111, Riyadh 4545, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3147","DOI":"10.1093\/brain\/awac016","article-title":"How Patients with Multiple Sclerosis Acquire Disability","volume":"145","author":"Lublin","year":"2022","journal-title":"Brain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1177\/1352458520970841","article-title":"Rising Prevalence of Multiple Sclerosis Worldwide: Insights from the Atlas of Ms","volume":"26","author":"Walton","year":"2020","journal-title":"Mult. Scler. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e1583","DOI":"10.1002\/wsbm.1583","article-title":"Neurodegeneration in Multiple Sclerosis","volume":"15","author":"Mey","year":"2023","journal-title":"WIREs Mech. 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