Myelin-sensitive magnetisation transfer saturation (MTsat) corrects magnetisation transfer ratio (MTR) signal variance, accounting for T1 recovery and B1 inhomogeneities, but its validity as a longitudinal imaging marker in multiple sclerosis (MS) is not yet clear. Here, we examine longitudinal change in cerebral MTsat and MTR in a cohort of people with newly diagnosed MS (n=62). MTsat, but not MTR, decreased in normal-appearing white matter over one year and was associated with clinical disability progression. In white matter lesions, both MTsat and MTR increased longitudinally. We conclude that MTsat is more sensitive to subtle myelin damage over time than MTR.
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