Whole-Brain T1 Mapping in Multiple Sclerosis: Global Changes of Normal-appearing Gray and White Matter

Multiple sclerosis pathogenesis: missing pieces of an old puzzle

Traditionally, multiple sclerosis (MS) was considered to be a CD4 T cell-mediated CNS autoimmunity, compatible with experimental autoimmune encephalitis model, which can be characterized by focal lesions in the white matter. However, studies of recent decades revealed several missing pieces of MS puzzle and showed that MS pathogenesis is more complex than the traditional view and may include the following: a primary degenerative process (e.g. oligodendroglial pathology), generalized abnormality of normal-appearing brain tissue, pronounced gray matter pathology, involvement of innate immunity, and CD8 T cells and B cells. Here, we review these findings and discuss their implications in MS pathogenesis.

Sub-millimeter T1 mapping of rapidly relaxing compartments with gradient delay corrected spiral TAPIR and compressed sensing at 3T

PURPOSE

The TAPIR sequence is an accurate and efficient method for T₁ mapping. It combines a slice-interleaving Look-Locker read-out with an acquisition of multiple k-space lines in 1 shot. Whereas the acquisition of multiple lines per excitation increases imaging speed, the corresponding increase in TR and TE is detrimental to the T₁ fitting performance. This is especially problematic for substances exhibiting rapid T₂ ^* relaxation (e.g., myelin water).

METHODS

The T₁ fitting performance of TAPIR is enhanced by using an interleaved spiral read-out with shorter TE and TR. Furthermore, an improvement to a method for fast gradient delay estimation is presented. Whereas previous methods assume the gradient delay to be stationary, the presented approach corrects the spiral k-space trajectory by using a polynomial fit of the measured gradient delays.

RESULTS

Gradient delay artifacts are largely eliminated, requiring very little additional scanning time. The sampling efficiency of the spiral read-out allows for a significant reduction of the acquisition time in comparison to Cartesian TAPIR. Spiral TAPIR enables the sampling of more slices and an accurate measurement of rapidly relaxing compartments. Over a wide T₁ range (448-3115 ms), spiral TAPIR reduces the mean fitting error from -2.5% to -0.1%. Combining 50% undersampling with the shorter TR of spiral TAPIR, an increase in imaging speed by a factor of up to 3.3 was achieved.

CONCLUSION

Using a spiral read-out trajectory, the established TAPIR sequence enables measurement of rapidly relaxing T₁ compartments, while improving T₁ mapping performance and imaging speed.

Multiparameter MRI quantification of microstructural tissue alterations in multiple sclerosis

Objectives

Conventional MRI is not sensitive to many pathological processes underpinning multiple sclerosis (MS) ongoing in normal appearing brain tissue (NABT). Quantitative MRI (qMRI) and a multiparameter mapping (MPM) protocol are used to simultaneously quantify magnetization transfer (MT) saturation, transverse relaxation rate R2* (1/T2*) and longitudinal relaxation rate R1 (1/T1), and assess differences in NABT microstructure between MS patients and healthy controls (HC).

Methods

This prospective cross-sectional study involves 36 MS patients (21 females, 15 males; age range 22–63 years; 15 relapsing-remitting MS - RRMS; 21 primary or secondary progressive MS - PMS) and 36 age-matched HC (20 females, 16 males); age range 21–61 years). The qMRI maps are computed and segmented in lesions and 3 normal appearing cerebral tissue classes: normal appearing cortical grey matter (NACGM), normal appearing deep grey matter (NADGM), normal appearing white matter (NAWM). Individual median values are extracted for each tissue class and MR parameter. MANOVAs and stepwise regressions assess differences between patients and HC.

Results

MS patients are characterized by a decrease in MT, R2* and R1 within NACGM (p < .0001) and NAWM (p < .0001). In NADGM, MT decreases (p < .0001) but R2* and R1 remain normal. These observations tend to be more pronounced in PMS. Quantitative MRI parameters are independent predictors of clinical status: EDSS is significantly related to R1 in NACGM and R2* in NADGM; the latter also predicts motor score. Cognitive score is best predicted by MT parameter within lesions.

Conclusions

Multiparametric data of brain microstructure concord with the literature, predict clinical performance and suggest a diffuse reduction in myelin and/or iron content within NABT of MS patients.

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We revisit microstructural alterations of NABT in MS patients by simultaneously quantifying three MRI parameters.

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Data suggest reduction of MT/R2*/R1 in NABT of MS patients, suggesting a reduction in myelin and/or iron content.

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Quantitative MRI parameters in NABT are independent predictors of clinical status.

Quantitative 7T MRI does not detect occult brain damage in neuromyelitis optica

Objective

To investigate and compare occult damages in aquaporin-4 (AQP4)-rich periependymal regions in patients with neuromyelitis optica spectrum disorder (NMOSD) vs healthy controls (HCs) and patients with multiple sclerosis (MS) applying quantitative T1 mapping at 7 Tesla (T) in a cross-sectional study.

Methods

Eleven patients with NMOSD (median Expanded Disability Status Scale [EDSS] score 3.5, disease duration 9.3 years, age 43.7 years, and 11 female) seropositive for anti-AQP4 antibodies, 7 patients with MS (median EDSS score 1.5, disease duration 3.6, age 30.2 years, and 4 female), and 10 HCs underwent 7T MRI. The imaging protocol included T2*-weighted (w) imaging and an MP2RAGE sequence yielding 3D T1w images and quantitative T1 maps. We semiautomatically marked the lesion-free periependymal area around the cerebral aqueduct and the lateral, third, and fourth ventricles to finally measure and compare the T1 relaxation time within these areas.

Results

We did not observe any differences in the T1 relaxation time between patients with NMOSD and HCs (all p > 0.05). Contrarily, the T1 relaxation time was longer in patients with MS vs patients with NMOSD (lateral ventricle p = 0.056, third ventricle p = 0.173, fourth ventricle p = 0.016, and cerebral aqueduct p = 0.048) and vs HCs (third ventricle p = 0.027, fourth ventricle p = 0.013, lateral ventricle p = 0.043, and cerebral aqueduct p = 0.005).

Conclusion

Unlike in MS, we did not observe subtle T1 changes in lesion-free periependymal regions in NMOSD, which supports the hypothesis of a rather focal than diffuse brain pathology in NMOSD.

Multivariate prediction of multiple sclerosis using robust quantitative MR-based image metrics

OBJECTIVES

The current work investigates the performance of different multivariate supervised machine learning models to predict the presence or absence of multiple sclerosis (MS) based on features derived from quantitative MRI acquisitions. The performance of these models was evaluated for images which are significantly degraded due to subject motion, a problem which is often observed in clinical routine diagnostics. Finally, the difference between a true multivariate analysis and the corresponding univariate analysis based on single parameters alone was addressed.

MATERIALS AND METHODS

52 MS patients and 45 healthy controls where scanned on a 3T system. The datasets showed variable degrees of motion-associated artefacts. For each dataset, the average of T₁, T₂^*, total and myelin bound water content was determined in white and grey matter. Based on these parameters, different multivariate models were trained and their cross-validated performance to predict the presence of MS was evaluated. Furthermore, the univariate distributions of each quantitative parameter were employed to define optimised cut-offs that differentiate MS patients from healthy controls.

RESULTS

For data not affected by motion, 83.7% of all subjects were correctly classified using a crossvalidated multivariate model. Inclusion of data with significant artefacts reduces the rate of correct classification to 74.5%. T₁ in grey and myelin water content in white matter where the most discriminating variables in the multivariate analysis. In contrast, the total water content in white matter and the ratio of white and grey matter total water content each resulted in 77% correct classifications in a univariate regression analysis.

CONCLUSION

The results demonstrate that even simple quantitative MRI-based measures allow for an automated prediction of the presence/absence of multiple sclerosis with good specificity. Importantly, even highly degraded datasets due to motion-artefacts could be correctly classified, especially when pooling features derived from grey and white matter. Finally, the advantage of a multivariate over a univariate analysis of quantitative MR data was shown.

Revisiting Radiographic L5-S1 Parallelism Using MRI T1 Mapping

Purpose:

Thirty years ago, we reported that parallel aspect of the L5-S1 disc on a lateral view of the spine might be considered to be an initial stage of disk degeneration. The current study represents an attempt to increase the validity of parallel sign on conventional radiograph using MR real T1 mapping.

Methods:

Forty-four young asymptomatic volunteers (mean age 21.6 ± 2.3) underwent lumbar spine MRI, twice the same day, morning and afternoon. Dedicated sequences using the inversion-recovery technique were used to calculate the T1 relaxation time. A region of interest (ROI) representing the nucleus pulposus was defined in each disk. The volunteers were stratified according to the presence or absence of a parallel morphology of L5-S1. Correlation between endplates angles, sacral slopes and T1 values were then evaluated.

Results:

L5-S1 space looks parallel for angles <10° (mean value 6.9° ± 1.4°). Sacral slope was lower in parallel disks (31.7 ± 4.9° vs. 40.1 ± 5.6°), showing a significant difference of 8.4° (p < 0.05). The T1 relaxation values show a significant difference between the two groups (p < 0.05) with a difference of 96 ms for the morning (1090.9 ± 33.3 ms for the parallel group and 1186.9 ± 41.2 ms for the non-parallel) and 121.9 ms for the afternoon (respectively 1004.7 ± 22.2 ms and 1126.6 ± 12.9 ms).

Conclusion:

The difference between the two groups suggests that parallel morphology of the L5-S1 disk is associated with lower water content.

Evaluation of patients with relapsing-remitting multiple sclerosis using tract-based spatial statistics analysis: diffusion kurtosis imaging

Background

Diffusion kurtosis imaging (DKI) has the potential to provide microstructural insights into myelin and axonal pathology with additional kurtosis parameters. To our knowledge, few studies are available in the current literature using DKI by tract-based spatial statistics (TBSS) analysis in patients with multiple sclerosis (MS). The aim of this study is to assess the performance of commonly used parameters derived from DKI and diffusion tensor imaging (DTI) in detecting microstructural changes and associated pathology in relapsing remitting MS (RRMS).

Methods

Thirty-six patients with RRMS and 49 age and sex matched healthy controls underwent DKI. The brain tissue integrity was assessed by fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (Da), radial diffusivity (Dr), mean kurtosis (MK), axial kurtosis (Ka) and radial kurtosis (Kr) of DKI and FA, MD, Da and Dr of DTI. Group differences in these parameters were compared using TBSS (P < 0.01, corrected). To compare the sensitivity of these parameters in detecting white matter (WM) damage, the percentage of the abnormal voxels based on TBSS analysis, relative to the whole skeleton voxels for each parameter was calculated.

Results

The sensitivities in detecting WM abnormality in RRMS were MK (78.2%) > Kr (76.7%) > Ka (53.5%) and Dr (78.8%) > MD (76.7%) > FA (74.1%) > Da (28.3%) for DKI, and Dr (79.8%) > MD (79.5%) > FA (68.6%) > Da (40.1%) for DTI. DKI-derived diffusion parameters (FA, MD, and Dr) were sensitive for detecting abnormality in WM regions with coherent fiber arrangement; however, the kurtosis parameters (MK and Kr) were sensitive to discern abnormalities in WM regions with complex fiber arrangement.

Conclusions

The diffusion and kurtosis parameters could provide complementary information for revealing brain microstructural damage in RRMS. Dr and DKI_Kr may be regarded as useful surrogate markers for reflecting pathological changes in RRMS.

SyMRI of the Brain: Rapid Quantification of Relaxation Rates and Proton Density, With Synthetic MRI, Automatic Brain Segmentation, and Myelin Measurement

Conventional magnetic resonance images are usually evaluated using the image signal contrast between tissues and not based on their absolute signal intensities. Quantification of tissue parameters, such as relaxation rates and proton density, would provide an absolute scale; however, these methods have mainly been performed in a research setting. The development of rapid quantification, with scan times in the order of 6 minutes for full head coverage, has provided the prerequisites for clinical use. The aim of this review article was to introduce a specific quantification method and synthesis of contrast-weighted images based on the acquired absolute values, and to present automatic segmentation of brain tissues and measurement of myelin based on the quantitative values, along with application of these techniques to various brain diseases. The entire technique is referred to as “SyMRI” in this review. SyMRI has shown promising results in previous studies when used for multiple sclerosis, brain metastases, Sturge-Weber syndrome, idiopathic normal pressure hydrocephalus, meningitis, and postmortem imaging.

Future Brain and Spinal Cord Volumetric Imaging in the Clinic for Monitoring Treatment Response in MS

PURPOSE OF REVIEW

Volumetric analysis of brain imaging has emerged as a standard approach used in clinical research, e.g., in the field of multiple sclerosis (MS), but its application in individual disease course monitoring is still hampered by biological and technical limitations. This review summarizes novel developments in volumetric imaging on the road towards clinical application to eventually monitor treatment response in patients with MS.

RECENT FINDINGS

In addition to the assessment of whole-brain volume changes, recent work was focused on the volumetry of specific compartments and substructures of the central nervous system (CNS) in MS. This included volumetric imaging of the deep brain structures and of the spinal cord white and gray matter. Volume changes of the latter indeed independently correlate with clinical outcome measures especially in progressive MS. Ultrahigh field MRI and quantitative MRI added to this trend by providing a better visualization of small compartments on highly resolving MR images as well as microstructural information. New developments in volumetric imaging have the potential to improve sensitivity as well as specificity in detecting and hence monitoring disease-related CNS volume changes in MS.

Comparison of Brain Atrophy, Cognition and Optical Coherence Tomography Results Between Multiple Sclerosis Patients and Healthy Controls

Introduction

Cognitive impairment is also an important cause of disability in MS in addition to motor, sensory, visual, and cerebellar affections. The aim of this study is to show the relation between the cognitive disability in MS with brain atrophy and retinal nerve fiber layer (RNFL).

Methods

Forty-three multiple sclerosis (MS) patients, and 15 healthy individuals as controls were included in the study. MS patients were divided into three groups as relapsing-remitting MS (RRMS), relapsing-remitting with optic neuritis (RRMS+ON), and secondary-progressive MS (SPMS). An experienced psychologist performed modified Wechsler Memory Scale Revised form (WMS-R), Lines Orientation test, Stroop Color Word Interference test (STROOP), Standard Raven Progressive Matrices (SRPM), Benton Facial Recognition Test, verbal fluency test, and Paced Auditory Serial Addition tests in all cases. Optic coherence tomographies (OCT) were done. Cranial subcortical volumes of all subjects were measured using 3-dimensonal T1A imagines obtained by the cranial subcortical 1.5 tesla MR device (fully automatic Freesurfer program). Brain parenchymal fractions were calculated by proportioning the obtained volume measurements to the total intracranial volume.

Results

Fifty-eight subjects (65.5% female, 34.5% male) were enrolled in the study. There were significant differences among the groups in terms of parenchymal thickness, volumes of third ventricle, and white matter. There was a significant correlation between the volumes of the deep gray matter, mesial temporal structures and lateral ventricular volumes, and the test results of the WMS-R. OCT scores of all MS patients, whether or not they experienced optic neuritis, had increased, being worse especially in the SPMS group. Correlation between RNFL and the brain parenchymal fractions of the patients were statistically significant.

Conclusion

Manual methods instead of automatic segmentation method are being more commonly used in the studies with brain atrophy and MS in our country. A significant correlation between OCT scores and brain atrophy is shown with our present study, and this is followed as a reflection of decrease in cognitive tests that provides valuable and reliable knowledge for the literature.

Technical Note: The effect of 2D excitation profile on T1 measurement accuracy using the variable flip angle method with an average flip angle assumption

PURPOSE

To study the accuracy and precision of T₁ estimates using the Variable Flip Angle (VFA) method in 2D and 3D acquisitions.

METHODS

Excitation profiles were simulated using numerical implementation of the Bloch equations for Hamming-windowed sinc excitation pulses with different time-bandwidth products (TBP) of 2, 6, and 10 and for T₁ values of 295 ms and 1045 ms. Experimental data were collected in 5° increments from 5° to 90° for the same T₁ and TBP values. T₁ was calculated for every combination of flip angle with and without a correction for B₁ and slice profile variation. Calculations were also made for flat slice profile such as obtained in 3D acquisition. Monte Carlo simulations were performed to obtain T₁ measurement uncertainty.

RESULTS

VFA T₁ measurements in 2D without correction can result in a 40-80% underestimation of true T₁ . Flip angle correction can reduce the underestimation, but results in accurate measurements of T₁ only within a narrow band of flip angle combinations. The narrow band of accuracy increases with TBP, but remains too narrow for any practical range of T₁ values or B₁ variation. Simulated noisy VFA T₁ measurements in 3D were accurate as long as the two angles chosen are on either side of the Ernst angle.

CONCLUSIONS

Accurate T1 estimates from VFA 2D acquisitions are possible, but only a narrow range of T1 values within a narrow range of flip angle combinations can be accurately calculated using a 2D slice. Unless a better flip angle correction method is used, these results demonstrate that accurate measurements of T1 in 2D cannot be obtained robustly enough for practical use and are more likely obtained by a thin slab 3D VFA acquisition than from multiple-slice 2D acquisitions. VFA T₁ measurements in 3D are accurate for wide ranges of flip angle combinations and T₁ values.

Generalized min-max bound-based MRI pulse sequence design framework for wide-range T1 relaxometry: A case study on the tissue specific imaging sequence

This paper proposes a new design strategy for optimizing MRI pulse sequences for T₁ relaxometry. The design strategy optimizes the pulse sequence parameters to minimize the maximum variance of unbiased T₁ estimates over a range of T₁ values using the Cramér-Rao bound. In contrast to prior sequences optimized for a single nominal T₁ value, the optimized sequence using our bound-based strategy achieves improved precision and accuracy for a broad range of T₁ estimates within a clinically feasible scan time. The optimization combines the downhill simplex method with a simulated annealing process. To show the effectiveness of the proposed strategy, we optimize the tissue specific imaging (TSI) sequence. Preliminary Monte Carlo simulations demonstrate that the optimized TSI sequence yields improved precision and accuracy over the popular driven-equilibrium single-pulse observation of T₁ (DESPOT1) approach for normal brain tissues (estimated T₁ 700–2000 ms at 3.0T). The relative mean estimation error (MSE) for T₁ estimation is less than 1.7% using the optimized TSI sequence, as opposed to less than 7.0% using DESPOT1 for normal brain tissues. The optimized TSI sequence achieves good stability by keeping the MSE under 7.0% over larger T₁ values corresponding to different lesion tissues and the cerebrospinal fluid (up to 5000 ms). The T₁ estimation accuracy using the new pulse sequence also shows improvement, which is more pronounced in low SNR scenarios.

Real T1 relaxation time measurement and diurnal variation analysis of intervertebral discs in a healthy population of 50 volunteers

PURPOSE

To measure the real T1 relaxation time of the lumbar intervertebral discs in a young and healthy population, using different inversion recovery times, and assess diurnal variation.

MATERIAL AND METHODS

Intervertebral discs from D12 to S1 of 50 healthy volunteers from 18 to 25 years old were evaluated twice the same day, in the morning and in the late afternoon. Dedicated MRI sequences with different inversion recovery times (from 100 to 2500ms) were used to calculate the real T1 relaxation time. Three regions of interest (ROIs) were defined in each disc, the middle representing the nucleus pulposus (NP) and the outer parts the annulus fibrosus (AF) anterior and posterior. Diurnal variation and differences between each disc level were analyzed.

RESULTS

T1 mean values in the NP were 1142±12ms in the morning and 1085±13ms in the afternoon, showing a highly significant decrease of 57ms (p<0.001). A highly significant difference between the levels of the spine was found. The mean T1 of the anterior part of the AF was 577±9ms in the morning and 554±8ms in the afternoon. For the posterior part, the mean values were 633±8ms in the morning and 581±7ms in the evening. It shows a highly significant decrease of 23ms for the anterior part and 51ms for the posterior part (all p<0.001).

CONCLUSION

T1 mapping is a promising method of intervertebral disc evaluation. Significant diurnal variation and difference between levels of the lumbar spine were demonstrated. A potential use for longitudinal study in post-operative follow up or sport medicine needs to be evaluated.

Fast T1 mapping of the brain at high field using Look-Locker and fast imaging

This study aims to develop and evaluate a new method for fast high resolution T1 mapping of the brain based on the Look-Locker technique. Single-shot turboflash sequence with high temporal acceleration is used to sample the recovery of inverted magnetization. Multi-slice interleaved acquisition within one inversion slab is used to reduce the number of inversion pulses and hence SAR. Accuracy of the proposed method was studied using simulation and validated in phantoms. It was then evaluated in healthy volunteers and stroke patients. In-vivo results were compared to values obtained by inversion recovery fast spin echo (IR-FSE) and literatures. With the new method, T₁ values in phantom experiments agreed with reference values with median error <3%. For in-vivo experiments, a T1 map was acquired in 3.35s and the T1 maps of the whole brain were acquired in 2min with two-slice interleaving, with a spatial resolution of 1.1×1.1×4mm³. The T₁ values obtained were comparable to those measured with IR-FSE and those reported in literatures. These results demonstrated the feasibility of the proposed method for fast T1 mapping of the brain in both healthy volunteers and stroke patients at 3T.

Comparison of two quantitative proton density mapping methods in multiple sclerosis

OBJECTIVE

Proton density (PD) mapping requires correction for the receive profile (RP), which is frequently performed via bias-field correction. An alternative RP-mapping method utilizes a comparison of uncorrected PD-maps and a value ρ(T1) directly derived from T1-maps via the Fatouros equation. This may be problematic in multiple sclerosis (MS), if respective parameters are only valid for healthy brain tissue. We aimed to investigate whether the alternative method yields correct PD values in MS patients.

MATERIALS/METHODS

PD mapping was performed on 27 patients with relapsing-remitting MS and 27 healthy controls, utilizing both methods, yielding reference PD values (PD_ref, bias-field method) and PD_alt (alternative method).

RESULTS

PD_alt-values closely matched PD_ref, both for patients and controls. In contrast, ρ(T1) differed by up to 3 % from PD_ref, and the voxel-wise correlation between PD_ref and ρ(T1) was reduced in a patient subgroup with a higher degree of disability. Still, discrepancies between ρ(T1) and PD_ref were almost identical across different tissue types, thus translating into a scaling factor, which cancelled out during normalization to 100 % in CSF, yielding a good agreement between PD_alt and PD_ref.

CONCLUSION

RP correction utilizing the auxiliary parameter ρ(T1) derived via the Fatouros equation provides accurate PD results in MS patients, in spite of discrepancies between ρ(T1) and actual PD values.

The Relationship between Gray Matter Quantitative MRI and Disability in Secondary Progressive Multiple Sclerosis

PURPOSE

In secondary progressive Multiple Sclerosis (SPMS), global neurodegeneration as a driver of disability gains importance in comparison to focal inflammatory processes. However, clinical MRI does not visualize changes of tissue composition outside MS lesions. This quantitative MRI (qMRI) study investigated cortical and deep gray matter (GM) proton density (PD) values and T1 relaxation times to explore their potential to assess neuronal damage and its relationship to clinical disability in SPMS.

MATERIALS AND METHODS

11 SPMS patients underwent quantitative T1 and PD mapping. Parameter values across the cerebral cortex and deep GM structures were compared with 11 healthy controls, and correlation with disability was investigated for regions exhibiting significant group differences.

RESULTS

PD was increased in the whole GM, cerebral cortex, thalamus, putamen and pallidum. PD correlated with disability in the whole GM, cerebral cortex, putamen and pallidum. T1 relaxation time was prolonged and correlated with disability in the whole GM and cerebral cortex.

CONCLUSION

Our study suggests that the qMRI parameters GM PD (which likely indicates replacement of neural tissue with water) and cortical T1 (which reflects cortical damage including and beyond increased water content) are promising qMRI candidates for the assessment of disease status, and are related to disability in SPMS.

PREVAIL: Predicting Recovery through Estimation and Visualization of Active and Incident Lesions

Objective

The goal of this study was to develop a model that integrates imaging and clinical information observed at lesion incidence for predicting the recovery of white matter lesions in multiple sclerosis (MS) patients.

Methods

Demographic, clinical, and magnetic resonance imaging (MRI) data were obtained from 60 subjects with MS as part of a natural history study at the National Institute of Neurological Disorders and Stroke. A total of 401 lesions met the inclusion criteria and were used in the study. Imaging features were extracted from the intensity-normalized T₁-weighted (T₁w) and T₂-weighted sequences as well as magnetization transfer ratio (MTR) sequence acquired at lesion incidence. T₁w and MTR signatures were also extracted from images acquired one-year post-incidence. Imaging features were integrated with clinical and demographic data observed at lesion incidence to create statistical prediction models for long-term damage within the lesion.

Validation

The performance of the T₁w and MTR predictions was assessed in two ways: first, the predictive accuracy was measured quantitatively using leave-one-lesion-out cross-validated (CV) mean-squared predictive error. Then, to assess the prediction performance from the perspective of expert clinicians, three board-certified MS clinicians were asked to individually score how similar the CV model-predicted one-year appearance was to the true one-year appearance for a random sample of 100 lesions.

Results

The cross-validated root-mean-square predictive error was 0.95 for normalized T₁w and 0.064 for MTR, compared to the estimated measurement errors of 0.48 and 0.078 respectively. The three expert raters agreed that T₁w and MTR predictions closely resembled the true one-year follow-up appearance of the lesions in both degree and pattern of recovery within lesions.

Conclusion

This study demonstrates that by using only information from a single visit at incidence, we can predict how a new lesion will recover using relatively simple statistical techniques. The potential to visualize the likely course of recovery has implications for clinical decision-making, as well as trial enrichment.

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A model for predicting degree and pattern of MS lesion tissue recovery is proposed.

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The model relies solely on MR images at lesion incidence and patient information.

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Predictions performed well when rated for accuracy by expert MS clinicians.

Multislice T1 -prepared 2D single-shot EPI: analysis of a clinical T1 mapping method unbiased by B0 or B1 inhomogeneity

Quantitative MR imaging is as sensitive in detecting lesions as qualitative imaging, but it is potentially more specific in differentiating disease. T1 mapping in particular might help to assess acute ischemic stroke, multiple sclerosis, epilepsy and Alzheimer's disease better. Thus, a rapid and robust clinical technique is vital. In 1990, Ordidge and colleagues developed the multislice T1 -prepared two-dimensional (2D) single-shot echo planar imaging technique. Subsequent studies demonstrated its clinical viability, but none performed an in-depth analysis of the strengths and advantages of this T1 mapping method. Herein, theoretical and experimental evidence shows that the technique accounts for 2D slice profile effects and is unbiased by B0 or B1 inhomogeneity. This is verified explicitly by varying the linear shims, the T1 preparation flip angle and the excitation flip angle. Furthermore, it is shown that the repetition time (and hence scan time) can be reduced without a loss of T1 accuracy. Copyright © 2016 John Wiley & Sons, Ltd.

High-resolution T1-relaxation time mapping displays subtle, clinically relevant, gray matter damage in long-standing multiple sclerosis

Background:

Gray matter (GM) pathology has high clinical relevance in multiple sclerosis (MS), but conventional magnetic resonance imaging (MRI) is insufficiently sensitive to visualize the rather subtle damage.

Objective:

To investigate whether high spatial resolution T1-relaxation time (T1-RT) measurements can detect changes in the normal-appearing GM of patients with long-standing MS and whether these changes are associated with physical and cognitive impairment.

Methods:

High spatial resolution (1.05 × 1.05 × 1.2 mm3) T1-RT measurements were performed at 3 T in 156 long-standing MS patients and 54 healthy controls. T1-RT histogram parameters in several regions were analyzed to investigate group differences. Stepwise linear regression analyses were used to assess the relation of T1-RT with physical and cognitive impairment.

Results:

In both thalamus and cortex, T1-RT histogram skewness was higher in patients than controls. In the cortex, this was driven by the frontal and temporal lobes. No differences were found in other GM histogram parameters. Cortical skewness, thalamus volume, and average white matter (WM) lesion T1-RT emerged as the strongest predictors for cognitive performance (adjusted R2 = 0.39).

Conclusion:

Subtle GM damage was present in the cortex and thalamus of MS patients, as indicated by increased T1-RT skewness. Increased cortical skewness emerged as an independent predictor of cognitive dysfunction.

Platelet-Activating Factor Receptors Mediate Excitatory Postsynaptic Hippocampal Injury in Experimental Autoimmune Encephalomyelitis

Gray matter degeneration contributes to progressive disability in multiple sclerosis (MS) and can occur out of proportion to measures of white matter disease. Although white matter pathology, including demyelination and axon injury, can lead to secondary gray matter changes, we hypothesized that neurons can undergo direct excitatory injury within the gray matter independent of these. We tested this using a model of experimental autoimmune encephalomyelitis (EAE) with hippocampal degeneration in C57BL/6 mice, in which immunofluorescent staining showed a 28% loss of PSD95-positive excitatory postsynaptic puncta in hippocampal area CA1 compared with sham-immunized controls, despite preservation of myelin and VGLUT1-positive excitatory axon terminals. Loss of postsynaptic structures was accompanied by appearance of PSD95-positive debris that colocalized with the processes of activated microglia at 25 d after immunization, and clearance of debris was followed by persistently reduced synaptic density at 55 d. In vitro, addition of activated BV2 microglial cells to hippocampal cultures increased neuronal vulnerability to excitotoxic dendritic damage following a burst of synaptic activity in a manner dependent on platelet-activating factor receptor (PAFR) signaling. In vivo treatment with PAFR antagonist BN52021 prevented PSD95-positive synapse loss in hippocampi of mice with EAE but did not affect development of EAE or local microglial activation. These results demonstrate that postsynaptic structures can be a primary target of injury within the gray matter in autoimmune neuroinflammatory disease, and suggest that this may occur via PAFR-mediated modulation of activity-dependent synaptic physiology downstream of microglial activation.

SIGNIFICANCE STATEMENT

Unraveling gray matter degeneration is critical for developing treatments for progressive disability and cognitive impairment in multiple sclerosis (MS). In a mouse model of MS, we show that neurons can undergo injury at their synaptic connections within the gray matter, independent of the white matter pathology, demyelination, and axon injury that have been the focus of most current and emerging treatments. Damage to excitatory synapses in the hippocampus occurs in association with activated microglia, which can promote excitotoxic injury via activation of receptors for platelet-activating factor, a proinflammatory signaling molecule elevated in the brain in MS. Platelet-activating factor receptor blockade protected synapses in the mouse model, identifying a potential target for neuroprotective treatments in MS.

Rapid and robust variable flip angle T1 mapping using interleaved two-dimensional multislice spoiled gradient echo imaging

PURPOSE

Conventional T₁ mapping using three-dimensional (3D) radiofrequency (RF) spoiled gradient echo (SPGR) imaging with short repetition times (TR) is adversely affected by incomplete spoiling (i.e. residual T₂ dependency). In this work, an optimized interleaved 2D multislice SPGR sequence scheme and an adapted postprocessing procedure are evaluated for highly T₂ -insensitive T₁ quantification of human brain tissues.

METHODS

An efficient 2D multislice SPGR protocol including a relatively long TR of 200 ms is investigated with careful consideration of cross talk and magnetization transfer effects. Based on the derived scan protocol, T₁ is quantified from the signal ratio of two SPGR datasets acquired at different flip angles. The effect of nonideal RF excitation profiles is incorporated into the SPGR signal model by performing Bloch simulations.

RESULTS

Simulations showed that the parameters of the SPGR protocol (such as TR and the spoiler gradient moments) guarantee virtually complete spoiling. This result was confirmed by T₁ measurements both in vitro using a 2% agar probe doped with 0.1 mM Gd (Gadovist) and in vivo in the human brain.

CONCLUSION

The derived 2D multislice SPGR protocol offers efficient, highly reproducible, and in particular T₂ -insensitive T₁ quantification of human brain tissues. Magn Reson Med 77:1606-1611, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Heterogeneity of Multiple Sclerosis Lesions in Multislice Myelin Water Imaging

Purpose

To assess neuroprotection and remyelination in Multiple Sclerosis (MS), we applied a more robust myelin water imaging (MWI) processing technique, including spatial priors into image reconstruction, which allows for lower SNR, less averages and shorter acquisition times. We sought to evaluate this technique in MS-patients and healthy controls (HC).

Materials and Methods

Seventeen MS-patients and 14 age-matched HCs received a 3T Magnetic Resonance Imaging (MRI) examination including MWI (8 slices, 12 minutes acquisition time), T2w and T1mprage pre and post gadolinium (GD) administration. Black holes (BH), contrast enhancing lesions (CEL) and T2 lesions were marked and registered to MWI. Additionally, regions of interest (ROI) were defined in the frontal, parietal and occipital normal appearing white matter (NAWM)/white matter (WM), the corticospinal tract (CST), the splenium (SCC) and genu (GCC) of the corpus callosum in patients and HCs. Mean values of myelin water fraction (MWF) were determined for each ROI.

Results

Significant differences (p≤0.05) of the MWF were found in all three different MS-lesion types (BH, CEL, T2 lesions), compared to the WM of HCs. The mean MWF values among the different lesion types were significantly differing from each other. Comparing MS-patients vs. HCs, we found a significant (p≤0.05) difference of the MWF in all measured ROIs except of GCC and SCC. The mean reduction of MWF in the NAWM of MS-patients compared to HCs was 37%. No age, sex, disability score and disease duration dependency was found for the NAWM MWF.

Conclusion

MWF measures were in line with previous studies and lesions were clearly visible in MWI. MWI allows for quantitative assessment of NAWM and lesions in MS, which could be used as an additional sensitive imaging endpoint for larger MS studies. Measurements of the MWF also differ between patients and healthy controls.

In vivo dentate nucleus MRI relaxometry correlates with previous administration of Gadolinium-based contrast agents

OBJECTIVES

To evaluate changes in T1 and T2* relaxometry of dentate nuclei (DN) with respect to the number of previous administrations of Gadolinium-based contrast agents (GBCA).

METHODS

In 74 relapsing-remitting multiple sclerosis (RR-MS) patients with variable disease duration (9.8±6.8 years) and severity (Expanded Disability Status Scale scores:3.1±0.9), the DN R1 (1/T1) and R2* (1/T2*) relaxation rates were measured using two unenhanced 3D Dual-Echo spoiled Gradient-Echo sequences with different flip angles. Correlations of the number of previous GBCA administrations with DN R1 and R2* relaxation rates were tested, including gender and age effect, in a multivariate regression analysis.

RESULTS

The DN R1 (normalized by brainstem) significantly correlated with the number of GBCA administrations (p<0.001), maintaining the same significance even when including MS-related factors. Instead, the DN R2* values correlated only with age (p=0.003), and not with GBCA administrations (p=0.67). In a subgroup of 35 patients for whom the administered GBCA subtype was known, the effect of GBCA on DN R1 appeared mainly related to linear GBCA.

CONCLUSIONS

In RR-MS patients, the number of previous GBCA administrations correlates with R1 relaxation rates of DN, while R2* values remain unaffected, suggesting that T1-shortening in these patients is related to the amount of Gadolinium given.

KEY POINTS

• In multiple sclerosis, previous Gadolinium administrations correlate with dentate nuclei T1 relaxometry. • Such correlation is linked to linear Gadolinium chelates and unrelated to disease duration or severity. • Dentate nuclei T2* relaxometry is age-related and independent of previous Gadolinium administrations. • Changes in dentate nuclei T1 relaxometry are not determined by iron accumulation. • MR relaxometry can quantitatively assess Gadolinium accumulation in dentate nuclei.

Statistical estimation of T1 relaxation times using conventional magnetic resonance imaging

Quantitative T1 maps estimate T1 relaxation times and can be used to assess diffuse tissue abnormalities within normal-appearing tissue. T1 maps are popular for studying the progression and treatment of multiple sclerosis (MS). However, their inclusion in standard imaging protocols remains limited due to the additional scanning time and expert calibration required and susceptibility to bias and noise. Here, we propose a new method of estimating T1 maps using four conventional MR images, which are intensity-normalized using cerebellar gray matter as a reference tissue and related to T1 using a smooth regression model. Using cross-validation, we generate statistical T1 maps for 61 subjects with MS. The statistical maps are less noisy than the acquired maps and show similar reproducibility. Tests of group differences in normal-appearing white matter across MS subtypes give similar results using both methods.

Simultaneous T1 and T2 Brain Relaxometry in Asymptomatic Volunteers using Magnetic Resonance Fingerprinting

Magnetic resonance fingerprinting (MRF) is an imaging tool that produces multiple magnetic resonance imaging parametric maps from a single scan. Herein we describe the normal range and progression of MRF-derived relaxometry values with age in healthy individuals. In total, 56 normal volunteers (24 men and 32 women) aged 11-71 years were scanned. Regions of interest were drawn on T₁ and T₂ maps in 38 areas, including lobar and deep white matter (WM), deep gray nuclei, thalami, and posterior fossa structures. Relaxometry differences were assessed using a forward stepwise selection of a baseline model that included either sex, age, or both, where variables were included if they contributed significantly (P < .05). In addition, differences in regional anatomy, including comparisons between hemispheres and between anatomical subcomponents, were assessed by paired t tests. MRF-derived T₁ and T₂ in frontal WM regions increased with age, whereas occipital and temporal regions remained relatively stable. Deep gray nuclei such as substantia nigra, were found to have age-related decreases in relaxometry. Differences in sex were observed in T₁ and T₂ of temporal regions, the cerebellum, and pons. Men were found to have more rapid age-related changes in frontal and parietal WM. Regional differences were identified between hemispheres, between the genu and splenium of the corpus callosum, and between posteromedial and anterolateral thalami. In conclusion, MRF quantification measures relaxometry trends in healthy individuals that are in agreement with the current understanding of neurobiology and has the ability to uncover additional patterns that have not yet been explored.

Histogram analysis of quantitative T1 and MT maps from ultrahigh field MRI in clinically isolated syndrome and relapsing-remitting multiple sclerosis

This study used quantitative MRI to study normal appearing white matter (NAWM) in patients with clinically isolated syndromes suggestive of multiple sclerosis and relapsing-remitting multiple sclerosis (RRMS). This was done at ultrahigh field (7 T) for greater spatial resolution and sensitivity. 17 CIS patients, 11 RRMS patients, and 20 age-matched healthy controls were recruited. They were scanned using a 3D inversion recovery turbo field echo sequence to measure the longitudinal relaxation time (T1). A 3D magnetization transfer prepared turbo field echo (MT-TFE) sequence was also acquired, first without a presaturation pulse and then with the MT presaturation pulse applied at -1.05 kHz and +1.05 kHz off resonance from water to produce two magnetization transfer ratio maps (MTR(-) and MTR(+)). Histogram analysis was performed on the signal from the voxels in the NAWM mask. The upper quartile cut-off of the T1 histogram was significantly higher in RRMS patients than in controls (p < 0.05), but there was no difference in CIS. In contrast, MTR was significantly different between CIS or RRMS patients and controls (p < 0.05) for most histogram measures considered. The difference between MTR(+) and MTR(-) signals showed that NOE contributions dominated the changes found. There was a weak negative correlation (r = -0.46, p < 0.05) between the mode of T1 distributions and healthy controls' age; this was not significant for MTR(+) (r = -0.34, p > 0.05) or MTR(-) (r = 0.13, p > 0.05). There was no significant correlation between the median of T1, MTR(-), or MTR(+) and the age of healthy controls. Furthermore, no significant correlation was observed between EDSS or disease duration and T1, MTR(-), or MTR(+) for either CIS or RRMS patients. In conclusion, MTR was found to be more sensitive to early changes in MS disease than T1.

Biexponential longitudinal relaxation in white matter: Characterization and impact on T1 mapping with IR-FSE and MP2RAGE

PURPOSE

Magnetization transfer in white matter (WM) causes biexponential relaxation, but most quantitative T1 measurements fit data assuming monoexponential relaxation. The resulting monoexponential T1 estimate varies based on scan parameters and represents a source of variation between studies, especially at high fields. In this study, we characterized WM T1 relaxation and performed simulations to determine how to minimize this deviation.

METHODS

To characterize biexponential relaxation, four volunteers were scanned at 3T and 7T using inversion recovery fast spin echo (IR-FSE) with 13 inversion times (TIs). Three volunteers were scanned with IR-FSE using TIs chosen by simulations to reduce T1 deviation, and with MP2RAGE.

RESULTS

At 3T, the biexponential relaxation has a short component of T1  = 48 ms (9%) and a long component of T1  = 939 ms. At 7T the short component is T1  = 57 ms (11%) and the long component is 1349 ms (89%). For IR-FSE, acquiring four TIs with a minimum of 150 ms (3T) or 200 ms (7T) yielded monoexponential T1 estimates that match the long component to within 10 ms. For MP2RAGE, significant differences (90 ms at 3T, 125 ms at 7T) remain at all parameter values.

CONCLUSION

Many T1 mapping sequences yield robust estimates of the long T1 component with suitable choice of TIs, allowing reproducible, sequence-independent T1 values to be measured. However, this is not true of MP2RAGE in its current implementation. Magn Reson Med 75:2265-2277, 2016. © 2015 Wiley Periodicals, Inc.

Variable flip angle T1 mapping in the human brain with reduced T2 sensitivity using fast radiofrequency-spoiled gradient echo imaging

PURPOSE

Variable flip angle (VFA) T1 quantification using three-dimensional (3D) radiofrequency (RF) spoiled gradient echo imaging offers the acquisition of whole-brain T1 maps in clinically acceptable times. However, conventional VFA T1 relaxometry is biased by incomplete spoiling (i.e., residual T2 dependency). A new postprocessing approach is proposed to overcome this T2-related bias.

METHODS

T1 is quantified from the signal ratio of two spoiled gradient echo (SPGR) images acquired at different flip angles using an analytical solution for the RF-spoiled steady-state signal in combination with a global T2 guess. T1 accuracy is evaluated from simulations and in vivo 3D SPGR imaging of the human brain at 3 Tesla.

RESULTS

The simulations demonstrated that the sensitivity of VFA T1 mapping to T2 can considerably be reduced using a global T2 guess. The method proved to deliver reliable and accurate T1 values in vivo for white and gray matter in good agreement with inversion recovery reference measurements.

CONCLUSION

Based on a global T2 estimate, the accuracy of VFA T1 relaxometry in the human brain can substantially be improved compared with conventional approaches which rely on the generally wrong assumption of ideal spoiling.

Fast whole-brain three-dimensional macromolecular proton fraction mapping in multiple sclerosis

PURPOSE

To evaluate the clinical utility of fast whole-brain macromolecular proton fraction ( MPF macromolecular proton fraction ) mapping in multiple sclerosis ( MS multiple sclerosis ) and compare MPF macromolecular proton fraction with established quantitative magnetic resonance (MR) imaging measures of tissue damage including magnetization transfer ( MT magnetization transfer ) ratio and relaxation rate (R1).

MATERIALS AND METHODS

In this institutional review board-approved and HIPAA-compliant study, 14 healthy control participants, 18 relapsing-remitting MS multiple sclerosis ( RRMS relaxing-remitting MS ) patients, and 12 secondary progressive MS multiple sclerosis ( SPMS secondary progressive MS ) patients provided written informed consent and underwent 3-T MR imaging. Three-dimensional MPF macromolecular proton fraction maps were reconstructed from MT magnetization transfer -weighted images and R1 maps by the single-point method. Mean MPF macromolecular proton fraction , R1, and MT magnetization transfer ratio in normal-appearing white matter ( WM white matter ), gray matter ( GM gray matter ), and lesions were compared between subject groups by using analysis of variance. Correlations (Pearson r) between imaging data and clinical scores (Expanded Disability Status Scale [EDSS] and MS multiple sclerosis Functional Composite [ MSFC MS functional composite ]) were compared by using Hotelling-Williams test.

RESULTS

RRMS relaxing-remitting MS patients had lower WM white matter and GM gray matter MPF macromolecular proton fraction than controls, with percentage decreases of 6.5% (P < .005) and 5.4% (P < .05). MPF macromolecular proton fraction in SPMS secondary progressive MS was reduced relative to RRMS relaxing-remitting MS in WM white matter , GM gray matter , and lesions by 6.4% (P < .005), 13.4% (P < .005), and 11.7% (P < .05), respectively. EDSS Expanded Disability Status Scale and MSFC MS functional composite demonstrated strongest correlations with MPF macromolecular proton fraction in GM gray matter (r = -0.74 and 0.81; P < .001) followed by WM white matter (r = -0.57 and 0.72; P < .01) and lesions (r = -0.42 and 0.50; P < .05). R1 and MT magnetization transfer ratio in all tissues were significantly less correlated with clinical scores than GM gray matter MPF macromolecular proton fraction (P < .05).

CONCLUSION

MPF macromolecular proton fraction mapping enables quantitative assessment of demyelination in normal-appearing brain tissues and shows primary clinical relevance of GM gray matter damage in MS multiple sclerosis . MPF macromolecular proton fraction outperforms MT magnetization transfer ratio and R1 in detection of MS multiple sclerosis -related tissue changes.

Challenges in multiple sclerosis; how to define occurence of progression

The challenges in MS are related to number of controversies in various aspects of disease but the relationship between relapses and disability progression, or aspects of MS as an inflammatory and/or neurodegenerative disease are extremely important because of its implications on prognosis and therapy of MS. MS was classically regarded as white matter inflammatory disease, while disability progression, brain and spinal cord atrophy were regarded as a consequence of global inflammation of NAWM and secondary involvement of grey matter. More recent histopathology studies, but also new, modern MRI techniques changed this view in MS as a prominent grey and white matter disease. Inflammatory demyelination of grey matter occurs early in MS sometimes even before occurrence of white matter lesions. Inspite of early therapy of MS with immunomodulatory drugs disability progression and neurodegeneration are still important and common part of MS pathogenesis. This indicate that treatment is not adequate to the predicted severity of MS, or perhaps to the basic pathogenetic mechanisms in MS. Beside acute clinical symptoms, conclusions about the severity of the disease are reflection of MRI sensitivity to detect focal WM lesions and insensitivity to detect grey matter lesions which correlate better with clinical symptoms. All presented studies and evaluations point to the necessity of changing the established diagnostic evaluation and treatment in MS. At the earliest stage of MS as well as in follow up of disease it would be necessary to apply a new MRI techniques more available for clinical practice such as DIR brain MR imaging at 3T because of their sensitivity to detect grey matter lesions. In patient with present cortical lesions even in earliest stages of MS depending on severity of grey matter involvement more efficacious therapy like second or even third line therapy should start.

MP2RAGE provides new clinically-compatible correlates of mild cognitive deficits in relapsing-remitting multiple sclerosis

Despite that cognitive impairment is a known early feature present in multiple sclerosis (MS) patients, the biological substrate of cognitive deficits in MS remains elusive. In this study, we assessed whether T1 relaxometry, as obtained in clinically acceptable scan times by the recent Magnetization Prepared 2 Rapid Acquisition Gradient Echoes (MP2RAGE) sequence, may help identifying the structural correlate of cognitive deficits in relapsing-remitting MS patients (RRMS). Twenty-nine healthy controls (HC) and forty-nine RRMS patients underwent high-resolution 3T magnetic resonance imaging to obtain optimal cortical lesion (CL) and white matter lesion (WML) count/volume and T1 relaxation times. T1 z scores were then obtained between T1 relaxation times in lesion and the corresponding HC tissue. Patient cognitive performance was tested using the Brief Repeatable Battery of Neuro-psychological Tests. Multivariate analysis was applied to assess the contribution of MRI variables (T1 z scores, lesion count/volume) to cognition in patients and Bonferroni correction was applied for multiple comparison. T1 z scores were higher in WML (p < 0.001) and CL-I (p < 0.01) than in the corresponding normal-appearing tissue in patients, indicating relative microstructural loss. (1) T1 z scores in CL-I (p = 0.01) and the number of CL-II (p = 0.04) were predictors of long-term memory; (2) T1 z scores in CL-I (β = 0.3; p = 0.03) were independent determinants of long-term memory storage, and (3) lesion volume did not significantly influenced cognitive performances in patients. Our study supports evidence that T1 relaxometry from MP2RAGE provides information about microstructural properties in CL and WML and improves correlation with cognition in RRMS patients, compared to conventional measures of disease burden.

Normal appearing and diffusely abnormal white matter in patients with multiple sclerosis assessed with quantitative MR

INTRODUCTION

Magnetic Resonance Imaging is a sensitive technique for detecting white matter (WM) MS lesions, but the relation with clinical disability is low. Because of this, changes in both 'normal appearing white matter' (NAWM) and 'diffusely abnormal white matter' (DAWM) have been of interest in recent years. MR techniques, including quantitative magnetic resonance imaging (qMRI) and quantitative magnetic resonance spectroscopy (qMRS), have been developed in order to detect and quantify such changes. In this study, qMRI and qMRS were used to investigate NAWM and DAWM in typical MS patients and in MS patients with low number of WM lesions. Patient data were compared to 'normal white matter' (NWM) in healthy controls.

METHODS

QMRI and qMRS measurements were performed on a 1.5 T Philips MR-scanner. 35 patients with clinically definite MS and 20 healthy controls were included. Twenty of the patients fulfilled the 'Barkhof-Tintoré criteria' for MS, ('MRIpos'), whereas 15 showed radiologically atypical findings with few WM lesions ('MRIneg'). QMRI properties were determined in ROIs of NAWM, DAWM and lesions in the MS groups and of NWM in controls. Descriptive statistical analysis and comparisons were performed. Correlations were calculated between qMRI measurements and (1) clinical parameters and (2) WM metabolite concentrations. Regression analyses were performed with brain parenchyma fraction and MSSS.

RESULTS

NAWM in the MRIneg group was significantly different from NAWM in the MRIpos group and NWM. In addition, R1 and R2 of NAWM in the MRIpos group correlated negatively with EDSS and MSSS. DAWM was significantly different from NWM, but similar in the MS groups. N-acetyl aspartate correlated negatively with R1 and R2 in MRIneg. R2 of DAWM was associated with BPF.

CONCLUSIONS

Changes in NAWM and DAWM are independent pathological entities in the disease. The correlation between qMRI and clinical status may shed new light on the clinicoradiological paradox.

Rapid parametric mapping of the longitudinal relaxation time T1 using two-dimensional variable flip angle magnetic resonance imaging at 1.5 Tesla, 3 Tesla, and 7 Tesla

INTRODUCTION

Visual but subjective reading of longitudinal relaxation time (T1) weighted magnetic resonance images is commonly used for the detection of brain pathologies. For this non-quantitative measure, diagnostic quality depends on hardware configuration, imaging parameters, radio frequency transmission field (B1+) uniformity, as well as observer experience. Parametric quantification of the tissue T1 relaxation parameter offsets the propensity for these effects, but is typically time consuming. For this reason, this study examines the feasibility of rapid 2D T1 quantification using a variable flip angles (VFA) approach at magnetic field strengths of 1.5 Tesla, 3 Tesla, and 7 Tesla. These efforts include validation in phantom experiments and application for brain T1 mapping.

METHODS

T1 quantification included simulations of the Bloch equations to correct for slice profile imperfections, and a correction for B1+. Fast gradient echo acquisitions were conducted using three adjusted flip angles for the proposed T1 quantification approach that was benchmarked against slice profile uncorrected 2D VFA and an inversion-recovery spin-echo based reference method. Brain T1 mapping was performed in six healthy subjects, one multiple sclerosis patient, and one stroke patient.

RESULTS

Phantom experiments showed a mean T1 estimation error of (-63±1.5)% for slice profile uncorrected 2D VFA and (0.2±1.4)% for the proposed approach compared to the reference method. Scan time for single slice T1 mapping including B1+ mapping could be reduced to 5 seconds using an in-plane resolution of (2×2) mm2, which equals a scan time reduction of more than 99% compared to the reference method.

CONCLUSION

Our results demonstrate that rapid 2D T1 quantification using a variable flip angle approach is feasible at 1.5T/3T/7T. It represents a valuable alternative for rapid T1 mapping due to the gain in speed versus conventional approaches. This progress may serve to enhance the capabilities of parametric MR based lesion detection and brain tissue characterization.

Quantitative multi-modal MRI of the Hippocampus and cognitive ability in community-dwelling older subjects

Hippocampal structural integrity is commonly quantified using volumetric measurements derived from brain magnetic resonance imaging (MRI). Previously reported associations with cognitive decline have not been consistent. We investigate hippocampal integrity using quantitative MRI techniques and its association with cognitive abilities in older age.

Participants from the Lothian Birth Cohort 1936 underwent brain MRI at mean age 73 years. Longitudinal relaxation time (T1), magnetization transfer ratio (MTR), fractional anisotropy (FA) and mean diffusivity (MD) were measured in the hippocampus. General factors of fluid-type intelligence (g), cognitive processing speed (speed) and memory were obtained at age 73 years, as well as childhood IQ test results at age 11 years. Amongst 565 older adults, multivariate linear regression showed that, after correcting for ICV, gender and age 11 IQ, larger left hippocampal volume was significantly associated with better memory ability (β = .11, p = .003), but not with speed or g. Using quantitative MRI and after correcting for multiple testing, higher T1 and MD were significantly associated with lower scores of g (β range = −.11 to −.14, p < .001), speed (β range = −.15 to −.20, p < .001) and memory (β range = −.10 to −.12, p < .001). Higher MTR and FA in the hippocampus were also significantly associated with higher scores of g (β range = .17 to .18, p < .0001) and speed (β range = .10 to .15, p < .0001), but not memory.

Quantitative multi-modal MRI assessments were more sensitive at detecting cognition-hippocampal integrity associations than volumetric measurements, resulting in stronger associations between MRI biomarkers and age-related cognition changes.

Deep gray matter demyelination detected by magnetization transfer ratio in the cuprizone model

In multiple sclerosis (MS), the correlation between lesion load on conventional magnetic resonance imaging (MRI) and clinical disability is weak. This clinico-radiological paradox might partly be due to the low sensitivity of conventional MRI to detect gray matter demyelination. Magnetization transfer ratio (MTR) has previously been shown to detect white matter demyelination in mice. In this study, we investigated whether MTR can detect gray matter demyelination in cuprizone exposed mice. A total of 54 female C57BL/6 mice were split into one control group () and eight cuprizone exposed groups (). The mice were exposed to (w/w) cuprizone for up to six weeks. MTR images were obtained at a 7 Tesla Bruker MR-scanner before cuprizone exposure, weekly for six weeks during cuprizone exposure, and once two weeks after termination of cuprizone exposure. Immunohistochemistry staining for myelin (anti-Proteolopid Protein) and oligodendrocytes (anti-Neurite Outgrowth Inhibitor Protein A) was obtained after each weekly scanning. Rates of MTR change and correlations between MTR values and histological findings were calculated in five brain regions. In the corpus callosum and the deep gray matter a significant rate of MTR value decrease was found, per week () and per week () respectively. The MTR values correlated to myelin loss as evaluated by immunohistochemistry (Corpus callosum: . Deep gray matter: ), but did not correlate to oligodendrocyte density. Significant results were not found in the cerebellum, the olfactory bulb or the cerebral cortex. This study shows that MTR can be used to detect demyelination in the deep gray matter, which is of particular interest for imaging of patients with MS, as deep gray matter demyelination is common in MS, and is not easily detected on conventional clinical MRI.

Multimodal tract-based analysis in ALS patients at 7T: a specific white matter profile?

Our objective was to explore the value of additional MR contrasts in elucidating the decrease in fractional anisotropy (FA) as has been observed in the corticospinal tracts (CST) of patients with amyotrophic lateral sclerosis (ALS). Eleven patients and nine healthy control subjects were scanned at 3T and 7T MRI. Whole brain and tract specific comparison was performed of both diffusion weighted (3T), quantitative T1 (qT1), magnetization transfer ratio (MTR) and amide proton transfer weighted (APTw) imaging (7T). Results of whole brain comparison using histogram analyses showed no significant differences between patients and controls. Measures along the CST showed a significantly reduced FA together with a significantly increased diffusivity perpendicular to the tract direction in patients compared to controls. In addition, patients showed a small but significant increase in MTR values within the right CST. No significant changes were observed in qT1 and APTw values. In conclusion, our findings, based on a multimodal approach, revealed that the decrease in FA is most probably caused by an increased diffusivity perpendicular to the CST. This diffusivity profile, together with the increase in MTR is inconsistent with demyelination but consistent with an increase of free liquid spins in the white matter tissue.

Brain characterization using normalized quantitative magnetic resonance imaging

Objectives

To present a method for generating reference maps of typical brain characteristics of groups of subjects using a novel combination of rapid quantitative Magnetic Resonance Imaging (qMRI) and brain normalization. The reference maps can be used to detect significant tissue differences in patients, both locally and globally.

Materials and Methods

A rapid qMRI method was used to obtain the longitudinal relaxation rate (R₁), the transverse relaxation rate (R₂) and the proton density (PD). These three tissue properties were measured in the brains of 32 healthy subjects and in one patient diagnosed with Multiple Sclerosis (MS). The maps were normalized to a standard brain template using a linear affine registration. The differences of the mean value ofR₁, R₂ and PD of 31 healthy subjects in comparison to the oldest healthy subject and in comparison to an MS patient were calculated. Larger anatomical structures were characterized using a standard atlas. The vector sum of the normalized differences was used to show significant tissue differences.

Results

The coefficient of variation of the reference maps was high at the edges of the brain and the ventricles, moderate in the cortical grey matter and low in white matter and the deep grey matter structures. The elderly subject mainly showed significantly lower R₁ and R₂ and higher PD values along all sulci. The MS patient showed significantly lower R₁ and R₂ and higher PD values at the edges of the ventricular system as well as throughout the periventricular white matter, at the internal and external capsules and at each of the MS lesions.

Conclusion

Brain normalization of rapid qMRI is a promising new method to generate reference maps of typical brain characteristics and to automatically detect deviating tissue properties in the brain.

Within-lesion differences in quantitative MRI parameters predict contrast enhancement in multiple sclerosis

PURPOSE

To investigate the relationship between quantitative magnetic resonance imaging (qMRI) and contrast enhancement in multiple sclerosis (MS) lesions. We compared maps of T1 relaxation time, proton density (PD), and magnetization transfer ratio (MTR) between lesions with and without contrast enhancement as quantified by the amount of T1 shortening postcontrast agent (CA).

MATERIALS AND METHODS

In 17 patients with relapsing-remitting MS (RRMS), 15 with progressive MS (PMS), and 17 healthy controls, T1, PD, and MTR were measured at 3T and T1-mapping was repeated after CA administration. Manually drawn MS-lesions (3D-FLAIR) were labeled as enhancing if post-CA T1-shortening exceeded mean T1-shortening in normal-appearing white matter (NAWM) by at least 2 standard deviations. Precontrast T1, PD, and MTR were compared in enhancing lesions, nonenhancing lesions, NAWM, and gray matter.

RESULTS

Precontrast T1, PD, and MTR differed significantly between enhancing and nonenhancing lesions in RRMS and PMS patients (all P < 0.01). In PMS patients, PD of NAWM, enhancing, and nonenhancing lesions and MTR and T1 of gray matter differed significantly from RRMS and controls. Only MTR of gray matter differed between RRMS and controls.

CONCLUSION

Contrast enhancement in MS quantified by relative T1 shortening may be predicted by precontrast abnormalities of T1, PD, and MTR and likely represents blood-brain barrier damage.

Practical medical applications of quantitative MR relaxometry

Conventional MR images are qualitative, and their signal intensity is dependent on several complementary contrast mechanisms that are manipulated by the MR hardware and software. In the absence of a quantitative metric for absolute interpretation of pixel signal intensities, one that is independent of scanner hardware and sequences, it is difficult to perform comparisons of MR images across subjects or longitudinally in the same subject. Quantitative relaxometry isolates the contributions of individual MR contrast mechanisms (T1, T2, T2) and provides maps, which are independent of the MR protocol and have a physical interpretation often expressed in absolute units. In addition to providing an unbiased metric for comparing MR scans, quantitative relaxometry uses the relationship between MR maps and physiology to provide a noninvasive surrogate for biopsy and histology. This study provides an overview of some promising clinical applications of quantitative relaxometry, followed by a description of the methods and challenges of acquiring accurate and precise quantitative MR maps. It concludes with three case studies of quantitative relaxometry applied to studying multiple sclerosis, liver iron, and acute myocardial infarction.

Accelerating MR parameter mapping using sparsity-promoting regularization in parametric dimension

MR parameter mapping requires sampling along additional (parametric) dimension, which often limits its clinical appeal due to a several-fold increase in scan times compared to conventional anatomic imaging. Data undersampling combined with parallel imaging is an attractive way to reduce scan time in such applications. However, inherent SNR penalties of parallel MRI due to noise amplification often limit its utility even at moderate acceleration factors, requiring regularization by prior knowledge. In this work, we propose a novel regularization strategy, which uses smoothness of signal evolution in the parametric dimension within compressed sensing framework (p-CS) to provide accurate and precise estimation of parametric maps from undersampled data. The performance of the method was demonstrated with variable flip angle T1 mapping and compared favorably to two representative reconstruction approaches, image space-based total variation regularization and an analytical model-based reconstruction. The proposed p-CS regularization was found to provide efficient suppression of noise amplification and preservation of parameter mapping accuracy without explicit utilization of analytical signal models. The developed method may facilitate acceleration of quantitative MRI techniques that are not suitable to model-based reconstruction because of complex signal models or when signal deviations from the expected analytical model exist.

Multicentre absolute myelin water content mapping: Development of a whole brain atlas and application to low-grade multiple sclerosis

The current study investigates the whole brain myelin water content distribution applying a new approach that allows for the simultaneous mapping of total and relative myelin water content, T 1 and T 2* with full brain coverage and high resolution (1 × 1 × 2 mm(3)). The data was collected at two different sites in healthy controls to validate the independence of a specific setup. In addition, a group of patients with known white matter affections was investigated to compare two measures of myelin, i.e. relative and absolute myelin water content. Based on the first dataset, a quantitative myelin water content atlas was created which served as a control set for the other two datasets. Both control groups measured at different institutions yielded consistent results. However, distinct regions of reduced myelin water content were observed for the patient dataset, both on an individual basis and in a group-wise comparison. The comparison between the absolute and relative measurement of myelin water content in MS patients showed that the relative measurement, which is employed by many researchers, overestimates both disease volume and the corresponding reduction of myelin water content in white matter lesions. However, for normal appearing white matter, no difference between both approaches was detected. The results obtained in the current study demonstrate that absolute myelin water content can reliably be determined in a multicentre environment using standard MR sequences. The optimised protocol allows for a measurement of four quantitative parameters with full brain coverage in only 10 min. This might expedite a more widespread future use of quantitative MRI methods for clinical research and diagnosis.