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Hemond CC, Gaitán MI, Absinta M, Reich DS. New Imaging Markers in Multiple Sclerosis and Related Disorders: Smoldering Inflammation and the Central Vein Sign. Neuroimaging Clin N Am 2024; 34:359-373. [PMID: 38942521 PMCID: PMC11213979 DOI: 10.1016/j.nic.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Concepts of multiple sclerosis (MS) biology continue to evolve, with observations such as "progression independent of disease activity" challenging traditional phenotypic categorization. Iron-sensitive, susceptibility-based imaging techniques are emerging as highly translatable MR imaging sequences that allow for visualization of at least 2 clinically useful biomarkers: the central vein sign and the paramagnetic rim lesion (PRL). Both biomarkers demonstrate high specificity in the discrimination of MS from other mimics and can be seen at 1.5 T and 3 T field strengths. Additionally, PRLs represent a subset of chronic active lesions engaged in "smoldering" compartmentalized inflammation behind an intact blood-brain barrier.
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Affiliation(s)
- Christopher C Hemond
- Department of Neurology, University of Massachusetts Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, MA, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - María I Gaitán
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Martina Absinta
- Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Calabrese M, Preziosa P, Scalfari A, Colato E, Marastoni D, Absinta M, Battaglini M, De Stefano N, Di Filippo M, Hametner S, Howell OW, Inglese M, Lassmann H, Martin R, Nicholas R, Reynolds R, Rocca MA, Tamanti A, Vercellino M, Villar LM, Filippi M, Magliozzi R. Determinants and Biomarkers of Progression Independent of Relapses in Multiple Sclerosis. Ann Neurol 2024; 96:1-20. [PMID: 38568026 DOI: 10.1002/ana.26913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/04/2024] [Accepted: 02/15/2024] [Indexed: 06/20/2024]
Abstract
Clinical, pathological, and imaging evidence in multiple sclerosis (MS) suggests that a smoldering inflammatory activity is present from the earliest stages of the disease and underlies the progression of disability, which proceeds relentlessly and independently of clinical and radiological relapses (PIRA). The complex system of pathological events driving "chronic" worsening is likely linked with the early accumulation of compartmentalized inflammation within the central nervous system as well as insufficient repair phenomena and mitochondrial failure. These mechanisms are partially lesion-independent and differ from those causing clinical relapses and the formation of new focal demyelinating lesions; they lead to neuroaxonal dysfunction and death, myelin loss, glia alterations, and finally, a neuronal network dysfunction outweighing central nervous system (CNS) compensatory mechanisms. This review aims to provide an overview of the state of the art of neuropathological, immunological, and imaging knowledge about the mechanisms underlying the smoldering disease activity, focusing on possible early biomarkers and their translation into clinical practice. ANN NEUROL 2024;96:1-20.
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Affiliation(s)
- Massimiliano Calabrese
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Scalfari
- Centre of Neuroscience, Department of Medicine, Imperial College, London, UK
| | - Elisa Colato
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Damiano Marastoni
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Martina Absinta
- Translational Neuropathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Battaglini
- Siena Imaging S.r.l., Siena, Italy
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Owain W Howell
- Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Matilde Inglese
- Dipartimento di neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili - DINOGMI, University of Genova, Genoa, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Roland Martin
- Institute of Experimental Immunology, University of Zurich, Zurich, Switzerland
- Therapeutic Design Unit, Center for Molecular Medicine, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
- Cellerys AG, Schlieren, Switzerland
| | - Richard Nicholas
- Department of Brain Sciences, Faculty of Medicine, Burlington Danes, Imperial College London, London, UK
| | - Richard Reynolds
- Division of Neuroscience, Department of Brain Sciences, Imperial College London, London, UK
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Agnese Tamanti
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
| | - Marco Vercellino
- Multiple Sclerosis Center & Neurologia I U, Department of Neuroscience, University Hospital AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Luisa Maria Villar
- Department of Immunology, Ramon y Cajal University Hospital. IRYCIS. REI, Madrid, Spain
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Magliozzi
- Department of Neurosciences and Biomedicine and Movement, The Multiple Sclerosis Center of University Hospital of Verona, Verona, Italy
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Rimkus CDM, Otsuka FS, Nunes DM, Chaim KT, Otaduy MCG. Central Vein Sign and Paramagnetic Rim Lesions: Susceptibility Changes in Brain Tissues and Their Implications for the Study of Multiple Sclerosis Pathology. Diagnostics (Basel) 2024; 14:1362. [PMID: 39001252 PMCID: PMC11240827 DOI: 10.3390/diagnostics14131362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 07/16/2024] Open
Abstract
Multiple sclerosis (MS) is the most common acquired inflammatory and demyelinating disease in adults. The conventional diagnostic of MS and the follow-up of inflammatory activity is based on the detection of hyperintense foci in T2 and fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) and lesions with brain-blood barrier (BBB) disruption in the central nervous system (CNS) parenchyma. However, T2/FLAIR hyperintense lesions are not specific to MS and the MS pathology and inflammatory processes go far beyond focal lesions and can be independent of BBB disruption. MRI techniques based on the magnetic susceptibility properties of the tissue, such as T2*, susceptibility-weighted images (SWI), and quantitative susceptibility mapping (QSM) offer tools for advanced MS diagnostic, follow-up, and the assessment of more detailed features of MS dynamic pathology. Susceptibility-weighted techniques are sensitive to the paramagnetic components of biological tissues, such as deoxyhemoglobin. This capability enables the visualization of brain parenchymal veins. Consequently, it presents an opportunity to identify veins within the core of multiple sclerosis (MS) lesions, thereby affirming their venocentric characteristics. This advancement significantly enhances the accuracy of the differential diagnostic process. Another important paramagnetic component in biological tissues is iron. In MS, the dynamic trafficking of iron between different cells, such as oligodendrocytes, astrocytes, and microglia, enables the study of different stages of demyelination and remyelination. Furthermore, the accumulation of iron in activated microglia serves as an indicator of latent inflammatory activity in chronic MS lesions, termed paramagnetic rim lesions (PRLs). PRLs have been correlated with disease progression and degenerative processes, underscoring their significance in MS pathology. This review will elucidate the underlying physical principles of magnetic susceptibility and their implications for the formation and interpretation of T2*, SWI, and QSM sequences. Additionally, it will explore their applications in multiple sclerosis (MS), particularly in detecting the central vein sign (CVS) and PRLs, and assessing iron metabolism. Furthermore, the review will discuss their role in advancing early and precise MS diagnosis and prognostic evaluation, as well as their utility in studying chronic active inflammation and degenerative processes.
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Affiliation(s)
- Carolina de Medeiros Rimkus
- Department of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo 05403-010, SP, Brazil
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Instituto D'Or de Ensino e Pesquisa (IDOR), Sao Paulo 01401-002, SP, Brazil
| | - Fábio Seiji Otsuka
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
| | - Douglas Mendes Nunes
- Department of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo 05403-010, SP, Brazil
- Grupo Fleury, Sao Paulo 04701-200, SP, Brazil
| | - Khallil Taverna Chaim
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
| | - Maria Concepción Garcia Otaduy
- Department of Radiology and Oncology, Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo 05403-010, SP, Brazil
- Laboratory of Medical Investigation in Magnetic Resonance-44 (LIM 44), University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil
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Park C, Weerakkody JS, Schneider R, Miao S, Pitt D. CNS cell-derived exosome signatures as blood-based biomarkers of neurodegenerative diseases. Front Neurosci 2024; 18:1426700. [PMID: 38966760 PMCID: PMC11222337 DOI: 10.3389/fnins.2024.1426700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/07/2024] [Indexed: 07/06/2024] Open
Abstract
Molecular biomarkers require the reproducible capture of disease-associated changes and are ideally sensitive, specific and accessible with minimal invasiveness to patients. Exosomes are a subtype of extracellular vesicles that have gained attention as potential biomarkers. They are released by all cell types and carry molecular cargo that reflects the functional state of the cells of origin. These characteristics make them an attractive means of measuring disease-related processes within the central nervous system (CNS), as they cross the blood-brain barrier (BBB) and can be captured in peripheral blood. In this review, we discuss recent progress made toward identifying blood-based protein and RNA biomarkers of several neurodegenerative diseases from circulating, CNS cell-derived exosomes. Given the lack of standardized methodology for exosome isolation and characterization, we discuss the challenges of capturing and quantifying the molecular content of exosome populations from blood for translation to clinical use.
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Affiliation(s)
- Calvin Park
- Columbia University Irving Medical Center, Columbia University, New York, NY, United States
| | | | | | - Sheng Miao
- Yale School of Medicine, Yale University, New Haven, CT, United States
| | - David Pitt
- Yale School of Medicine, Yale University, New Haven, CT, United States
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Yang D. Looking at multiple sclerosis prognosis with susceptibility eyes. Eur Radiol 2024; 34:3849-3850. [PMID: 37962599 DOI: 10.1007/s00330-023-10433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Dahong Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
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Tazza F, Boffa G, Schiavi S, Lapucci C, Piredda GF, Cipriano E, Zacà D, Roccatagliata L, Hilbert T, Kober T, Inglese M, Costagli M. Multiparametric Characterization and Spatial Distribution of Different MS Lesion Phenotypes. AJNR Am J Neuroradiol 2024:ajnr.A8271. [PMID: 38816021 DOI: 10.3174/ajnr.a8271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/01/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND PURPOSE MS lesions exhibit varying degrees of axonal and myelin damage. A comprehensive description of lesion phenotypes could contribute to an improved radiologic evaluation of smoldering inflammation and remyelination processes. This study aimed to identify in vivo distinct MS lesion types using quantitative susceptibility mapping and susceptibility mapping-weighted imaging and to characterize them through T1-relaxometry, myelin mapping, and diffusion MR imaging. The spatial distribution of lesion phenotypes in relation to ventricular CSF was investigated. MATERIALS AND METHODS MS lesions of 53 individuals were categorized into iso- or hypointense lesions, hyperintense lesions, and paramagnetic rim lesions, on the basis of their appearance on quantitative susceptibility mapping alone, according to published criteria, and with the additional support of susceptibility mapping-weighted imaging. Susceptibility values, T1-relaxation times, myelin and free water fractions, intracellular volume fraction, and the orientation dispersion index were compared among lesion phenotypes. The distance of the geometric center of each lesion from the ventricular CSF was calculated. RESULTS Eight hundred ninety-six MS lesions underwent the categorization process using quantitative susceptibility mapping and susceptibility mapping-weighted imaging. The novel use of susceptibility mapping-weighted images, which revealed additional microvasculature details, led us to re-allocate several lesions to different categories, resulting in a 35.6% decrease in the number of paramagnetic rim lesions, a 22.5% decrease in hyperintense lesions, and a 17.2% increase in iso- or hypointense lesions, with respect to the categorization based on quantitative susceptibility mapping only. The outcome of the categorization based on the joint use of quantitative susceptibility mapping and susceptibility mapping-weighted imaging was that 44.4% of lesions were iso- or hypointense lesions, 47.9% were hyperintense lesions, and 7.7% were paramagnetic rim lesions. A worsening gradient was observed from iso- or hypointense lesions to hyperintense lesions to paramagnetic rim lesions in T1-relaxation times, myelin water fraction, free water faction, and intracellular volume fraction. Paramagnetic rim lesions were located closer to ventricular CSF than iso- or hypointense lesions. The volume of hyperintense lesions was associated with a more severe disease course. CONCLUSIONS Quantitative susceptibility mapping and susceptibility mapping-weighted imaging allow in vivo classification of MS lesions into different phenotypes, characterized by different levels of axonal and myelin loss and spatial distribution. Hyperintense lesions and paramagnetic rim lesions, which have the most severe microstructural damage, were more often observed in the periventricular WM and were associated with a more severe disease course.
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Affiliation(s)
- Francesco Tazza
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | - Giacomo Boffa
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | - Simona Schiavi
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | - Caterina Lapucci
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology (G.F.P., T.H., T.K.), Siemens Healthineers International AG, Lausanne, Switzerland
| | - Emilio Cipriano
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
| | | | - Luca Roccatagliata
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences (L.R.), University of Genoa, Genoa, Italy
| | - Tom Hilbert
- Advanced Clinical Imaging Technology (G.F.P., T.H., T.K.), Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology (T.H., T.K.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5 (T.H., T.K.), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology (G.F.P., T.H., T.K.), Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology (T.H., T.K.), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5 (T.H., T.K.), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Matilde Inglese
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Costagli
- From the Departments of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (F.T., G.B., S.S., E.C., M.I., M.C.), University of Genoa, Genoa, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (C.L., L.R., M.I., M.C.), Ospedale Policlinico San Martino, Genoa, Italy
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Bilgic B, Costagli M, Chan KS, Duyn J, Langkammer C, Lee J, Li X, Liu C, Marques JP, Milovic C, Robinson SD, Schweser F, Shmueli K, Spincemaille P, Straub S, van Zijl P, Wang Y. Recommended implementation of quantitative susceptibility mapping for clinical research in the brain: A consensus of the ISMRM electro-magnetic tissue properties study group. Magn Reson Med 2024; 91:1834-1862. [PMID: 38247051 PMCID: PMC10950544 DOI: 10.1002/mrm.30006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/31/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
This article provides recommendations for implementing QSM for clinical brain research. It is a consensus of the International Society of Magnetic Resonance in Medicine, Electro-Magnetic Tissue Properties Study Group. While QSM technical development continues to advance rapidly, the current QSM methods have been demonstrated to be repeatable and reproducible for generating quantitative tissue magnetic susceptibility maps in the brain. However, the many QSM approaches available have generated a need in the neuroimaging community for guidelines on implementation. This article outlines considerations and implementation recommendations for QSM data acquisition, processing, analysis, and publication. We recommend that data be acquired using a monopolar 3D multi-echo gradient echo (GRE) sequence and that phase images be saved and exported in Digital Imaging and Communications in Medicine (DICOM) format and unwrapped using an exact unwrapping approach. Multi-echo images should be combined before background field removal, and a brain mask created using a brain extraction tool with the incorporation of phase-quality-based masking. Background fields within the brain mask should be removed using a technique based on SHARP or PDF, and the optimization approach to dipole inversion should be employed with a sparsity-based regularization. Susceptibility values should be measured relative to a specified reference, including the common reference region of the whole brain as a region of interest in the analysis. The minimum acquisition and processing details required when reporting QSM results are also provided. These recommendations should facilitate clinical QSM research and promote harmonized data acquisition, analysis, and reporting.
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Affiliation(s)
- Berkin Bilgic
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
| | - Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
- Laboratory of Medical Physics and Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Kwok-Shing Chan
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts, USA
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Jeff Duyn
- Advanced MRI Section, NINDS, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Jongho Lee
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Republic of Korea
| | - Xu Li
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, California, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, California, USA
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Carlos Milovic
- School of Electrical Engineering (EIE), Pontificia Universidad Catolica de Valparaiso, Valparaiso, Chile
| | - Simon Daniel Robinson
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Centre of Advanced Imaging, University of Queensland, Brisbane, Australia
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA
- Center for Biomedical Imaging, Clinical and Translational Science Institute at the University at Buffalo, Buffalo, New York, USA
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Pascal Spincemaille
- MRI Research Institute, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Sina Straub
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Peter van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Yi Wang
- MRI Research Institute, Departments of Radiology and Biomedical Engineering, Cornell University, New York, New York, USA
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Liu M, Zhao S, Chen Z. Interscanner reproducibility of volumetric quantitative susceptibility mapping about cerebral subcortical gray nuclei at different MR vendors with the same magnetic strength. Brain Behav 2024; 14:e3473. [PMID: 38594225 PMCID: PMC11004039 DOI: 10.1002/brb3.3473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/05/2024] [Accepted: 03/16/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Quantitative susceptibility mapping (QSM) technique was a new quantitative magnetic resonance imaging technique to evaluate the cerebral iron deposition in clinical practice. The current study was aimed to investigate the reproducibility of the volumetric susceptibility value of the subcortical gray nuclei at two different MR vendor with the same magnetic strength. METHODS Cerebral magnitude and phase images of 21 normal subjects were acquired from a 3D multiecho enhanced gradient recalled echo sequence at two different 3.0T MR scanner, and then the magnetic susceptibility images were generated by STI software. The brain structural images were coregistered with magnitude images and generated the normalized parameters, and then generated the normalized susceptibility images. The subcortical gray nuclei template was applied to extract the volumetric susceptibility value of the target nuclei. RESULTS ICC value (95% CI) of the caudate, putamen and GP were 0.847 (0.660-0.935), 0.848 (0.663-0.935) and 0.838 (0.643-0.931), respectively. The ICC value of the thalamus was 0.474 (0.064-0.747). Ninety-five point two percent (20/21) of the difference points of the susceptibility located between the 95% LA for the caudate at the two different 3.0T MR scanner, while the less than 95% of the difference points of the susceptibility value located between the 95% LA for the putamen, globus pallidus and thalamus. CONCLUSION The current study identified that the caudate had the stable reproducibility of the magnetic susceptibility value, and the other basal ganglion nuclei should be cautious for the quantitative evaluation of the magnetic susceptibility value at different 3.0T MR scanner.
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Affiliation(s)
- Mengqi Liu
- Department of RadiologyHainan Hospital of PLA General HospitalSanyaChina
- Department of RadiologyFirst Medical Center of PLA General HospitalBeijingChina
| | - Shuqiang Zhao
- Department of RadiologyHainan Hospital of PLA General HospitalSanyaChina
| | - Zhiye Chen
- Department of RadiologyHainan Hospital of PLA General HospitalSanyaChina
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Voon CC, Wiltgen T, Wiestler B, Schlaeger S, Mühlau M. Quantitative susceptibility mapping in multiple sclerosis: A systematic review and meta-analysis. Neuroimage Clin 2024; 42:103598. [PMID: 38582068 PMCID: PMC11002889 DOI: 10.1016/j.nicl.2024.103598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) is a quantitative measure based on magnetic resonance imaging sensitive to iron and myelin content. This makes QSM a promising non-invasive tool for multiple sclerosis (MS) in research and clinical practice. OBJECTIVE We performed a systematic review and meta-analysis on the use of QSM in MS. METHODS Our review was prospectively registered on PROSPERO (CRD42022309563). We searched five databases for studies published between inception and 30th April 2023. We identified 83 English peer-reviewed studies that applied QSM images on MS cohorts. Fifty-five included studies had at least one of the following outcome measures: deep grey matter QSM values in MS, either compared to healthy controls (HC) (k = 13) or correlated with the score on the Expanded Disability Status Scale (EDSS) (k = 7), QSM lesion characteristics (k = 22) and their clinical correlates (k = 17), longitudinal correlates (k = 11), histological correlates (k = 7), or correlates with other imaging techniques (k = 12). Two meta-analyses on deep grey matter (DGM) susceptibility data were performed, while the remaining findings could only be analyzed descriptively. RESULTS After outlier removal, meta-analyses demonstrated a significant increase in the basal ganglia susceptibility (QSM values) in MS compared to HC, caudate (k = 9, standardized mean difference (SDM) = 0.54, 95 % CI = 0.39-0.70, I2 = 46 %), putamen (k = 9, SDM = 0.38, 95 % CI = 0.19-0.57, I2 = 59 %), and globus pallidus (k = 9, SDM = 0.48, 95 % CI = 0.28-0.67, I2 = 60 %), whereas thalamic QSM values exhibited a significant reduction (k = 12, SDM = -0.39, 95 % CI = -0.66--0.12, I2 = 84 %); these susceptibility differences in MS were independent of age. Further, putamen QSM values positively correlated with EDSS (k = 4, r = 0.36, 95 % CI = 0.16-0.53, I2 = 0 %). Regarding rim lesions, four out of seven studies, representing 73 % of all patients, reported rim lesions to be associated with more severe disability. Moreover, lesion development from initial detection to the inactive stage is paralleled by increasing, plateauing (after about two years), and gradually decreasing QSM values, respectively. Only one longitudinal study provided clinical outcome measures and found no association. Histological data suggest iron content to be the primary source of QSM values in DGM and at the edges of rim lesions; further, when also considering data from myelin water imaging, the decrease of myelin is likely to drive the increase of QSM values within WM lesions. CONCLUSIONS We could provide meta-analytic evidence for DGM susceptibility changes in MS compared to HC; basal ganglia susceptibility is increased and, in the putamen, associated with disability, while thalamic susceptibility is decreased. Beyond these findings, further investigations are necessary to establish the role of QSM in MS for research or even clinical routine.
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Affiliation(s)
- Cui Ci Voon
- Dept. of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Dept. of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Dept. of Neuroradiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sarah Schlaeger
- Dept. of Neuroradiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Dept. of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, School of Medicine and Health, Technical University of Munich, Munich, Germany.
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10
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Zhu Z, Naji N, Esfahani JH, Snyder J, Seres P, Emery DJ, Noga M, Blevins G, Smyth P, Wilman AH. MR Susceptibility Separation for Quantifying Lesion Paramagnetic and Diamagnetic Evolution in Relapsing-Remitting Multiple Sclerosis. J Magn Reson Imaging 2024. [PMID: 38308397 DOI: 10.1002/jmri.29266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) lesion evolution may involve changes in diamagnetic myelin and paramagnetic iron. Conventional quantitative susceptibility mapping (QSM) can provide net susceptibility distribution, but not the discrete paramagnetic and diamagnetic components. PURPOSE To apply susceptibility separation (χ separation) to follow lesion evolution in MS with comparison to R2 */R2 ' /QSM. STUDY TYPE Longitudinal, prospective. SUBJECTS Twenty relapsing-remitting MS subjects (mean age: 42.5 ± 9.4 years, 13 females; mean years of symptoms: 4.3 ± 1.4 years). FIELD STRENGTH/SEQUENCE Three-dimensional multiple echo gradient echo (QSM and R2 * mapping), two-dimensional dual echo fast spin echo (R2 mapping), T2 -weighted fluid attenuated inversion recovery, and T1-weighted magnetization prepared gradient echo sequences at 3 T. ASSESSMENT Data were analyzed from two scans separated by a mean interval of 14.4 ± 2.0 months. White matter lesions on fluid-attenuated inversion recovery were defined by an automatic pipeline, then manually refined (by ZZ/AHW, 3/25 years' experience in MRI), and verified by a radiologist (MN, 25 years' experience in MS). Susceptibility separation yielded the paramagnetic and diamagnetic susceptibility content of each voxel. Lesions were classified into four groups based on the variation of QSM/R2 * or separated into positive/negative components from χ separation. STATISTICAL TESTS Two-sample paired t tests for assessment of longitudinal differences. Spearman correlation coefficients to assess associations between χ separation and R2 */R2 ' /QSM. Significant level: P < 0.005. RESULTS A total of 183 lesions were quantified. Categorizing lesions into groups based on χ separation demonstrated significant annual changes in QSM//R2 */R2 ' . When lesions were grouped based on changes in QSM and R2 *, both changing in unison yielded a significant dominant paramagnetic variation and both opposing yielded a dominant diamagnetic variation. Significant Spearman correlation coefficients were found between susceptibility-sensitive MRI indices and χ separation. DATA CONCLUSION Susceptibility separation changes in MS lesions may distinguish and quantify paramagnetic and diamagnetic evolution, potentially providing additional insight compared to R2 * and QSM alone. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ziyan Zhu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Nashwan Naji
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Javad Hamidi Esfahani
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Jeff Snyder
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Seres
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Derek J Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Noga
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Gregg Blevins
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alan H Wilman
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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11
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Steinmaurer A, Riedl C, König T, Testa G, Köck U, Bauer J, Lassmann H, Höftberger R, Berger T, Wimmer I, Hametner S. The relation between BTK expression and iron accumulation of myeloid cells in multiple sclerosis. Brain Pathol 2024:e13240. [PMID: 38254312 DOI: 10.1111/bpa.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Activation of Bruton's tyrosine kinase (BTK) has been shown to play a crucial role in the proinflammatory response of B cells and myeloid cells upon engagement with B cell, Fc, Toll-like receptor, and distinct chemokine receptors. Previous reports suggest BTK actively contributes to the pathogenesis of multiple sclerosis (MS). The BTK inhibitor Evobrutinib has been shown to reduce the numbers of gadolinium-enhancing lesions and relapses in relapsing-remitting MS patients. In vitro, BTK inhibition resulted in reduced phagocytic activity and modulated BTK-dependent inflammatory signaling of microglia and macrophages. Here, we investigated the protein expression of BTK and CD68 as well as iron accumulation in postmortem control (n = 10) and MS (n = 23) brain tissue, focusing on microglia and macrophages. MS cases encompassed active, chronic active, and inactive lesions. BTK+ and iron+ cells positively correlated across all regions of interests and, along with CD68, revealed highest numbers in the center of active and at the rim of chronic active lesions. We then studied the effect of BTK inhibition in the human immortalized microglia-like HMC3 cell line in vitro. In particular, we loaded HMC3 cells with iron-dextran and subsequently administered the BTK inhibitor Evobrutinib. Iron treatment alone induced a proinflammatory phenotype and increased the expression of iron importers as well as the intracellular iron storage protein ferritin light chain (FTL). BTK inhibition of iron-laden cells dampened the expression of microglia-related inflammatory genes as well as iron-importers, whereas the iron-exporter ferroportin was upregulated. Our data suggest that BTK inhibition not only dampens the proinflammatory response but also reduces iron import and storage in activated microglia and macrophages with possible implications on microglial iron accumulation in chronic active lesions in MS.
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Affiliation(s)
- Anja Steinmaurer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christian Riedl
- Division of Neurochemistry and Neuropathology, Medical University of Vienna, Vienna, Austria
| | - Theresa König
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Giulia Testa
- Division of Neurochemistry and Neuropathology, Medical University of Vienna, Vienna, Austria
| | - Ulrike Köck
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Jan Bauer
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neurochemistry and Neuropathology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Isabella Wimmer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Simon Hametner
- Division of Neurochemistry and Neuropathology, Medical University of Vienna, Vienna, Austria
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12
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Strunk D, Sinnecker T, Kleffner I, Doerr J, Ringelstein M, Gross CC, Deuschl C, Maderwald S, Quick HH, Yamac E, Wrede KH, Kraemer M. Central intra-lesional iron deposits as a possible novel imaging marker at 7 Tesla MRI in Susac Syndrome - an exploratory study. BMC Med Imaging 2024; 24:4. [PMID: 38166655 PMCID: PMC10759674 DOI: 10.1186/s12880-023-01171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Susac syndrome (SuS) is a rare autoimmune disease that leads to hearing impairment, visual field deficits, and encephalopathy due to an occlusion of precapillary arterioles in the brain, retina, and inner ear. Given the potentially disastrous outcome and difficulties in distinguishing SuS from its differential diagnoses, such as multiple sclerosis (MS), our exploratory study aimed at identifying potential new SuS-specific neuroimaging markers. METHODS Seven patients with a definite diagnosis of SuS underwent magnetic resonance imaging (MRI) at 7 Tesla (7T), including T2* weighted and quantitative susceptibility mapping (QSM) sequences. T2 weighted hyperintense lesions were analyzed with regard to number, volume, localization, central vein sign, T1 hypointensity, and focal iron deposits in the center of SuS lesions ("iron dots"). Seven T MRI datasets from the same institute, comprising 75 patients with, among others, MS, served as controls. RESULTS The "iron dot" sign was present in 71.4% (5/7) of the SuS patients, compared to 0% in our control cohort. Thus, sensitivity was 71.4% and specificity 100%. A central vein sign was only incidentally detected. CONCLUSION We are the first to demonstrate this type of "iron dot" lesions on highly resolving 7T T2*w and QSM images in vivo as a promising neuroimaging marker of SuS, corroborating previous histopathological ex vivo findings.
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Affiliation(s)
- Daniel Strunk
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Tim Sinnecker
- Medical Image Analysis Center (MIAC AG), Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ilka Kleffner
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Jan Doerr
- Department of Neurology, Oberhavel Kliniken, Hennigsdorf, Germany
- Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Westfälische Wilhelms University of Münster, Münster, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance ImagingEssen, Germany & High Field and Hybrid MR Imaging, University Duisburg-EssenUniversity Hospital Essen, Essen, Germany
| | - Harald H Quick
- Erwin L. Hahn Institute for Magnetic Resonance ImagingEssen, Germany & High Field and Hybrid MR Imaging, University Duisburg-EssenUniversity Hospital Essen, Essen, Germany
| | - Elif Yamac
- Department of Intracranial Endovascular Therapy, Alfried Krupp Hospital, Essen, Germany
| | - Karsten H Wrede
- Erwin L. Hahn Institute for Magnetic Resonance ImagingEssen, Germany & High Field and Hybrid MR Imaging, University Duisburg-EssenUniversity Hospital Essen, Essen, Germany
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45147, Essen, Germany
| | - Markus Kraemer
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany.
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
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13
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Sacco S, Virupakshaiah A, Papinutto N, Schoeps VA, Akula A, Zhao H, Arona J, Stern WA, Chong J, Hart J, Zamvil SS, Sati P, Henry RG, Waubant E. Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler 2023; 29:1736-1747. [PMID: 37897254 PMCID: PMC10687802 DOI: 10.1177/13524585231204414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) and pediatric-onset multiple sclerosis (POMS) share clinical and magnetic resonance imaging (MRI) features but differ in prognosis and management. Early POMS diagnosis is essential to avoid disability accumulation. Central vein sign (CVS), paramagnetic rim lesions (PRLs), and central core lesions (CCLs) are susceptibility-based imaging (SbI)-related signs understudied in pediatric populations that may help discerning POMS from MOGAD. METHODS T2-FLAIR and SbI (three-dimensional echoplanar imaging (3D-EPI)/susceptibility-weighted imaging (SWI) or similar) were acquired on 1.5T/3T scanners. Two readers assessed CVS-positive rate (%CVS+), and their average score was used to build a receiver operator curve (ROC) assessing the ability to discriminate disease type. PRLs and CCLs were identified using a consensual approach. RESULTS The %CVS+ distinguished 26 POMS cases (mean age 13.7 years, 63% females, median EDSS 1.5) from 14 MOGAD cases (10.8 years, 35% females, EDSS 1.0) with ROC = 1, p < 0.0001, (cutoff 41%). PRLs were only detectable in POMS participants (mean 2.1±2.3, range 1-10), discriminating the two conditions with a sensitivity of 69% and a specificity of 100%. CCLs were more sensitive (81%) but less specific (71.43%). CONCLUSION The %CVS+ and PRLs are highly specific markers of POMS. After proper validation on larger multicenter cohorts, consideration should be given to including such imaging markers for diagnosing POMS at disease onset.
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Affiliation(s)
- Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akash Virupakshaiah
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Vinicius A Schoeps
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amit Akula
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Haojun Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Arona
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Chong
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janace Hart
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pascal Sati
- Neuroimaging Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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14
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Hofmann A, Krajnc N, Dal-Bianco A, Riedl CJ, Zrzavy T, Lerma-Martin C, Kasprian G, Weber CE, Pezzini F, Leutmezer F, Rommer P, Bsteh G, Platten M, Gass A, Berger T, Eisele P, Magliozzi R, Schirmer L, Hametner S. Myeloid cell iron uptake pathways and paramagnetic rim formation in multiple sclerosis. Acta Neuropathol 2023; 146:707-724. [PMID: 37715818 PMCID: PMC10564819 DOI: 10.1007/s00401-023-02627-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 09/18/2023]
Abstract
In multiple sclerosis (MS), sustained inflammatory activity can be visualized by iron-sensitive magnetic resonance imaging (MRI) at the edges of chronic lesions. These paramagnetic rim lesions (PRLs) are associated with clinical worsening, although the cell type-specific and molecular pathways of iron uptake and metabolism are not well known. We studied two postmortem cohorts: an exploratory formalin-fixed paraffin-embedded (FFPE) tissue cohort of 18 controls and 24 MS cases and a confirmatory snap-frozen cohort of 6 controls and 14 MS cases. Besides myelin and non-heme iron imaging, the haptoglobin-hemoglobin scavenger receptor CD163, the iron-metabolizing markers HMOX1 and HAMP as well as immune-related markers P2RY12, CD68, C1QA and IL10 were visualized in myeloid cell (MC) subtypes at RNA and protein levels across different MS lesion areas. In addition, we studied PRLs in vivo in a cohort of 98 people with MS (pwMS) via iron-sensitive 3 T MRI and haptoglobin genotyping by PCR. CSF samples were available from 38 pwMS for soluble CD163 (sCD163) protein level measurements by ELISA. In postmortem tissues, we observed that iron uptake was linked to rim-associated C1QA-expressing MC subtypes, characterized by upregulation of CD163, HMOX1, HAMP and, conversely, downregulation of P2RY12. We found that pwMS with [Formula: see text] 4 PRLs had higher sCD163 levels in the CSF than pwMS with [Formula: see text] 3 PRLs with sCD163 correlating with the number of PRLs. The number of PRLs was associated with clinical worsening but not with age, sex or haptoglobin genotype of pwMS. However, pwMS with Hp2-1/Hp2-2 haplotypes had higher clinical disability scores than pwMS with Hp1-1. In summary, we observed upregulation of the CD163-HMOX1-HAMP axis in MC subtypes at chronic active lesion rims, suggesting haptoglobin-bound hemoglobin but not transferrin-bound iron as a critical source for MC-associated iron uptake in MS. The correlation of CSF-associated sCD163 with PRL counts in MS highlights the relevance of CD163-mediated iron uptake via haptoglobin-bound hemoglobin. Also, while Hp haplotypes had no noticeable influence on PRL counts, pwMS carriers of a Hp2 allele might have a higher risk to experience clinical worsening.
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Affiliation(s)
- Annika Hofmann
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Nik Krajnc
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Assunta Dal-Bianco
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Christian J Riedl
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Tobias Zrzavy
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Celia Lerma-Martin
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gregor Kasprian
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Francesco Pezzini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Fritz Leutmezer
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Paulus Rommer
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Innate Immunity, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Interdisciplinary Center for Neurosciences, Heidelberg University, Heidelberg, Germany
- DKTK Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center, INF 280, Heidelberg, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Berger
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Roberta Magliozzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lucas Schirmer
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Mannheim Institute for Innate Immunity, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Interdisciplinary Center for Neurosciences, Heidelberg University, Heidelberg, Germany.
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
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15
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Galbusera R, Bahn E, Weigel M, Schaedelin S, Franz J, Lu P, Barakovic M, Melie‐Garcia L, Dechent P, Lutti A, Sati P, Reich DS, Nair G, Brück W, Kappos L, Stadelmann C, Granziera C. Postmortem quantitative MRI disentangles histological lesion types in multiple sclerosis. Brain Pathol 2023; 33:e13136. [PMID: 36480267 PMCID: PMC10580009 DOI: 10.1111/bpa.13136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022] Open
Abstract
Quantitative MRI (qMRI) probes the microstructural properties of the central nervous system (CNS) by providing biophysical measures of tissue characteristics. In this work, we aimed to (i) identify qMRI measures that distinguish histological lesion types in postmortem multiple sclerosis (MS) brains, especially the remyelinated ones; and to (ii) investigate the relationship between those measures and quantitative histological markers of myelin, axons, and astrocytes in the same experimental setting. Three fixed MS whole brains were imaged with qMRI at 3T to obtain magnetization transfer ratio (MTR), myelin water fraction (MWF), quantitative T1 (qT1), quantitative susceptibility mapping (QSM), fractional anisotropy (FA) and radial diffusivity (RD) maps. The identification of lesion types (active, inactive, chronic active, or remyelinated) and quantification of tissue components were performed using histological staining methods as well as immunohistochemistry and immunofluorescence. Pairwise logistic and LASSO regression models were used to identify the best qMRI discriminators of lesion types. The association between qMRI and quantitative histological measures was performed using Spearman's correlations and linear mixed-effect models. We identified a total of 65 lesions. MTR and MWF best predicted the chance of a lesion to be remyelinated, whereas RD and QSM were useful in the discrimination of active lesions. The measurement of microstructural properties through qMRI did not show any difference between chronic active and inactive lesions. MWF and RD were associated with myelin content in both lesions and normal-appearing white matter (NAWM), FA was the measure most associated with axon content in both locations, while MWF was associated with astrocyte immunoreactivity only in lesions. Moreover, we provided evidence of extensive astrogliosis in remyelinated lesions. Our study provides new information on the discriminative power of qMRI in differentiating MS lesions -especially remyelinated ones- as well as on the relative association between multiple qMRI measures and myelin, axon and astrocytes.
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Affiliation(s)
- Riccardo Galbusera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of MedicineUniversity Hospital Basel and University of BaselBaselSwitzerland
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Erik Bahn
- Institute of NeuropathologyUniversity Medical CenterGöttingenGermany
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of MedicineUniversity Hospital Basel and University of BaselBaselSwitzerland
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
- Division of Radiological Physics, Department of RadiologyUniversity Hospital BaselBaselSwitzerland
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical ResearchUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Jonas Franz
- Institute of NeuropathologyUniversity Medical CenterGöttingenGermany
- Campus Institute for Dynamics of Biological NetworksUniversity of GöttingenGöttingenGermany
- Max Planck Institute for Experimental MedicineGöttingenGermany
| | - Po‐Jui Lu
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of MedicineUniversity Hospital Basel and University of BaselBaselSwitzerland
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of MedicineUniversity Hospital Basel and University of BaselBaselSwitzerland
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Lester Melie‐Garcia
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of MedicineUniversity Hospital Basel and University of BaselBaselSwitzerland
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Peter Dechent
- Department of Cognitive NeurologyMR‐Research in Neurosciences, University Medical Center GöttingenGöttingenGermany
| | - Antoine Lutti
- Centre for Research in Neuroscience, Department of Clinical NeurosciencesLaboratoire de Recherche en Neuroimagerie (LREN) University Hospital and University of LausanneLausanneSwitzerland
| | - Pascal Sati
- Department of NeurologyCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Daniel S. Reich
- Translational Neuroradiology SectionNational Institute of Neurological Disorders and Stroke, National Institutes of HealthBethesdaMarylandUSA
| | - Govind Nair
- National Institute of Neurological Disorders and StrokeBethesdaMarylandUSA
| | - Wolfgang Brück
- Institute of NeuropathologyUniversity Medical CenterGöttingenGermany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
| | - Christine Stadelmann
- Institute of NeuropathologyUniversity Medical CenterGöttingenGermany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Network of Excitable Cells (MBExC) ”University of GoettingenGermany
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, Faculty of MedicineUniversity Hospital Basel and University of BaselBaselSwitzerland
- Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB)University Hospital Basel and University of BaselBaselSwitzerland
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16
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Krajnc N, Schmidbauer V, Leinkauf J, Haider L, Bsteh G, Kasprian G, Leutmezer F, Kornek B, Rommer PS, Berger T, Lassmann H, Dal-Bianco A, Hametner S. Paramagnetic rim lesions lead to pronounced diffuse periplaque white matter damage in multiple sclerosis. Mult Scler 2023; 29:1406-1417. [PMID: 37712486 PMCID: PMC10580674 DOI: 10.1177/13524585231197954] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Paramagnetic rim lesions (PRLs) are an imaging biomarker in multiple sclerosis (MS), associated with a more severe disease. OBJECTIVES To determine quantitative magnetic resonance imaging (MRI) metrics of PRLs, lesions with diffuse susceptibility-weighted imaging (SWI)-hypointense signal (DSHLs) and SWI-isointense lesions (SILs), their surrounding periplaque area (PPA) and the normal-appearing white matter (NAWM). METHODS In a cross-sectional study, quantitative MRI metrics were measured in people with multiple sclerosis (pwMS) using the multi-dynamic multi-echo (MDME) sequence post-processing software "SyMRI." RESULTS In 30 pwMS, 59 PRLs, 74 DSHLs, and 107 SILs were identified. Beside longer T1 relaxation times of PRLs compared to DSHLs and SILs (2030.5 (1519-2540) vs 1615.8 (1403.3-1953.5) vs 1199.5 (1089.6-1334.6), both p < 0.001), longer T1 relaxation times were observed in the PRL PPA compared to the SIL PPA and the NAWM but not the DSHL PPA. Patients with secondary progressive multiple sclerosis (SPMS) had longer T1 relaxation times in PRLs compared to patients with late relapsing multiple sclerosis (lRMS) (2394.5 (2030.5-3040) vs 1869.3 (1491.4-2451.3), p = 0.015) and also in the PRL PPA compared to patients with early relapsing multiple sclerosis (eRMS) (982 (927-1093.5) vs 904.3 (793.3-958.5), p = 0.013). CONCLUSION PRLs are more destructive than SILs, leading to diffuse periplaque white matter (WM) damage. The quantitative MRI-based evaluation of the PRL PPA could be a marker for silent progression in pwMS.
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Affiliation(s)
- Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Victor Schmidbauer
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Joel Leinkauf
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Paulus Stefan Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Assunta Dal-Bianco
- Department of Neurology, Medical University of Vienna, Vienna, Austria/Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Simon Hametner
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria/Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
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17
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Abou Mrad T, Naja K, Khoury SJ, Hannoun S. Central vein sign and paramagnetic rim sign: From radiologically isolated syndrome to multiple sclerosis. Eur J Neurol 2023; 30:2912-2918. [PMID: 37350369 DOI: 10.1111/ene.15922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
The widespread use of magnetic resonance imaging (MRI) has led to an increase in incidental findings in the central nervous system. Radiologically isolated syndrome (RIS) is a condition where imaging reveals lesions suggestive of demyelinating disease without any clinical episodes consistent with multiple sclerosis (MS). The prognosis for RIS patients is uncertain, with some remaining asymptomatic while others progress to MS. Several risk factors for disease progression have been identified, including male sex, younger age at diagnosis, and spinal cord lesions. This article reviews two promising biomarkers, the central vein sign (CVS) and the paramagnetic rim sign (PRS), and their potential role in the diagnosis and prognosis of MS and RIS. Both CVS and PRS have been shown to be accurate diagnostic markers in MS, with high sensitivity and specificity, and have been useful in distinguishing MS from other disorders. Further research is needed to validate these findings and determine the clinical utility of these biomarkers in routine practice.
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Affiliation(s)
- Tatiana Abou Mrad
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kim Naja
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Medical Imaging Sciences Program, Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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18
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Chari A, Sedlacik J, Seunarine K, Piper RJ, Hales P, Shmueli K, Mankad K, Löbel U, Eltze C, Moeller F, Scott RC, Tisdall MM, Cross JH, Carmichael DW. Epileptogenic Tubers Are Associated with Increased Kurtosis of Susceptibility Values: A Combined Quantitative Susceptibility Mapping and Stereoelectroencephalography Pilot Study. AJNR Am J Neuroradiol 2023; 44:974-982. [PMID: 37474265 PMCID: PMC10411828 DOI: 10.3174/ajnr.a7929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND PURPOSE Prior studies have found an association between calcification and the epileptogenicity of tubers in tuberous sclerosis complex. Quantitative susceptibility mapping is a novel tool sensitive to magnetic susceptibility alterations due to tissue calcification. We assessed the utility of quantitative susceptibility mapping in identifying putative epileptogenic tubers in tuberous sclerosis complex using stereoelectroencephalography data as ground truth. MATERIALS AND METHODS We studied patients with tuberous sclerosis complex undergoing stereoelectroencephalography at a single center who had multiecho gradient-echo sequences available. Quantitative susceptibility mapping and R2* values were extracted for all tubers on the basis of manually drawn 3D ROIs using T1- and T2-FLAIR sequences. Characteristics of quantitative susceptibility mapping and R2* distributions from implanted tubers were compared using binary logistic generalized estimating equation models designed to identify ictal (involved in seizure onset) and interictal (persistent interictal epileptiform activity) tubers. These models were then applied to the unimplanted tubers to identify potential ictal and interictal tubers that were not sampled by stereoelectroencephalography. RESULTS A total of 146 tubers were identified in 10 patients, 76 of which were sampled using stereoelectroencephalography. Increased kurtosis of the tuber quantitative susceptibility mapping values was associated with epileptogenicity (P = .04 for the ictal group and P = .005 for the interictal group) by the generalized estimating equation model. Both groups had poor sensitivity (35.0% and 44.1%, respectively) but high specificity (94.6% and 78.6%, respectively). CONCLUSIONS Our finding of increased kurtosis of quantitative susceptibility mapping values (heavy-tailed distribution) was highly specific, suggesting that it may be a useful biomarker to identify putative epileptogenic tubers in tuberous sclerosis complex. This finding motivates the investigation of underlying tuber mineralization and other properties driving kurtosis changes in quantitative susceptibility mapping values.
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Affiliation(s)
- A Chari
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | | | - K Seunarine
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | - R J Piper
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | - P Hales
- Neuroradiology (J.S., P.H., K.M., U.L.)
| | - K Shmueli
- Department of Medical Physics and Bioengineering (K. Shmueli), University College London, London, UK
| | - K Mankad
- Neuroradiology (J.S., P.H., K.M., U.L.)
| | - U Löbel
- Neuroradiology (J.S., P.H., K.M., U.L.)
| | - C Eltze
- Neurology (C.E., R.C.S., J.H.C.)
| | - F Moeller
- Neurophysiology (F.M.), Great Ormond Street Hospital, London, UK
| | - R C Scott
- Neurology (C.E., R.C.S., J.H.C.)
- Department of Pediatric Neurology (R.C.S.), Nemours Children's Hospital, Wilmington, Delaware
| | - M M Tisdall
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Departments of Neurosurgery (A.C., K. Seunarine, R.J.P. M.M.T.)
| | - J H Cross
- From Developmental Neurosciences (A.C., K. Seunarine, R.J.P., M.M.T., J.H.C.), Great Ormond Street Institute of Child Health
- Neurology (C.E., R.C.S., J.H.C.)
| | - D W Carmichael
- Engineering and Physical Sciences Research Council/Wellcome Centre for Medical Engineering and Department of Biomedical Engineering (D.W.C.), School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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19
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Zhang X, Chen F, Sun M, Wu N, Liu B, Yi X, Ge R, Fan X. Microglia in the context of multiple sclerosis. Front Neurol 2023; 14:1157287. [PMID: 37360338 PMCID: PMC10287974 DOI: 10.3389/fneur.2023.1157287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Multiple sclerosis (MS) is an inflammatory and neurodegenerative disease that commonly results in nontraumatic disability in young adults. The characteristic pathological hallmark of MS is damage to myelin, oligodendrocytes, and axons. Microglia provide continuous surveillance in the CNS microenvironment and initiate defensive mechanisms to protect CNS tissue. Additionally, microglia participate in neurogenesis, synaptic refinement, and myelin pruning through the expression and release of different signaling factors. Continuous activation of microglia has been implicated in neurodegenerative disorders. We first review the lifetime of microglia, including the origin, differentiation, development, and function of microglia. We then discuss microglia participate in the whole processes of remyelination and demyelination, microglial phenotypes in MS, and the NF-κB/PI3K-AKT signaling pathway in microglia. The damage to regulatory signaling pathways may change the homeostasis of microglia, which would accelerate the progression of MS.
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Affiliation(s)
- Xue Zhang
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Fang Chen
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Mingyue Sun
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Nan Wu
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Bin Liu
- Institute for Metabolic and Neuropsychiatric Disorders, Binzhou Medical University Hospital, Binzhou, China
| | - Xiangming Yi
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Ruli Ge
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Xueli Fan
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
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20
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Wang Z, Mak HKF, Cao P. Deep learning-regularized, single-step quantitative susceptibility mapping quantification. NMR IN BIOMEDICINE 2023; 36:e4849. [PMID: 36259729 DOI: 10.1002/nbm.4849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
The purpose of the current study was to develop deep learning-regularized, single-step quantitative susceptibility mapping (QSM) quantification, directly generating QSM from the total phase map. A deep learning-regularized, single-step QSM quantification model, named SS-POCSnet, was trained with datasets created using the QSM synthesis approach in QSM reconstruction challenge 2.0. In SS-POCSnet, a data fidelity term based on a single-step model was iteratively applied that combined the spherical mean value kernel and dipole model. Meanwhile, SS-POCSnet regularized susceptibility maps, avoiding underestimating susceptibility values. We evaluated the SS-POCSnet on 10 synthetic datasets, 24 clinical datasets with lesions of cerebral microbleed (CMB) and calcification, and 10 datasets with multiple sclerosis (MS).On synthetic datasets, SS-POCSnet showed the best performance among the methods evaluated, with a normalized root mean squared error of 37.3% ± 4.2%, susceptibility-tuned structured similarity index measure of 0.823 ± 0.02, high-frequency error norm of 37.0 ± 5.7, and peak signal-to-noise ratio of 42.8 ± 1.1. SS-POCSnet also reduced the underestimations of susceptibility values in deep brain nuclei compared with those from the other models evaluated. Furthermore, SS-POCSnet was sensitive to CMB/calcification and MS lesions, demonstrating its clinical applicability. Our method also supported variable imaging parameters, including matrix size and resolution. It was concluded that deep learning-regularized, single-step QSM quantification can mitigate underestimating susceptibility values in deep brain nuclei.
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Affiliation(s)
- Zuojun Wang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Peng Cao
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
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21
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Martire MS, Moiola L, Rocca MA, Filippi M, Absinta M. What is the potential of paramagnetic rim lesions as diagnostic indicators in multiple sclerosis? Expert Rev Neurother 2022; 22:829-837. [PMID: 36342396 DOI: 10.1080/14737175.2022.2143265] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
INTRODUCTION In multiple sclerosis (MS), paramagnetic rim lesions (PRLs) on MRI identify a subset of chronic active lesions (CALs), which have been linked through clinical and pathological studies to more severe disease course and greater disability accumulation. Beside their prognostic relevance, increasing evidence supports the use of PRL as a diagnostic biomarker. AREAS COVERED This review summarizes the most recent updates regarding the MRI pathophysiology of PRL, their prevalence in MS (by clinical phenotypes) vs mimicking conditions, and their potential role as diagnostic MS biomarkers. We searched PubMed with terms including 'multiple sclerosis' AND 'paramagnetic rim lesions' OR 'iron rim lesions' OR 'rim lesions' for manuscripts published between January 2008 and July 2022. EXPERT OPINION Current research suggests that PRL can improve the diagnostic specificity and the overall accuracy of MS diagnosis when used together with the dissemination in space MRI criteria and the central vein sign. Nevertheless, future prospective multicenter studies should further define the real-world prevalence and specificity of PRL. International guidelines are needed to establish methodological criteria for PRL identification before its implementation into clinical practice.
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Affiliation(s)
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Assunta Rocca
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Absinta
- Division of Neuroscience, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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22
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Hu H, Ye L, Ding S, Zhu Q, Yan Z, Chen X, Chen G, Feng X, Li Q, Li Y. The heterogeneity of tissue destruction between iron rim lesions and non-iron rim lesions in multiple sclerosis: A diffusion MRI study. Mult Scler Relat Disord 2022; 66:104070. [PMID: 35914471 DOI: 10.1016/j.msard.2022.104070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/04/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
OBJECTIVES This study aimed to explore the microstructural heterogeneity of different white matter (WM) tissues in relapsing-remitting multiple sclerosis (RRMS) patients by diffusion magnetic resonance imaging (dMRI) and its correlation with disability and cognitive status. MATERIALS AND METHODS A total of 337 iron rim lesions (IRLs), 337 perilesional white matters of IRLs (IRLs-PLWMs), 330 non-iron rim lesions (non-IRLs), 330 non-IRLs-PLWMs, 42 normal-appearing white matters (NAWMs) in 42 RRMS patients, and 30 white matters in healthy controls (WMs in HCs) were enrolled in the lesion-wise analysis. Diffusion kurtosis imaging (DKI) parameters including kurtosis fractional anisotropy (KFA) and mean kurtosis (MK), and diffusion tensor imaging (DTI) parameters including fractional anisotropy (FA) and mean diffusivity (MD) were measured in the six types of tissues. Subgroup analysis was performed between non-IRLs with QSM hyperintense (non-IRLs-H) and non-IRLs with QSM isointense or hypointense (non-IRLs-I), as well as between non-IRLs-H-PLWMs and non-IRLs-I-PLWMs. Thirty-four out of forty-two patients were enrolled in patient-wise analysis. The relationships between these diffusion metrics of patients and their Kurtzke Expanded Disability Status Scale (EDSS) score and Symbol Digit Modalities Test (SDMT) score were analyzed separately by partial correlation analysis with age and disease duration (DD) as covariates. RESULTS The KFA, FA, MK, and MD values were significantly different among the six types of tissues. The lowest KFA, FA, and MK values and the highest MD values were revealed in IRLs. There were significant differences in all the enrolled diffusion metrics between IRLs and non-IRLs, as well as between IRLs-PLWMs and non-IRLs-PLWMs (p < 0.05). There were no significant differences between NAWMs and WMs in HCs (p = 1.000 for all enrolled diffusion metrics). For all the enrolled diffusion metrics, no significant differences were found in the subgroup analysis. The FA, MK, and MD values of total lesions (including IRLs and non-IRLs) (r = -0.420, p = 0.017; r = -0.472, p = 0.006; r = -0.475, p = 0.006) and the MK values of IRLs (r = -0.438, p = 0.012) were correlated with the EDSS scores. There was no significant correlation between the diffusion parameter values and the SDMT scores. CONCLUSION Our findings demonstrate that IRLs are more destructive than non-IRLs. Similarly, IRLs-PLWMs are more destructive than non-IRLs-PLWMs. Additionally, diffusion parameter values of MS lesions can reflect the disability degree. These findings contribute to a better understanding of the different evolution of MS lesions and the relationship between the disability level of patients and focal lesion damage degree.
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Affiliation(s)
- Hai Hu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China; Department of Radiology, Chengdu Second People's Hospital, No.10 Qingyun South Street, Jinjiang District, Chengdu, Sichuan 610011, China
| | - Long Ye
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China; Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan 621000, China
| | - Shuang Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, Yuzhong District, Chongqing 400014, China
| | - Qiyuan Zhu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Zichun Yan
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Xiaoya Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China
| | - Guangwen Chen
- Department of Radiology, Chengdu Second People's Hospital, No.10 Qingyun South Street, Jinjiang District, Chengdu, Sichuan 610011, China
| | - Xu Feng
- Department of Radiology, The Second People's Hospital of Yibin, Yibin, Sichuan 644000, China
| | - Qing Li
- MR Collaborations, Siemens Healthineers Ltd., Shanghai, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China.
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23
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Hemond CC, Reich DS, Dundamadappa SK. Paramagnetic Rim Lesions in Multiple Sclerosis: Comparison of Visualization at 1.5-T and 3-T MRI. AJR Am J Roentgenol 2022; 219:120-131. [PMID: 34851712 PMCID: PMC9416872 DOI: 10.2214/ajr.21.26777] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Multiple sclerosis (MS) is characterized by both acute and chronic intrathecal inflammation. A subset of MS lesions show paramagnetic rims on susceptibility-weighted MRI sequences, reflecting iron accumulation in microglia. These para-magnetic rim lesions have been proposed as a marker of compartmentalized smoldering disease. Paramagnetic rim lesions have been shown at 7 T and, more recently, at 3 T. As susceptibility effects are weaker at lower field strength, it remains unclear if paramagnetic rim lesions are visible at 1.5 T. OBJECTIVE. The purpose of our study was to compare visualization of paramagnetic rim lesions using susceptibility-weighted imaging at 1.5-T and 3-T MRI in patients with MS. METHODS. This retrospective study included nine patients (five women, four men; mean age, 46.8 years) with MS who underwent both 1.5-T and 3-T MRI using a comparable susceptibility-weighted angiography (SWAN) sequence from the same manufacturer. Lesions measuring greater than 3 mm were annotated. Two reviewers independently assessed images at each field strength in separate sessions and classified the annotated lesions as isointense, diffusely paramagnetic, or paramagnetic rim lesions. Discrepancies were discussed at consensus sessions including a third reviewer. Agreement was assessed using kappa coefficients. RESULTS. Based on the 3-T consensus readings, 115 of 140 annotated lesions (82%) were isointense lesions, 16 (11%) were diffusely paramagnetic lesions, and nine (6%) were paramagnetic rim lesions; based on the 1.5-T consensus readings, 115 (82%) were isointense lesions, 14 (10%) were diffusely paramagnetic lesions, and 11 (8%) were para-magnetic rim lesions. The mean lesion diameter was 11.9 mm for paramagnetic rim lesions versus 6.4 mm for diffusely paramagnetic lesions (p = .006) and 7.8 mm for iso-intense lesions (p = .003). Interrater agreement for lesion classification as a paramagnetic rim lesion was substantial at 1.5 T (κ = 0.65) and 3 T (κ = 0.70). Agreement for paramagnetic rim lesions was also substantial between the consensus readings at the two field strengths (κ = 0.79). CONCLUSION. We show comparable identification of paramagnetic rim lesions at 1.5-T and 3-T MRI with substantial interrater agreement at both field strengths and substantial consensus agreement between the field strengths. CLINICAL IMPACT. Paramagnetic rim lesions may be an emerging marker of chronic neuroinflammation in MS. Their visibility at 1.5 T supports the translational potential of paramagnetic rim lesion identification to more widespread clinical settings, where 1.5-T scanners are prevalent.
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Affiliation(s)
- Christopher C Hemond
- Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655
| | - Daniel S Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
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24
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Huang W, Sweeney EM, Kaunzner UW, Wang Y, Gauthier SA, Nguyen TD. Quantitative susceptibility mapping versus phase imaging to identify multiple sclerosis iron rim lesions with demyelination. J Neuroimaging 2022; 32:667-675. [PMID: 35262241 PMCID: PMC9308704 DOI: 10.1111/jon.12987] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE To compare quantitative susceptibility mapping (QSM) and high-pass-filtered (HPF) phase imaging for (1) identifying chronic active rim lesions with more myelin damage and (2) distinguishing patients with increased clinical disability in multiple sclerosis. METHODS Eighty patients were scanned with QSM for paramagnetic rim detection and Fast Acquisition with Spiral Trajectory and T2prep for myelin water fraction (MWF). Chronic lesions were classified based on the presence/absence of rim on HPF and QSM images. A lesion-level linear mixed-effects model with MWF as the outcome was used to compare myelin damage among the lesion groups. A multiple patient-level linear regression model was fit to establish the association between Expanded Disease Status Scale (EDSS) and the log of the number of rim lesions. RESULTS Of 2062 lesions, 188 (9.1%) were HPF rim+/QSM rim+, 203 (9.8%) were HPF rim+/QSM rim-, and the remainder had no rim. In the linear mixed-effects model, HPF rim+/QSM rim+ lesions had significantly lower MWF than both HPF rim+/QSM rim- (p < .001) and HPF rim-/QSM rim- (p < .001) lesions, while the MWF difference between HPF rim+/QSM rim- and HPF rim-/QSM rim- lesions was not statistically significant (p = .130). Holding all other factors constant, the log number of QSM rim+ lesion was associated with EDSS increase (p = .044). The association between the log number of HPF rim+ lesions and EDSS was not statistically significant (p = .206). CONCLUSIONS QSM identifies paramagnetic rim lesions that on average have more myelin damage and stronger association with clinical disability than those detected by phase imaging.
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Affiliation(s)
- Weiyuan Huang
- Department of Radiotherapy, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China.,Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth M Sweeney
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE) Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ulrike W Kaunzner
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Susan A Gauthier
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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25
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Rahmanzadeh R, Galbusera R, Lu PJ, Bahn E, Weigel M, Barakovic M, Franz J, Nguyen TD, Spincemaille P, Schiavi S, Daducci A, La Rosa F, Absinta M, Sati P, Cuadra MB, Radue EW, Leppert D, Kuhle J, Kappos L, Brück W, Reich DS, Stadelmann C, Wang Y, Granziera C. A new advanced MRI biomarker for remyelinated lesions in Multiple Sclerosis. Ann Neurol 2022; 92:486-502. [PMID: 35713309 PMCID: PMC9527017 DOI: 10.1002/ana.26441] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
Objectives Neuropathological studies have shown that multiple sclerosis (MS) lesions are heterogeneous in terms of myelin/axon damage and repair as well as iron content. However, it remains a challenge to identify specific chronic lesion types, especially remyelinated lesions, in vivo in patients with MS. Methods We performed 3 studies: (1) a cross‐sectional study in a prospective cohort of 115 patients with MS and 76 healthy controls, who underwent 3 T magnetic resonance imaging (MRI) for quantitative susceptibility mapping (QSM), myelin water fraction (MWF), and neurite density index (NDI) maps. White matter (WM) lesions in QSM were classified into 5 QSM lesion types (iso‐intense, hypo‐intense, hyperintense, lesions with hypo‐intense rims, and lesions with paramagnetic rim legions [PRLs]); (2) a longitudinal study of 40 patients with MS to study the evolution of lesions over 2 years; (3) a postmortem histopathology‐QSM validation study in 3 brains of patients with MS to assess the accuracy of QSM classification to identify neuropathological lesion types in 63 WM lesions. Results At baseline, hypo‐ and isointense lesions showed higher mean MWF and NDI values compared to other QSM lesion types (p < 0.0001). Further, at 2‐year follow‐up, hypo‐/iso‐intense lesions showed an increase in MWF. Postmortem analyses revealed that QSM highly accurately identifies (1) fully remyelinated areas as hypo‐/iso‐intense (sensitivity = 88.89% and specificity = 100%), (2) chronic inactive lesions as hyperintense (sensitivity = 71.43% and specificity = 92.00%), and (3) chronic active/smoldering lesions as PRLs (sensitivity = 92.86% and specificity = 86.36%). Interpretation These results provide the first evidence that it is possible to distinguish chronic MS lesions in a clinical setting, hereby supporting with new biomarkers to develop and assess remyelinating treatments. ANN NEUROL 2022;92:486–502
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Affiliation(s)
- Reza Rahmanzadeh
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Erik Bahn
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Matthias Weigel
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center, Göttingen, Germany.,Max Planck Institute for Experimental Medicine, Göttingen, Germany.,Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Pascal Spincemaille
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Simona Schiavi
- Department of Computer Science, University of Verona, Verona, Italy
| | | | - Francesco La Rosa
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Martina Absinta
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive MSC 1400, Building 10 Room 5C103, Bethesda, Maryland, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Meritxell Bach Cuadra
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Ernst-Wilhelm Radue
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive MSC 1400, Building 10 Room 5C103, Bethesda, Maryland, USA
| | | | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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26
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Chiang GC, Cho J, Dyke J, Zhang H, Zhang Q, Tokov M, Nguyen T, Kovanlikaya I, Amoashiy M, de Leon M, Wang Y. Brain oxygen extraction and neural tissue susceptibility are associated with cognitive impairment in older individuals. J Neuroimaging 2022; 32:697-709. [PMID: 35294075 DOI: 10.1111/jon.12990] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/02/2022] [Accepted: 03/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE We investigated the effects of aging, white matter hyperintensities (WMH), and cognitive impairment on brain iron levels and cerebral oxygen metabolism, known to be altered in Alzheimer's disease (AD), using quantitative susceptibility mapping and MR-based cerebral oxygen extraction fraction (OEF). METHODS In 100 individuals over the age of 50 (68/32 cognitively impaired/intact), OEF and neural tissue susceptibility (χn ) were computed retrospectively from MRI multi-echo gradient echo data, obtained on a 3 Tesla MRI scanner. The effects of age and WMH on OEF and χn were assessed within groups, and OEF and χn were assessed between groups, using multivariate regression analyses. RESULTS Cognitively impaired subjects were found to have 19% higher OEF and 34% higher χn than cognitively intact subjects in the cortical gray matter and several frontal, temporal, and parietal regions (p < .05). Increased WMH burden was significantly associated with decreased OEF in the cognitively impaired, but not in the cognitively intact. Older age had a stronger association with decreased OEF in the cognitively intact group. Both older age and increased WMH burden were significantly associated with increased χn in temporoparietal regions in the cognitively impaired. CONCLUSIONS Higher brain OEF and χn in cognitively impaired older individuals may reflect altered oxygen metabolism and iron in areas with underlying AD pathology. Both age and WMH have associations with OEF and χn but are modified by the presence of cognitive impairment.
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Affiliation(s)
- Gloria C Chiang
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Junghun Cho
- MRI Research Institute, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Jonathan Dyke
- Citigroup Biomedical Imaging Center, Weill Cornell Medicine, New York, New York, USA
| | - Hang Zhang
- Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Qihao Zhang
- Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Michael Tokov
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York, USA
| | - Thanh Nguyen
- MRI Research Institute, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Ilhami Kovanlikaya
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael Amoashiy
- Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Mony de Leon
- Brain Health Imaging Institute, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Yi Wang
- MRI Research Institute, Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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27
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Disease correlates of rim lesions on quantitative susceptibility mapping in multiple sclerosis. Sci Rep 2022; 12:4411. [PMID: 35292734 PMCID: PMC8924224 DOI: 10.1038/s41598-022-08477-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/08/2022] [Indexed: 12/26/2022] Open
Abstract
Quantitative susceptibility mapping (QSM), an imaging technique sensitive to brain iron, has been used to detect paramagnetic rims of iron-laden active microglia and macrophages in a subset of multiple sclerosis (MS) lesions, known as rim+ lesions, that are consistent with chronic active lesions. Because of the potential impact of rim+ lesions on disease progression and tissue damage, investigating their influence on disability and neurodegeneration is critical to establish the impact of these lesions on the disease course. This study aimed to explore the relationship between chronic active rim+ lesions, identified as having a hyperintense rim on QSM, and both clinical disability and imaging measures of neurodegeneration in patients with MS. The patient cohort was composed of 159 relapsing-remitting multiple sclerosis patients. The Expanded Disability Status Scale (EDSS) and Brief International Cognitive Assessment for Multiple Sclerosis, which includes both the Symbol Digit Modalities Test and California Verbal Learning Test-II, were used to assess clinical disability. Cortical thickness and thalamic volume were evaluated as imaging measures of neurodegeneration. A total of 4469 MS lesions were identified, of which 171 QSM rim+ (3.8%) lesions were identified among 57 patients (35.8%). In a multivariate regression model, as the overall total lesion burden increased, patients with at least one rim+ lesion on QSM performed worse on both physical disability and cognitive assessments, specifically the Symbol Digit Modalities Test (p = 0.010), California Verbal Learning Test-II (p = 0.030), and EDSS (p = 0.001). In a separate univariate regression model, controlling for age (p < 0.001) and having at least one rim+ lesion was related to more cortical thinning (p = 0.03) in younger patients (< 45 years). Lower thalamic volume was associated with older patients (p = 0.038) and larger total lesion burden (p < 0.001); however, the association did not remain significant with rim+ lesions (p = 0.10). Our findings demonstrate a novel observation that chronic active lesions, as identified on QSM, modify the impact of lesion burden on clinical disability in MS patients. These results support further exploration of rim+ lesions for therapeutic targeting in MS to reduce disability and subsequent neurodegeneration.
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28
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Zinger N, Ponath G, Sweeney E, Nguyen TD, Lo CH, Diaz I, Dimov A, Teng L, Zexter L, Comunale J, Wang Y, Pitt D, Gauthier SA. Dimethyl Fumarate Reduces Inflammation in Chronic Active Multiple Sclerosis Lesions. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1138. [PMID: 35046083 PMCID: PMC8771666 DOI: 10.1212/nxi.0000000000001138] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/10/2021] [Indexed: 12/14/2022]
Abstract
Background and Objectives To determine the effects of dimethyl fumarate (DMF) and glatiramer acetate on iron content in chronic active lesions in patients with multiple sclerosis (MS) and in human microglia in vitro. Methods This was a retrospective observational study of 34 patients with relapsing-remitting MS and clinically isolated syndrome treated with DMF or glatiramer acetate. Patients had lesions with hyperintense rims on quantitative susceptibility mapping, were treated with DMF or glatiramer acetate (GA), and had a minimum of 2 on-treatment scans. Changes in susceptibility in rim lesions were compared among treatment groups in a linear mixed effects model. In a separate in vitro study, induced pluripotent stem cell–derived human microglia were treated with DMF or GA, and treatment-induced changes in iron content and activation state of microglia were compared. Results Rim lesions in patients treated with DMF had on average a 2.77-unit reduction in susceptibility per year over rim lesions in patients treated with GA (bootstrapped 95% CI −5.87 to −0.01), holding all other variables constant. Moreover, DMF but not GA reduced inflammatory activation and concomitantly iron content in human microglia in vitro. Discussion Together, our data indicate that DMF-induced reduction of susceptibility in MS lesions is associated with a decreased activation state in microglial cells. We have demonstrated that a specific disease modifying therapy, DMF, decreases glial activity in chronic active lesions. Susceptibility changes in rim lesions provide an in vivo biomarker for the effect of DMF on microglial activity. Classification of Evidence This study provided Class III evidence that DMF is superior to GA in the presence of iron as a marker of inflammation as measured by MRI quantitative susceptibility mapping.
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Affiliation(s)
- Nicole Zinger
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Gerald Ponath
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Elizabeth Sweeney
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Thanh D Nguyen
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Chih Hung Lo
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Ivan Diaz
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Alexey Dimov
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Leilei Teng
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Lily Zexter
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Joseph Comunale
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Yi Wang
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - David Pitt
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore
| | - Susan A Gauthier
- From the Department of Neurology (N.Z., L.Z., S.A.G.), Weill Cornell Medicine, New York; Department of Neurology (G.P., C.H.L., D.P.), Yale School of Medicine, New Haven, CT; Department of Population Health Sciences (E.S., I.D.), and Department of Radiology (T.D.N., A.D., J.C., Y.W., S.A.G.), Weil Cornell Medicine, New York; Department of Medicine (L.T.), Yale New Haven Hospital, New Haven, CT; Feil Family Brain and Mind Institute (S.A.G.), Weill Cornell Medicine, New York; and Lee Kong Chian School of Medicine (C.H.L.), Nanyang Technological University, Singapore.
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Cho J, Nguyen TD, Huang W, Sweeney EM, Luo X, Kovanlikaya I, Zhang S, Gillen KM, Spincemaille P, Gupta A, Gauthier SA, Wang Y. Brain oxygen extraction fraction mapping in patients with multiple sclerosis. J Cereb Blood Flow Metab 2022; 42:338-348. [PMID: 34558996 PMCID: PMC9122515 DOI: 10.1177/0271678x211048031] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We aimed to demonstrate the feasibility of whole brain oxygen extraction fraction (OEF) mapping for measuring lesion specific and regional OEF abnormalities in multiple sclerosis (MS) patients. In 22 MS patients and 11 healthy controls (HC), OEF and neural tissue susceptibility (χn) maps were computed from MRI multi-echo gradient echo data. In MS patients, 80 chronic active lesions with hyperintense rim on quantitative susceptibility mapping were identified, and the mean OEF and χn within the rim and core were compared using linear mixed-effect model analysis. The rim showed higher OEF and χn than the core: relative to their adjacent normal appearing white matter, OEF contrast = -6.6 ± 7.0% vs. -9.8 ± 7.8% (p < 0.001) and χn contrast = 33.9 ± 20.3 ppb vs. 25.7 ± 20.5 ppb (p = 0.017). Between MS and HC, OEF and χn were compared using a linear regression model in subject-based regions of interest. In the whole brain, compared to HC, MS had lower OEF, 30.4 ± 3.3% vs. 21.4 ± 4.4% (p < 0.001), and higher χn, -23.7 ± 7.0 ppb vs. -11.3 ± 7.7 ppb (p = 0.018). Our feasibility study suggests that OEF may serve as a useful quantitative marker of tissue oxygen utilization in MS.
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Affiliation(s)
- Junghun Cho
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Weiyuan Huang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth M Sweeney
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Xianfu Luo
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Shun Zhang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Kelly M Gillen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Susan A Gauthier
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.,Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.,Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
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Chen Z, Zhao H, Chen X, Liu M, Li X, Ma L, Yu S. The increased iron deposition of the gray matter over the whole brain in chronic migraine: an exploratory quantitative susceptibility mapping study. Mol Pain 2022; 18:17448069221074987. [PMID: 35083927 PMCID: PMC8874206 DOI: 10.1177/17448069221074987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Prior studies identified iron deposition in deep brain nuclei and the periaqueductal gray matter region in chronic migraine, and less is known about the cerebral iron deposition over the whole cerebral gray matter in CM. The aim of this case–control study is to investigate the cerebral iron deposition of gray matter in CM using an advanced quantitative susceptibility mapping. Methods A multi-echo gradient echo MR sequence was used to obtain raw quantitative susceptibility mapping data from 12 CM patients and 18 normal controls and the quantitative susceptibility mapping were reconstructed. Three dimensional T1 images were segmented and the gray matter mask was generated to extract the susceptibility value of gray matter over the whole brain. The independent t test and receiver operating characteristic curve Receiver operating characteristics was used to investigate the iron deposition changes in CM patients. Results CM presented a higher susceptibility value (1.44 × 10−3 ppm) compared with NC group (0.47 × 10−3 ppm) (p < 0.0001) over the whole cerebral gray matter. There was no correlation between susceptibility value and the clinical variables including disease duration, Visual Analog Scale (VAS), Migraine Disability Assessment Scale (MIDAS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Montreal Cognitive Assessment (MoCA) scores (p > 0.05). ROC analysis demonstrated the susceptibility had a high diagnostic efficacy (AUC 0.949, sensitivity 77.78% and specificity 100%) in distinguishing CM from NC. Conclusion CM patients had increased iron deposition in total cerebral gray matter which could be considered as a potential diagnostic and evaluated imaging biomarker in CM.
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Affiliation(s)
| | | | - Xiaoyan Chen
- Department of Neurology104607Chinese PLA General Hospital
| | - Mengqi Liu
- Department of Radiology104607Chinese PLA General Hospital
| | | | - Lin Ma
- Department of Radiology104607Chinese PLA General Hospital
| | - Shengyuan Yu
- Department of Neurology104607Chinese PLA General Hospital
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31
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Lou C, Sati P, Absinta M, Clark K, Dworkin JD, Valcarcel AM, Schindler MK, Reich DS, Sweeney EM, Shinohara RT. Fully automated detection of paramagnetic rims in multiple sclerosis lesions on 3T susceptibility-based MR imaging. Neuroimage Clin 2022; 32:102796. [PMID: 34644666 PMCID: PMC8503902 DOI: 10.1016/j.nicl.2021.102796] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/16/2021] [Accepted: 08/17/2021] [Indexed: 11/21/2022]
Abstract
Paramagnetic rim lesions are an important subtype of multiple sclerosis lesion. Automated methods can accelerate the assessment of paramagnetic rim lesions. APRL automatically identifies and accurately classifies paramagnetic rim lesions.
Background and Purpose The presence of a paramagnetic rim around a white matter lesion has recently been shown to be a hallmark of a particular pathological type of multiple sclerosis lesion. Increased prevalence of these paramagnetic rim lesions is associated with a more severe disease course in MS, but manual identification is time-consuming. We present APRL, a method to automatically detect paramagnetic rim lesions on 3T T2*-phase images. Methods T1-weighted, T2-FLAIR, and T2*-phase MRI of the brain were collected at 3T for 20 subjects with MS. The images were then processed with automated lesion segmentation, lesion center detection, lesion labelling, and lesion-level radiomic feature extraction. A total of 951 lesions were identified, 113 (12%) of which contained a paramagnetic rim. We divided our data into a training set (16 patients, 753 lesions) and a testing set (4 patients, 198 lesions), fit a random forest classification model on the training set, and assessed our ability to classify paramagnetic rim lesions on the test set. Results The number of paramagnetic rim lesions per subject identified via our automated lesion labelling method was highly correlated with the gold standard count per subject, r = 0.86 (95% CI [0.68, 0.94]). The classification algorithm using radiomic features classified lesions with an area under the curve of 0.82 (95% CI [0.74, 0.92]). Conclusion This study develops a fully automated technique, APRL, for the detection of paramagnetic rim lesions using standard T1 and FLAIR sequences and a T2*phase sequence obtained on 3T MR images.
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Affiliation(s)
- Carolyn Lou
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE) Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kelly Clark
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE) Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan D Dworkin
- Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Alessandra M Valcarcel
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE) Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA; Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth M Sweeney
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE) Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA; Center for Biomedical Image Computing and Analytics, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
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QSMRim-Net: Imbalance-aware learning for identification of chronic active multiple sclerosis lesions on quantitative susceptibility maps. Neuroimage Clin 2022; 34:102979. [PMID: 35247730 PMCID: PMC8892132 DOI: 10.1016/j.nicl.2022.102979] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Chronic active multiple sclerosis (MS) lesions are characterized by a paramagnetic rim at the edge of the lesion and are associated with increased disability in patients. Quantitative susceptibility mapping (QSM) is an MRI technique that is sensitive to chronic active lesions, termed rim + lesions on the QSM. We present QSMRim-Net, a data imbalance-aware deep neural network that fuses lesion-level radiomic and convolutional image features for automated identification of rim + lesions on QSM. METHODS QSM and T2-weighted-Fluid-Attenuated Inversion Recovery (T2-FLAIR) MRI of the brain were collected at 3 T for 172 MS patients. Rim + lesions were manually annotated by two human experts, followed by consensus from a third expert, for a total of 177 rim + and 3986 rim negative (rim-) lesions. Our automated rim + detection algorithm, QSMRim-Net, consists of a two-branch feature extraction network and a synthetic minority oversampling network to classify rim + lesions. The first network branch is for image feature extraction from the QSM and T2-FLAIR, and the second network branch is a fully connected network for QSM lesion-level radiomic feature extraction. The oversampling network is designed to increase classification performance with imbalanced data. RESULTS On a lesion-level, in a five-fold cross validation framework, the proposed QSMRim-Net detected rim + lesions with a partial area under the receiver operating characteristic curve (pROC AUC) of 0.760, where clinically relevant false positive rates of less than 0.1 were considered. The method attained an area under the precision recall curve (PR AUC) of 0.704. QSMRim-Net out-performed other state-of-the-art methods applied to the QSM on both pROC AUC and PR AUC. On a subject-level, comparing the predicted rim + lesion count and the human expert annotated count, QSMRim-Net achieved the lowest mean square error of 0.98 and the highest correlation of 0.89 (95% CI: 0.86, 0.92). CONCLUSION This study develops a novel automated deep neural network for rim + MS lesion identification using T2-FLAIR and QSM images.
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Matrosova MS, Bryukhov VV, Belskaya GN, Krotenkova MV. [Quantitative susceptibility mapping in assessment of inflammation and neurodegeneration in multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:16-22. [PMID: 36537626 DOI: 10.17116/jnevro202212212116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Quantitative susceptibility mapping (QSM) is a relatively new MRI technique that may potentially help estimate iron concentrations in the brain. It plays a big role in diagnosis of many pathological processes, including multiple sclerosis (MS). Iron metabolism in the brain is a complex and not fully understood process. It is known that the content of iron in the brain increases with age; in addition, its accumulation is often observed in many neurodegenerative diseases, including MS foci, and its amount changes over time. In this regard, the values of magnetic susceptibility obtained using QSM can potentially become a convenient biomarker that reflects the latent activity and progression of MS, which, in turn, can influence the choice of therapy and the tactics of treating patients.
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Mertens C, Marques O, Horvat NK, Simonetti M, Muckenthaler MU, Jung M. The Macrophage Iron Signature in Health and Disease. Int J Mol Sci 2021; 22:ijms22168457. [PMID: 34445160 PMCID: PMC8395084 DOI: 10.3390/ijms22168457] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/13/2022] Open
Abstract
Throughout life, macrophages are located in every tissue of the body, where their main roles are to phagocytose cellular debris and recycle aging red blood cells. In the tissue niche, they promote homeostasis through trophic, regulatory, and repair functions by responding to internal and external stimuli. This in turn polarizes macrophages into a broad spectrum of functional activation states, also reflected in their iron-regulated gene profile. The fast adaptation to the environment in which they are located helps to maintain tissue homeostasis under physiological conditions.
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Affiliation(s)
- Christina Mertens
- Department of Pediatric Hematology, Oncology and Immunology, University of Heidelberg, INF 350, 69120 Heidelberg, Germany; (O.M.); (N.K.H.); (M.U.M.)
- Correspondence: (C.M.); (M.J.); Tel.: +(49)-622-156-4582 (C.M.); +(49)-696-301-6931 (M.J.)
| | - Oriana Marques
- Department of Pediatric Hematology, Oncology and Immunology, University of Heidelberg, INF 350, 69120 Heidelberg, Germany; (O.M.); (N.K.H.); (M.U.M.)
- Molecular Medicine Partnership Unit, 69120 Heidelberg, Germany
| | - Natalie K. Horvat
- Department of Pediatric Hematology, Oncology and Immunology, University of Heidelberg, INF 350, 69120 Heidelberg, Germany; (O.M.); (N.K.H.); (M.U.M.)
- Molecular Medicine Partnership Unit, 69120 Heidelberg, Germany
- European Molecular Biology Laboratory (EMBL), Collaboration for Joint PhD Degree between EMBL and the Faculty of Biosciences, University of Heidelberg, 69117 Heidelberg, Germany
| | - Manuela Simonetti
- Institute of Pharmacology, Medical Faculty Heidelberg, Heidelberg University, INF 366, 69120 Heidelberg, Germany;
| | - Martina U. Muckenthaler
- Department of Pediatric Hematology, Oncology and Immunology, University of Heidelberg, INF 350, 69120 Heidelberg, Germany; (O.M.); (N.K.H.); (M.U.M.)
- Molecular Medicine Partnership Unit, 69120 Heidelberg, Germany
| | - Michaela Jung
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, 60590 Frankfurt, Germany
- Correspondence: (C.M.); (M.J.); Tel.: +(49)-622-156-4582 (C.M.); +(49)-696-301-6931 (M.J.)
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35
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Nathoo N, Wu Y, Rogers JA, Yong VW, Dunn JF. Susceptibility weighted imaging detects prominent veins that precede or coincide with maximal motor disability in a model of multiple sclerosis: A pilot study. Mult Scler Relat Disord 2021; 54:103124. [PMID: 34243102 DOI: 10.1016/j.msard.2021.103124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Susceptibility weighted imaging (SWI) has detected veins in the center of white matter lesions and alterations in veins themselves in multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE). However, the relationship between SWI-detected venous alterations and disease progression is unclear. The objective of this study was to assess alterations in the lumbar spinal cord veins in EAE mice over the disease course using serial SWI. METHODS EAE mice (n = 8) underwent imaging for SWI using a 9.4T Bruker Avance console at baseline, 7 days (pre-motor dysfunction), 12 days (typical motor dysfunction onset), and 16-18 days (typical peak disease) post-immunization. Naïve controls were imaged alongside EAE mice (n = 3). SWI hypointensities were counted by two subjects and compared between time points. RESULTS SWI hypointensities appeared before motor dysfunction onset in most EAE mice. The ratio of SWI hypointensities to baseline was highly variable for EAE mice (0.45-6.75) while less so for controls (0.80-1.31). The time point for the maximum number of SWI hypointensities always preceded or coincided with maximum motor disability. CONCLUSION Venous alterations are detected before the onset of motor disability in some EAE mice using SWI which may relate to inflammation and/or tissue hypoxia.
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Affiliation(s)
- Nabeela Nathoo
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ying Wu
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - James A Rogers
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - V Wee Yong
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F Dunn
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Experimental Imaging Centre, University of Calgary, Calgary, Alberta, Canada.
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