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Boito D, Eklund A, Tisell A, Levi R, Özarslan E, Blystad I. MRI with generalized diffusion encoding reveals damaged white matter in patients previously hospitalized for COVID-19 and with persisting symptoms at follow-up. Brain Commun 2023; 5:fcad284. [PMID: 37953843 PMCID: PMC10638510 DOI: 10.1093/braincomms/fcad284] [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: 05/02/2023] [Revised: 08/25/2023] [Accepted: 10/26/2023] [Indexed: 11/14/2023] Open
Abstract
There is mounting evidence of the long-term effects of COVID-19 on the central nervous system, with patients experiencing diverse symptoms, often suggesting brain involvement. Conventional brain MRI of these patients shows unspecific patterns, with no clear connection of the symptomatology to brain tissue abnormalities, whereas diffusion tensor studies and volumetric analyses detect measurable changes in the brain after COVID-19. Diffusion MRI exploits the random motion of water molecules to achieve unique sensitivity to structures at the microscopic level, and new sequences employing generalized diffusion encoding provide structural information which are sensitive to intravoxel features. In this observational study, a total of 32 persons were investigated: 16 patients previously hospitalized for COVID-19 with persisting symptoms of post-COVID condition (mean age 60 years: range 41-79, all male) at 7-month follow-up and 16 matched controls, not previously hospitalized for COVID-19, with no post-COVID symptoms (mean age 58 years, range 46-69, 11 males). Standard MRI and generalized diffusion encoding MRI were employed to examine the brain white matter of the subjects. To detect possible group differences, several tissue microstructure descriptors obtainable with the employed diffusion sequence, the fractional anisotropy, mean diffusivity, axial diffusivity, radial diffusivity, microscopic anisotropy, orientational coherence (Cc) and variance in compartment's size (CMD) were analysed using the tract-based spatial statistics framework. The tract-based spatial statistics analysis showed widespread statistically significant differences (P < 0.05, corrected for multiple comparisons using the familywise error rate) in all the considered metrics in the white matter of the patients compared to the controls. Fractional anisotropy, microscopic anisotropy and Cc were lower in the patient group, while axial diffusivity, radial diffusivity, mean diffusivity and CMD were higher. Significant changes in fractional anisotropy, microscopic anisotropy and CMD affected approximately half of the analysed white matter voxels located across all brain lobes, while changes in Cc were mainly found in the occipital parts of the brain. Given the predominant alteration in microscopic anisotropy compared to Cc, the observed changes in diffusion anisotropy are mostly due to loss of local anisotropy, possibly connected to axonal damage, rather than white matter fibre coherence disruption. The increase in radial diffusivity is indicative of demyelination, while the changes in mean diffusivity and CMD are compatible with vasogenic oedema. In summary, these widespread alterations of white matter microstructure are indicative of vasogenic oedema, demyelination and axonal damage. These changes might be a contributing factor to the diversity of central nervous system symptoms that many patients experience after COVID-19.
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Affiliation(s)
- Deneb Boito
- Department of Biomedical Engineering, Linköping University, S-58183 Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, S-58183 Linköping, Sweden
| | - Anders Eklund
- Department of Biomedical Engineering, Linköping University, S-58183 Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, S-58183 Linköping, Sweden
- Division of Statistics and Machine learning, Department of Computer and Information Science, Linköping University, S-58183 Linköping, Sweden
| | - Anders Tisell
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, S-58183 Linköping, Sweden
- Department of Radiation Physics, Linköping University, S-58185 Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, S58183 Linköping, Sweden
| | - Richard Levi
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, S-58183 Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, S58183 Linköping, Sweden
- Department of Rehabilitation Medicine in Linköping, Linköping University, S-58185 Linköping, Sweden
| | - Evren Özarslan
- Department of Biomedical Engineering, Linköping University, S-58183 Linköping, Sweden
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, S-58183 Linköping, Sweden
| | - Ida Blystad
- Centre for Medical Image Science and Visualization (CMIV), Linköping University, S-58183 Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, S58183 Linköping, Sweden
- Department of Radiology in Linköping, Linköping University, S-58185 Linköping, Sweden
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Herberthson M, Boito D, Haije TD, Feragen A, Westin CF, Özarslan E. Q-space trajectory imaging with positivity constraints (QTI+). Neuroimage 2021; 238:118198. [PMID: 34029738 PMCID: PMC9596133 DOI: 10.1016/j.neuroimage.2021.118198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/02/2021] [Accepted: 05/20/2021] [Indexed: 01/18/2023] Open
Abstract
Q-space trajectory imaging (QTI) enables the estimation of useful scalar measures indicative of the local tissue structure. This is accomplished by employing generalized gradient waveforms for diffusion sensitization alongside a diffusion tensor distribution (DTD) model. The first two moments of the underlying DTD are made available by acquisitions at low diffusion sensitivity (b-values). Here, we show that three independent conditions have to be fulfilled by the mean and covariance tensors associated with distributions of symmetric positive semidefinite tensors. We introduce an estimation framework utilizing semi-definite programming (SDP) to guarantee that these conditions are met. Applying the framework on simulated signal profiles for diffusion tensors distributed according to non-central Wishart distributions demonstrates the improved noise resilience of QTI+ over the commonly employed estimation methods. Our findings on a human brain data set also reveal pronounced improvements, especially so for acquisition protocols featuring few number of volumes. Our method’s robustness to noise is expected to not only improve the accuracy of the estimates, but also enable a meaningful interpretation of contrast in the derived scalar maps. The technique’s performance on shorter acquisitions could make it feasible in routine clinical practice.
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Affiliation(s)
| | - Deneb Boito
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
| | - Tom Dela Haije
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark.
| | - Aasa Feragen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark.
| | - Carl-Fredrik Westin
- Laboratory for Mathematics in Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Evren Özarslan
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden.
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Liu C, Özarslan E. Multimodal integration of diffusion MRI for better characterization of tissue biology. NMR IN BIOMEDICINE 2019; 32:e3939. [PMID: 30011138 DOI: 10.1002/nbm.3939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/01/2018] [Accepted: 04/09/2018] [Indexed: 06/08/2023]
Abstract
The contrast in diffusion-weighted MR images is due to variations of diffusion properties within the examined specimen. Certain microstructural information on the underlying tissues can be inferred through quantitative analyses of the diffusion-sensitized MR signals. In the first part of the paper, we review two types of approach for characterizing diffusion MRI signals: Bloch's equations with diffusion terms, and statistical descriptions. Specifically, we discuss expansions in terms of cumulants and orthogonal basis functions, the confinement tensor formalism and tensor distribution models. Further insights into the tissue properties may be obtained by integrating diffusion MRI with other techniques, which is the subject of the second part of the paper. We review examples involving magnetic susceptibility, structural tensors, internal field gradients, transverse relaxation and functional MRI. Integrating information provided by other imaging modalities (MR based or otherwise) could be a key to improve our understanding of how diffusion MRI relates to physiology and biology.
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Affiliation(s)
- Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California, Berkeley, CA, USA
- Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Evren Özarslan
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Herberthson M, Özarslan E, Knutsson H, Westin CF. Dynamics of local magnetization in the eigenbasis of the Bloch-Torrey operator. J Chem Phys 2018; 146:124201. [PMID: 28388135 DOI: 10.1063/1.4978621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We consider diffusion within pores with general shapes in the presence of spatially linear magnetic field profiles. The evolution of local magnetization of the spin bearing particles can be described by the Bloch-Torrey equation. We study the diffusive process in the eigenbasis of the non-Hermitian Bloch-Torrey operator. It is possible to find expressions for some special temporal gradient waveforms employed to sensitize the nuclear magnetic resonance (NMR) signal to diffusion. For more general gradient waveforms, we derive an efficient numerical solution by introducing a novel matrix formalism. Compared to previous methods, this new approach requires a fewer number of eigenfunctions to achieve the same accuracy. This shows that these basis functions are better suited to the problem studied. The new framework could provide new important insights into the fundamentals of diffusion sensitization, which could further the development of the field of NMR.
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Affiliation(s)
- Magnus Herberthson
- Division of Mathematics and Applied Mathematics, Department of Mathematics, Linköping University, Linköping, Sweden
| | - Evren Özarslan
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Hans Knutsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Carl-Fredrik Westin
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
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Özarslan E, Yolcu C, Herberthson M, Westin CF, Knutsson H. Effective potential for magnetic resonance measurements of restricted diffusion. FRONTIERS IN PHYSICS 2017; 5:68. [PMID: 29629371 PMCID: PMC5889054 DOI: 10.3389/fphy.2017.00068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The signature of diffusive motion on the NMR signal has been exploited to characterize the mesoscopic structure of specimens in numerous applications. For compartmentalized specimens comprising isolated subdomains, a representation of individual pores is necessary for describing restricted diffusion within them. When gradient waveforms with long pulse durations are employed, a quadratic potential profile is identified as an effective energy landscape for restricted diffusion. The dependence of the stochastic effective force on the center-of-mass position is indeed found to be approximately linear (Hookean) for restricted diffusion even when the walls are sticky. We outline the theoretical basis and practical advantages of our picture involving effective potentials.
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Affiliation(s)
- Evren Özarslan
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Correspondence: Linköpings universitet, Campus US, Institutionen för medicinsk teknik, 581 85 Linköping Sweden,
| | - Cem Yolcu
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Magnus Herberthson
- Division of Mathematics and Applied Mathematics, Department of Mathematics, Linköping University, Linköping, Sweden
| | - Carl-Fredrik Westin
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Laboratory for Mathematics in Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Hans Knutsson
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
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Yolcu C, Memiç M, Şimşek K, Westin CF, Özarslan E. NMR signal for particles diffusing under potentials: From path integrals and numerical methods to a model of diffusion anisotropy. Phys Rev E 2016; 93:052602. [PMID: 27300946 DOI: 10.1103/physreve.93.052602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Indexed: 06/06/2023]
Abstract
We study the influence of diffusion on NMR experiments when the molecules undergo random motion under the influence of a force field and place special emphasis on parabolic (Hookean) potentials. To this end, the problem is studied using path integral methods. Explicit relationships are derived for commonly employed gradient waveforms involving pulsed and oscillating gradients. The Bloch-Torrey equation, describing the temporal evolution of magnetization, is modified by incorporating potentials. A general solution to this equation is obtained for the case of parabolic potential by adopting the multiple correlation function (MCF) formalism, which has been used in the past to quantify the effects of restricted diffusion. Both analytical and MCF results were found to be in agreement with random walk simulations. A multidimensional formulation of the problem is introduced that leads to a new characterization of diffusion anisotropy. Unlike the case of traditional methods that employ a diffusion tensor, anisotropy originates from the tensorial force constant, and bulk diffusivity is retained in the formulation. Our findings suggest that some features of the NMR signal that have traditionally been attributed to restricted diffusion are accommodated by the Hookean model. Under certain conditions, the formalism can be envisioned to provide a viable approximation to the mathematically more challenging restricted diffusion problems.
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Affiliation(s)
- Cem Yolcu
- Department of Physics, Boğaziçi University, Bebek, İstanbul 34342, Turkey
| | - Muhammet Memiç
- Department of Physics, Boğaziçi University, Bebek, İstanbul 34342, Turkey
| | - Kadir Şimşek
- Department of Physics, Boğaziçi University, Bebek, İstanbul 34342, Turkey
| | - Carl-Fredrik Westin
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02215, USA
| | - Evren Özarslan
- Department of Physics, Boğaziçi University, Bebek, İstanbul 34342, Turkey
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