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Beaumont J, Fripp J, Raniga P, Acosta O, Ferre JC, McMahon K, Trinder J, Kober T, Gambarota G. Multi T1-weighted contrast imaging and T1 mapping with compressed sensing FLAWS at 3 T. MAGMA (NEW YORK, N.Y.) 2023; 36:823-836. [PMID: 36847989 DOI: 10.1007/s10334-023-01071-5] [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: 11/15/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE The Fluid And White matter Suppression (FLAWS) MRI sequence provides multiple T1-weighted contrasts of the brain in a single acquisition. However, the FLAWS acquisition time is approximately 8 min with a standard GRAPPA 3 acceleration factor at 3 T. This study aims at reducing the FLAWS acquisition time by providing a new sequence optimization based on a Cartesian phyllotaxis k-space undersampling and a compressed sensing (CS) reconstruction. This study also aims at showing that T1 mapping can be performed with FLAWS at 3 T. MATERIALS AND METHODS The CS FLAWS parameters were determined using a method based on a profit function maximization under constraints. The FLAWS optimization and T1 mapping were assessed with in-silico, in-vitro and in-vivo (10 healthy volunteers) experiments conducted at 3 T. RESULTS In-silico, in-vitro and in-vivo experiments showed that the proposed CS FLAWS optimization allows the acquisition time of a 1 mm-isotropic full-brain scan to be reduced from [Formula: see text] to [Formula: see text] without decreasing image quality. In addition, these experiments demonstrate that T1 mapping can be performed with FLAWS at 3 T. DISCUSSION The results obtained in this study suggest that the recent advances in FLAWS imaging allow to perform multiple T1-weighted contrast imaging and T1 mapping in a single [Formula: see text] sequence acquisition.
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Affiliation(s)
- Jeremy Beaumont
- Univ Rennes, CRLCC Eugene Marquis, Inserm, LTSI-UMR1099, LTSI, Campus de Beaulieu, Université de Rennes 1, 35042, Rennes, France.
- The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, Australia.
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, Australia
| | - Parnesh Raniga
- The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, Australia
| | - Oscar Acosta
- Univ Rennes, CRLCC Eugene Marquis, Inserm, LTSI-UMR1099, LTSI, Campus de Beaulieu, Université de Rennes 1, 35042, Rennes, France
| | - Jean-Christophe Ferre
- Univ Rennes, Inria, CNRS, Inserm, IRISA, EMPENN ERL U-1228, Rennes, France
- Department of Neuroradiology, CHU Rennes, Rennes, France
| | - Katie McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Herston Imaging Research Facility, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Julie Trinder
- The Australian e-Health Research Centre, CSIRO, Brisbane, QLD, Australia
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Giulio Gambarota
- Univ Rennes, CRLCC Eugene Marquis, Inserm, LTSI-UMR1099, LTSI, Campus de Beaulieu, Université de Rennes 1, 35042, Rennes, France
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Zenouzi R, von der Gablentz J, Heldmann M, Göttlich M, Weiler-Normann C, Sebode M, Ehlken H, Hartl J, Fellbrich A, Siemonsen S, Schramm C, Münte TF, Lohse AW. Patients with primary biliary cholangitis and fatigue present with depressive symptoms and selected cognitive deficits, but with normal attention performance and brain structure. PLoS One 2018; 13:e0190005. [PMID: 29320524 PMCID: PMC5761833 DOI: 10.1371/journal.pone.0190005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023] Open
Abstract
Background In primary biliary cholangitis (PBC) fatigue is a major clinical challenge of unknown etiology. By demonstrating that fatigue in PBC is associated with an impaired cognitive performance, previous studies have pointed out the possibility of brain abnormalities underlying fatigue in PBC. Whether structural brain changes are present in PBC patients with fatigue, however, is unclear. To evaluate the role of structural brain abnormalities in PBC patients severely affected from fatigue we, therefore, performed a case-control cerebral magnetic resonance imaging (cMRI) study and correlated changes of white and grey brain matter with the cognitive and attention performance. Methods 20 female patients with PBC and 20 female age-matched controls were examined in this study. The assessment of fatigue, psychological symptoms, cognitive and attention performance included clinical questionnaires, established cognition tests and a computerized test battery of attention performance. T1-weighted cMRI and diffusion tensor imaging (DTI) scans were acquired with a 3 Tesla scanner. Structural brain alterations were investigated with voxel-based morphometry (VBM) and DTI analyses. Results were correlated to the cognitive and attention performance. Results Compared to healthy controls, PBC patients had significantly higher levels of fatigue and associated psychological symptoms. Except for an impairment of verbal fluency, no cognitive or attention deficits were found in the PBC cohort. The VBM and DTI analyses revealed neither major structural brain abnormalities in the PBC cohort nor correlations with the cognitive and attention performance. Conclusions Despite the high burden of fatigue and selected cognitive deficits, the attention performance of PBC patients appears to be comparable to healthy people. As structural brain alterations do not seem to be present in PBC patients with fatigue, fatigue in PBC must be regarded as purely functional. Future studies should evaluate, whether functional brain changes underlie fatigue in PBC.
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Affiliation(s)
- Roman Zenouzi
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | | | - Marcus Heldmann
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Martin Göttlich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | | | - Marcial Sebode
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanno Ehlken
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Hartl
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Fellbrich
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Schramm
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas F. Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Ansgar W. Lohse
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Grover VPB, Southern L, Dyson JK, Kim JU, Crossey MME, Wylezinska‐Arridge M, Patel N, Fitzpatrick JA, Bak‐Bol A, Waldman AD, Alexander GJ, Mells GF, Chapman RW, Jones DEJ, Taylor‐Robinson SD. Early primary biliary cholangitis is characterised by brain abnormalities on cerebral magnetic resonance imaging. Aliment Pharmacol Ther 2016; 44:936-945. [PMID: 27604637 PMCID: PMC5082539 DOI: 10.1111/apt.13797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/09/2016] [Accepted: 08/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Brain change can occur in primary biliary cholangitis (PBC), potentially as a result of cholestatic and/or inflammatory processes. This change is linked to systemic symptoms of fatigue and cognitive impairment. AIM To identify whether brain change occurs early in PBC. If the change develops early and is progressive, it may explain the difficulty in treating these symptoms. METHODS Early disease brain change was explored in 13 patients with newly diagnosed biopsy-proven precirrhotic PBC using magnetisation transfer, diffusion-weighted imaging and 1 H magnetic resonance spectroscopy. Results were compared to 17 healthy volunteers. RESULTS Cerebral magnetisation transfer ratios were reduced in early PBC, compared to healthy volunteers, in the thalamus, putamen and head of caudate with no greater reduction in patients with greater symptom severity. Mean apparent diffusion coefficients were increased in the thalamus only. No 1 H magnetic resonance spectroscopy abnormalities were seen. Serum manganese levels were elevated in all PBC patients, but no relationship was seen with imaging or symptom parameters. There were no correlations between neuroimaging data, laboratory data, symptom severity scores or age. CONCLUSIONS This is the first study to be performed in this precirrhotic patient population, and we have highlighted that neuroimaging changes are present at a much earlier stage than previously demonstrated. The neuroimaging abnormalities suggest that the brain changes seen in PBC occur early in the pathological process, even before significant liver damage has occurred. If such changes are linked to symptom pathogenesis, this could have important implications for the timing of second-line-therapy use.
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Affiliation(s)
- V. P. B. Grover
- Liver UnitDivision of Diabetes, Endocrinology and MetabolismDepartment of MedicineImperial College LondonLondonUK,Robert Steiner MRI UnitImaging Sciences DepartmentMRC Clinical Sciences CentreImperial College LondonLondonUK
| | - L. Southern
- Liver UnitDivision of Diabetes, Endocrinology and MetabolismDepartment of MedicineImperial College LondonLondonUK
| | - J. K. Dyson
- Institute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneUK
| | - J. U. Kim
- Liver UnitDivision of Diabetes, Endocrinology and MetabolismDepartment of MedicineImperial College LondonLondonUK
| | - M. M. E. Crossey
- Liver UnitDivision of Diabetes, Endocrinology and MetabolismDepartment of MedicineImperial College LondonLondonUK
| | - M. Wylezinska‐Arridge
- Robert Steiner MRI UnitImaging Sciences DepartmentMRC Clinical Sciences CentreImperial College LondonLondonUK
| | - N. Patel
- Robert Steiner MRI UnitImaging Sciences DepartmentMRC Clinical Sciences CentreImperial College LondonLondonUK
| | - J. A. Fitzpatrick
- Liver UnitDivision of Diabetes, Endocrinology and MetabolismDepartment of MedicineImperial College LondonLondonUK,Robert Steiner MRI UnitImaging Sciences DepartmentMRC Clinical Sciences CentreImperial College LondonLondonUK
| | - A. Bak‐Bol
- Liver UnitDivision of Diabetes, Endocrinology and MetabolismDepartment of MedicineImperial College LondonLondonUK
| | - A. D. Waldman
- Robert Steiner MRI UnitImaging Sciences DepartmentMRC Clinical Sciences CentreImperial College LondonLondonUK
| | - G. J. Alexander
- Cambridge Hepatobiliary ServiceAddenbrookes Hospital. Hills RoadCambridgeUK
| | - G. F. Mells
- Cambridge Hepatobiliary ServiceAddenbrookes Hospital. Hills RoadCambridgeUK
| | - R. W Chapman
- Nuffield Department of MedicineOxford UniversityJohn Radcliffe HospitalOxfordUK
| | - D. E. J. Jones
- Institute of Cellular MedicineNewcastle UniversityNewcastle‐upon‐TyneUK
| | - S. D. Taylor‐Robinson
- Liver UnitDivision of Diabetes, Endocrinology and MetabolismDepartment of MedicineImperial College LondonLondonUK
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Menzies V, Jallo N, Kinser P, Robins JLW, An K, Driscoll C, Starkweather A, Bajaj JS, Lyon DE. Shared symptoms and putative biological mechanisms in chronic liver disease: implications for biobehavioral research. Biol Res Nurs 2015; 17:222-9. [PMID: 25037448 PMCID: PMC5818716 DOI: 10.1177/1099800414541541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Liver disease affects over 25 million people in the United States and, despite advances in medical management resulting in increased survival, a majority of these individuals report multiple co-occurring symptoms that severely impair functioning and quality of life. The purpose of this review is to (1) propose defining these co-occurring symptoms as a symptom cluster of chronic liver disease (CLD), (2) discuss putative underlying biological mechanisms related to CLD, including the liver-gut-brain axis and influence of the microbiome, and (3) discuss the implications for biobehavioral research in this patient population. Biobehavioral research focusing on the interrelated, and possibly synergistic, mechanisms of these symptoms may lead to the development and testing of targeted symptom management interventions for improving function and quality of life in this growing patient population.
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Affiliation(s)
- Victoria Menzies
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Nancy Jallo
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Patricia Kinser
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Jo Lynne W Robins
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Kyungeh An
- Virginia Commonwealth University School of Nursing, Richmond, VA, USA
| | - Carolyn Driscoll
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Jasmohan S Bajaj
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Debra E Lyon
- College of Nursing, University of Florida, Gainesville, FL
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Akamatsu N, Sugawara Y. Primary biliary cirrhosis and liver transplantation. Intractable Rare Dis Res 2012; 1:66-80. [PMID: 25343075 PMCID: PMC4204562 DOI: 10.5582/irdr.2012.v1.2.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 04/28/2012] [Accepted: 05/11/2012] [Indexed: 12/13/2022] Open
Abstract
Primary biliary cirrhosis (PBC) is an immune-mediated chronic progressive inflammatory liver disease, predominantly affecting middle-aged women, characterized by the presence of antimitochondrial antibodies (AMAs), which can lead to liver failure. Genetic contributions, environmental factors including chemical and infectious xenobiotics, autoimmunity and loss of tolerance have been aggressively investigated in the pathogenesis of PBC, however, the actual impact of these factors is still controversial. Survival of PBC patients has been largely improved with the widespread use of ursodeoxycholic acid (UDCA), however, one third of patients still do not respond to the treatment and proceed to liver cirrhosis, requiring liver transplantation as a last resort for cure. The outcome of liver transplantation is excellent with 5- and 10-year survival rates around 80% and 70%, respectively, while along with long survival, the recurrence of the disease has become an important outcome after liver transplantation. Prevalence rates of recurrent PBC rage widely between 1% and 35%, and seem to increase with longer follow-up. Center-specific issues, especially the use of protocol biopsy, affect the variety of incidence, yet, recurrence itself does not affect patient and graft survival at present, and retransplantation due to recurrent disease is extremely rare. With a longer follow-up, recurrent disease could have an impact on patient and graft survival.
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Affiliation(s)
- Nobuhisa Akamatsu
- Department of Hepato-biliary-pancreatic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yasuhiko Sugawara
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Address correspondence to: Dr. Yasuhiko Sugawara, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail:
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Abstract
Improved medical management and the changing disease demographic mean that the majority of patients with chronic liver disease are living with the disease rather than dying from it. Historically, the perception has been that the impact of chronic liver disease is related entirely to the consequences of endstage liver disease; however, more recently a number of systemic symptoms have been recognised that can occur at any point in the natural history of chronic liver disease and which can be associated with functional impairment and reduced quality of life. The most characteristic of these systemic symptoms is fatigue, which frequently associates with sleep disturbance and autonomic dysfunction, particularly manifest as abnormality of blood pressure regulation. Cognitive symptoms can occur even in non-cirrhotic patients. Falls can present in patients with autonomic dysfunction, complicated by the presence of peripheral muscle strength problems. Importantly for clinicians managing chronic liver disease, the severity of these systemic symptoms is typically not related to liver disease severity, and therefore despite optimal liver disease management, patients can often continue to experience debilitating symptoms. The similarity in systemic symptoms between different chronic liver diseases (and indeed chronic inflammatory conditions affecting other organs) suggests the possibility of shared pathogenetic processes and raises the possibility of common management strategies, although further research is urgently needed to confirm this. In primary biliary cirrhosis, where our understanding of systemic symptoms is arguably most developed, structured management strategies have been shown to improve the quality of life of patients. It is highly likely that similar approaches will have comparable benefits for other chronic liver disease groups. Here, we review the current understanding of systemic symptoms in chronic liver disease and offer recommendations regarding the successful management of these symptoms. Critical for successful treatment is use of a structured and systematic approach to management in which all contributing factors are addressed in an organised fashion. We believe that such a systematic approach, when applied to research as well as to clinical management, will allow us to reduce the overall burden of chronic liver disease, improve quality of life and enhance functional ability.
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Affiliation(s)
- Julia L Newton
- UK NIHR Biomedical Research Centre in Ageing and Age Related Diseases, Newcastle University, Newcastle, UK.
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Functional capacity is significantly impaired in primary biliary cirrhosis and is related to orthostatic symptoms. Eur J Gastroenterol Hepatol 2011; 23:566-72. [PMID: 21593676 DOI: 10.1097/meg.0b013e3283470256] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess patient-reported functional ability and its relationship with symptoms in primary biliary cirrhosis (PBC). METHODS Functional status was assessed in a representative cohort of 75 patients with PBC using the Patient-Reported Outcome Measure Information System Health-Assessment Questionnaire (PROMIS-HAQ) functional assessment tool and was related to both symptom severity at the point of assessment (assessed using the PBC-40 and Orthostatic Grading Scale) and symptom severity change over the previous 4 years. Functional status in the PBC group was compared with primary sclerosing cholangitis (cholestatic liver disease) and community controls. RESULTS Functional impairment at follow-up (PROMIS-HAQ) was substantial in PBC significantly higher than that in both primary sclerosing cholangitis and community controls. PROMIS-HAQ domain scores confirmed that patients with PBC had significant impairment in arising, eating, walking, reach and grip and activity, but not dressing or hygiene. Functional impairment correlated positively with greater PBC-40 Fatigue, Cognitive and Social and Emotional domains and higher orthostatic symptoms. Over 4 years, total symptom burden increased significantly (P=0.03). The predominant factor was rise in Cognitive domain scores indicating worsening cognitive symptoms (P<0.0001). Change in PBC-40 Cognitive, Social and Emotional scores (2005-2009) strongly predicted functional ability in 2009. Multivariate analysis confirmed that PROMIS-HAQ scores were predicted independently by PBC-40 Social and Emotional scores (P=0.02; β=0.3) and orthostatic symptoms (P=0.04; β=0.3). CONCLUSION PBC associates with substantial functional impairment. PBC symptom distribution evolves over time, with cognitive symptoms making ever-greater contribution to overall symptom burden. The major potentially modifiable determinant responsible for the functional impairment appears to be orthostatic symptoms.
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Abstract
Primary biliary cirrhosis is a chronic liver disease characterised by intrahepatic bile-duct destruction, cholestasis, and, in some cases, cirrhosis. Evidence supporting the autoimmune nature of this disorder includes the appearance of highly specific antimitochondrial antibodies (AMAs) and autoreactive T cells. Concordance rates in monozygotic twins, familial prevalence, and genetic associations underscore the importance of genetic factors, whereas findings of epidemiological studies and murine models suggest a possible role for exogenous chemicals and infectious agents through molecular mimicry. The incidence of primary biliary cirrhosis has increased over recent decades, possibly attributable to augmented testing of liver biochemistry rather than a rise in disease incidence. AMAs remain the hallmark of diagnosis in most cases and allow detection of asymptomatic patients. Symptomatic individuals usually present with either pruritus or fatigue and, more rarely, with either jaundice or complications of cirrhosis. The prognosis of primary biliary cirrhosis has improved because of early diagnosis and use of ursodeoxycholic acid, the only established medical treatment for this disorder. Although not a cure, treatment can slow disease progression and delay the need for liver transplantation. However, some patients do not respond adequately to ursodeoxycholic acid and might need alternative therapeutic approaches.
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Affiliation(s)
- Carlo Selmi
- Department of Translational Medicine, IRCCS-Istituto Clinico Humanitas, University of Milan, Milan, Italy
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