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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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2
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Okromelidze L, Patel V, Singh RB, Lopez Chiriboga AS, Tao S, Zhou X, Straub S, Westerhold EM, Gupta V, Agarwal AK, Murray JV, Desai A, Sandhu SJS, Marin Collazo IV, Middlebrooks EH. Central Vein Sign in Multiple Sclerosis: A Comparison Study of the Diagnostic Performance of 3T versus 7T MRI. AJNR Am J Neuroradiol 2023; 45:76-81. [PMID: 38164557 PMCID: PMC10756573 DOI: 10.3174/ajnr.a8083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE An early and accurate diagnosis of multiple sclerosis remains challenging in clinical neurology. Established diagnostic methods have less than desirable sensitivity and specificity. An accurate, noninvasive diagnostic test for MS could have a major impact on diagnostic criteria. We compared the frequency of detection of the central vein sign (CVS) in white matter lesions of MS and controls on 7T T2*-weighted and SWI to 3T SWI. Additionally, we assessed the diagnostic performance of 7T T2*, 7T SWI, and 3T SWI for MS. MATERIALS AND METHODS A retrospective case-control study was performed of patients with MS having both 7T MRI and 3T MRI. A control group of patients without MS was selected. Diagnosis of MS was established by board-certified neurologists with fellowship training in autoimmune neurology in line with the 2017 McDonald criteria. Percentage of lesions with a CVS was blindly measured for each technique. Diagnostic performance was computed by sensitivity, specificity, and positive and negative likelihood ratios (LRs). RESULTS Sixty-one patients with MS (903 lesions) and 39 controls (1088 lesions) were included. 7T T2* showed significantly more CVS (87%) than both 7T SWI (73%) and 3T SWI (31%) (all P < .001). CVS was identified in the control group in ≤6% of lesions on all sequences. Using a threshold of >40% of lesions with CVS on 7T T2* and >15% on 7T SWI, both sequences had an accuracy = 100%, sensitivity = 100%, specificity = 100%, infinite positive LR, and zero negative LR. Using an optimal threshold of >12%, 3T SWI had an accuracy = 96.0%, sensitivity = 93.4%, specificity = 100%, infinite positive LR, and negative LR = 0.066. CONCLUSIONS 7T MRI had 100% sensitivity and specificity for the diagnosis of MS and is superior to 3T. Future revisions to MS diagnostic criteria may consider recommendations for 7T MRI and inclusion of CVS as a biomarker.
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Affiliation(s)
- Lela Okromelidze
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Vishal Patel
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Rahul B Singh
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | | | - Shengzhen Tao
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Xiangzhi Zhou
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Sina Straub
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Erin M Westerhold
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Vivek Gupta
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Amit K Agarwal
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - John V Murray
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Amit Desai
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S J S Sandhu
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | | | - Erik H Middlebrooks
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
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Younger DS. Multiple sclerosis: Motor dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:119-147. [PMID: 37620066 DOI: 10.1016/b978-0-323-98817-9.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Multiple sclerosis is a chronic neurological disease characterized by inflammation and degeneration within the central nervous system. Over the course of the disease, most MS patients successively accumulate inflammatory lesions, axonal damage, and diffuse CNS pathology, along with an increasing degree of motor disability. While the pharmacological approach to MS targets inflammation to decrease relapse rates and relieve symptoms, disease-modifying therapy and immunosuppressive medications may not prevent the accumulation of pathology in most patients leading to long-term motor disability. This has been met with recent interest in promoting plasticity-guided concepts, enhanced by neurophysiological and neuroimaging approaches to address the preservation of motor function.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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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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5
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Chaaban L, Safwan N, Moussa H, El‐Sammak S, Khoury S, Hannoun S. Central vein sign: A putative diagnostic marker for multiple sclerosis. Acta Neurol Scand 2022; 145:279-287. [PMID: 34796472 DOI: 10.1111/ane.13553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/04/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022]
Abstract
The presence of a "central vein sign" (CVS) has been introduced as a biomarker for the diagnosis of multiple sclerosis (MS) and shown to have the ability to accurately differentiate MS from other white matter diseases (MS mimics). Following the development of susceptibility-based magnetic resonance venography that allowed the in vivo detection of CVS, a standard CVS definition was established by introducing the "40% rule" that assesses the number of MS lesions with CVS as a fraction of the total number of lesions to differentiate MS lesions from other types of lesions. The "50% rule," the "three-lesion criteria," and the "six-lesion criteria" were later introduced and defined. Each of these rules had high levels of sensitivity, specificity, and accuracy in differentiating MS from other diseases, which has been recognized by the Magnetic Resonance Imaging in MS (MAGNIMS) group and the Consortium of MS Centers task force. The North American Imaging in Multiple Sclerosis Cooperative even provided statements and recommendations aiming to refine, standardize and evaluate the CVS in MS. Herein, we review the existing literature on CVS and evaluate its added value in the diagnosis of MS and usefulness in differentiating it from other vasculopathies. We also review the histopathology of CVS and identify available automated CVS assessment methods as well as define the role of vascular comorbidities in the diagnosis of MS.
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Affiliation(s)
- Lara Chaaban
- Department of Agriculture and Food Sciences American University of Beirut Beirut Lebanon
| | - Nancy Safwan
- Department of Agriculture and Food Sciences American University of Beirut Beirut Lebanon
| | - Hussein Moussa
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
| | - Sally El‐Sammak
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
- Faculty of Medicine Abu‐Haidar Neuroscience Institute American University of Beirut Medical Center Beirut Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center American University of Beirut Medical Center Beirut Lebanon
- Medical Imaging Sciences Program Division of Health Professions Faculty of Health Sciences American University of Beirut Beirut Lebanon
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6
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Dal-Bianco A, Schranzer R, Grabner G, Lanzinger M, Kolbrink S, Pusswald G, Altmann P, Ponleitner M, Weber M, Kornek B, Zebenholzer K, Schmied C, Berger T, Lassmann H, Trattnig S, Hametner S, Leutmezer F, Rommer P. Iron Rims in Patients With Multiple Sclerosis as Neurodegenerative Marker? A 7-Tesla Magnetic Resonance Study. Front Neurol 2022; 12:632749. [PMID: 34992573 PMCID: PMC8724313 DOI: 10.3389/fneur.2021.632749] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Multiple sclerosis (MS) is a demyelinating and neurodegenerative disease of the central nervous system, characterized by inflammatory-driven demyelination. Symptoms in MS manifest as both physical and neuropsychological deficits. With time, inflammation is accompanied by neurodegeneration, indicated by brain volume loss on an MRI. Here, we combined clinical, imaging, and serum biomarkers in patients with iron rim lesions (IRLs), which lead to severe tissue destruction and thus contribute to the accumulation of clinical disability. Objectives: Subcortical atrophy and ventricular enlargement using an automatic segmentation pipeline for 7 Tesla (T) MRI, serum neurofilament light chain (sNfL) levels, and neuropsychological performance in patients with MS with IRLs and non-IRLs were assessed. Methods: In total 29 patients with MS [15 women, 24 relapsing-remitting multiple sclerosis (RRMS), and five secondary-progressive multiple sclerosis (SPMS)] aged 38 (22–69) years with an Expanded Disability Status Score of 2 (0–8) and a disease duration of 11 (5–40) years underwent neurological and neuropsychological examinations. Volumes of lesions, subcortical structures, and lateral ventricles on 7-T MRI (SWI, FLAIR, and MP2RAGE, 3D Segmentation Software) and sNfL concentrations using the Simoa SR-X Analyzer in IRL and non-IRL patients were assessed. Results: (1) Iron rim lesions patients had a higher FLAIR lesion count (p = 0.047). Patients with higher MP2Rage lesion volume exhibited more IRLs (p <0.014) and showed poorer performance in the information processing speed tested within 1 year using the Symbol Digit Modalities Test (SDMT) (p <0.047). (2) Within 3 years, patients showed atrophy of the thalamus (p = 0.021) and putamen (p = 0.043) and enlargement of the lateral ventricles (p = 0.012). At baseline and after 3 years, thalamic volumes were lower in IRLs than in non-IRL patients (p = 0.045). (3) At baseline, IRL patients had higher sNfL concentrations (p = 0.028). Higher sNfL concentrations were associated with poorer SDMT (p = 0.004), regardless of IRL presence. (4) IRL and non-IRL patients showed no significant difference in the neuropsychological performance within 1 year. Conclusions: Compared with non-IRL patients, IRL patients had higher FLAIR lesion counts, smaller thalamic volumes, and higher sNfL concentrations. Our pilot study combines IRL and sNfL, two biomarkers considered indicative for neurodegenerative processes. Our preliminary data underscore the reported destructive nature of IRLs.
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Affiliation(s)
| | - R Schranzer
- Department of Neurology, Vienna, Austria.,Department of Medical Engineering, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | - G Grabner
- Department of Neurology, Vienna, Austria.,Department of Medical Engineering, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | | | - S Kolbrink
- Department of Neurology, Vienna, Austria
| | - G Pusswald
- Department of Neurology, Vienna, Austria
| | - P Altmann
- Department of Neurology, Vienna, Austria
| | | | - M Weber
- Department of Biomedical Imaging and Image-Guided Therapy, High Field Magnetic Resonance Centre, Vienna, Austria
| | - B Kornek
- Department of Neurology, Vienna, Austria
| | | | - C Schmied
- Department of Neurology, Vienna, Austria
| | - T Berger
- Department of Neurology, Vienna, Austria
| | - H Lassmann
- Department of Neuroimmunology, Center for Brain Research, Vienna, Austria
| | - S Trattnig
- Department of Biomedical Imaging and Image-Guided Therapy, High Field Magnetic Resonance Centre, Vienna, Austria
| | - S Hametner
- Department of Neurology, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | | | - P Rommer
- Department of Neurology, Vienna, Austria
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7
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Weber CE, Wittayer M, Kraemer M, Dabringhaus A, Bail K, Platten M, Schirmer L, Gass A, Eisele P. Long-term dynamics of multiple sclerosis iron rim lesions. Mult Scler Relat Disord 2022; 57:103340. [PMID: 35158450 DOI: 10.1016/j.msard.2021.103340] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Several studies have pointed out that seemingly chronic multiple sclerosis (MS) lesions may also be in inflammatory states. In pathological studies, up to 40% of chronic MS lesions are characterized as "chronic active" or "smoldering" lesions that are characterized by a rim of iron-laden proinflammatory macrophages/microglial cells at the lesion edge with low-grade continuous myelin breakdown. In vivo, these lesions can be visualized as "iron rim lesions" (IRLs) on susceptibility-weighted imaging (SWI). The aim of this study was to investigate the long-term dynamics of IRLs in vivo for a more detailed evolution of dynamic lesion volume changes occurring over time. METHODS We retrospectively identified patients with MS who were followed for at least 36 months (up to 72 months) and underwent at least an annual MRI on the same 3 Tsystem. Using Voxel-Guided Morphometry (VGM) we investigated regional volume changes within lesions and correlated these findings with SWI for the presence of a characteristic hypointense lesion rim. To estimate tissue damage, apparent diffusion coefficient (ADC) values for every lesion at baseline and follow-up MRIs were determined. RESULTS Forty-three patients were included in the study. Overall, we identified 302 supratentorial non-confluent MS lesions (52 persistent IRLs, nine transient IRLs, 228 non-IRLs and 13 acute contrast-enhancing lesions). During follow-up, persistent IRLs significantly enlarged, whereas non-IRLs showed a tendency to shrink. At baseline MRI, ADC values were significantly higher in persistent IRLs (1.23 × 10-3 mm/s2) compared to non-IRLs (1.01 × 10-3 mm/s2; p < 0.001), but not compared to transient IRLs (1.06 × 10-3 mm/s2; p = 0.15) and contrast-enhancing lesions (1.15 × 10-3 mm/s2; p = 1.0). During follow-up, ADC values significantly increased more often in persistent IRLs compared to all other lesion types (p < 0.0001). CONCLUSIONS Our long-term data demonstrate that persistent IRLs enlarge during disease duration, whereas non-IRLs show a tendency to shrink. Furthermore, IRLs are associated with sustained tissue damage, supporting the notion that IRLs could represent a new imaging biomarker in MS.
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Affiliation(s)
- Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Matthias Kraemer
- VGMorph GmbH, Waterloostr. 32, 45472 Mülheim an der Ruhr, Germany; Neurocentrum, Am Ziegelkamp 1f, 41515 Grevenbroich, Germany.
| | | | - Kathrin Bail
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany; Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lucas Schirmer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany; Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Interdisciplinary Center for Neurosciences, Heidelberg University, Heidelberg, Germany.
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center of Translational Neurosciences (MCTN), Heidelberg University, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
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8
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Dal-Bianco A, Grabner G, Kronnerwetter C, Weber M, Kornek B, Kasprian G, Berger T, Leutmezer F, Rommer PS, Trattnig S, Lassmann H, Hametner S. Long-term evolution of multiple sclerosis iron rim lesions in 7 T MRI. Brain 2021; 144:833-847. [PMID: 33484118 DOI: 10.1093/brain/awaa436] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/24/2020] [Accepted: 10/01/2020] [Indexed: 01/10/2023] Open
Abstract
Recent data suggest that multiple sclerosis white matter lesions surrounded by a rim of iron containing microglia, termed iron rim lesions, signify patients with more severe disease course and a propensity to develop progressive multiple sclerosis. So far, however, little is known regarding the dynamics of iron rim lesions over long-time follow-up. In a prospective longitudinal cohort study in 33 patients (17 females; 30 relapsing-remitting, three secondary progressive multiple sclerosis; median age 36.6 years (18.6-62.6), we characterized the evolution of iron rim lesions by MRI at 7 T with annual scanning. The longest follow-up was 7 years in a subgroup of eight patients. Median and mean observation period were 1 (0-7) and 2.9 (±2.6) years, respectively. Images were acquired using a fluid-attenuated inversion recovery sequence fused with iron-sensitive MRI phase data, termed FLAIR-SWI, as well as a magnetization prepared two rapid acquisition gradient echoes, termed MP2RAGE. Volumes and T1 relaxation times of lesions with and without iron rims were assessed by manual segmentation. The pathological substrates of periplaque signal changes outside the iron rims were corroborated by targeted histological analysis on 17 post-mortem cases (10 females; two relapsing-remitting, 13 secondary progressive and two primary progressive multiple sclerosis; median age 66 years (34-88), four of them with available post-mortem 7 T MRI data. We observed 16 nascent iron rim lesions, which mainly formed in relapsing-remitting multiple sclerosis. Iron rim lesion fraction was significantly higher in relapsing-remitting than progressive disease (17.8 versus 7.2%; P < 0.001). In secondary progressive multiple sclerosis only, iron rim lesions showed significantly different volume dynamics (P < 0.034) compared with non-rim lesions, which significantly shrank with time in both relapsing-remitting (P < 0.001) and secondary progressive multiple sclerosis (P < 0.004). The iron rims themselves gradually diminished with time (P < 0.008). Compared with relapsing-remitting multiple sclerosis, iron rim lesions in secondary progressive multiple sclerosis were significantly more destructive than non-iron rim lesions (P < 0.001), reflected by prolonged lesional T1 relaxation times and by progressively increasing changes ascribed to secondary axonal degeneration in the periplaque white matter. Our study for the first time shows that chronic active lesions in multiple sclerosis patients evolve over many years after their initial formation. The dynamics of iron rim lesions thus provide one explanation for progressive brain damage and disability accrual in patients. Their systematic recording might become useful as a tool for predicting disease progression and monitoring treatment in progressive multiple sclerosis.
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Affiliation(s)
| | - Günther Grabner
- Department of Neurology, Medical University of Vienna, Austria.,Department of Medical Engineering, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | - Claudia Kronnerwetter
- Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Austria
| | - Michael Weber
- Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Austria
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Austria
| | - Gregor Kasprian
- Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Austria
| | | | - Siegfried Trattnig
- Biomedical Imaging and Image-guided Therapy, High Field MR Center, Medical University of Vienna, Austria
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Austria
| | - Simon Hametner
- Department of Neurology, Medical University of Vienna, Austria
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9
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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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10
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Aker L, Abandeh L, Abdelhady M, Aboughalia H, Vattoth S. Susceptibility-weighted Imaging in Neuroradiology: Practical Imaging Principles, Pearls and Pitfalls. Curr Probl Diagn Radiol 2021; 51:568-578. [PMID: 34210556 DOI: 10.1067/j.cpradiol.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/10/2021] [Indexed: 01/13/2023]
Abstract
Susceptibility-weighted imaging (SWI) was one of the recent and helpful advancement in magnetic resonance imaging. Its utilization -provided valuable information for the radiologists in multiple fields, including neuroradiology. SWI was able to demonstrate cerebral paramagnetic and diamagnetic substances. Therefore, the applications of this imaging technique were diverse in research and clinical neuroradiology. This article reviewed the basic technical steps, various clinical applications of SWI, and potential limitations. The practicing radiologist needs to be oriented about using SWI and phase images in the right- and left-handed MRI systems to demonstrate different brain pathologies, including neurovascular diseases, traumatic brain injuries, brain tumors, infectious and inflammatory, and neurodegenerative diseases.
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Affiliation(s)
- Loai Aker
- Department of Clinical Imaging, Hamad Medical Corporation,Doha,Qatar.
| | - Laith Abandeh
- Department of Radiology, University of Washington, Seattle,WA
| | | | - Hassan Aboughalia
- Radiology Department, Seattle Children's Hospital, University of Washington Medical Center,Seattle,WA
| | - Surjith Vattoth
- Neuroradiology Section, University of Arkansas for Medical Sciences (UAMS),Little Rock,AR
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11
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Weber CE, Wittayer M, Kraemer M, Dabringhaus A, Platten M, Gass A, Eisele P. Quantitative MRI texture analysis in chronic active multiple sclerosis lesions. Magn Reson Imaging 2021; 79:97-102. [PMID: 33771609 DOI: 10.1016/j.mri.2021.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Recently, there has been an increasing interest in "chronic enlarging" or "chronic active" multiple sclerosis (MS) lesions that are associated with clinical disability. However, investigation of dynamic lesion volume changes requires longitudinal MRI data from two or more time points. The aim of this study was to investigate the application of texture analysis (TA) on baseline T1-weighted 3D magnetization-prepared rapid acquisition gradient-echo (MPRAGE) images to differentiate chronic active from chronic stable MS lesions. MATERIAL AND METHODS To identify chronic active lesions as compared to non-enhancing stable lesions, two MPRAGE datasets acquired on a 3 T MRI at baseline and after 12 months follow-up were applied to the Voxel-Guided Morphometry (VGM) algorithm. TA was performed on the baseline MPRAGE images, 36 texture features were extracted for each lesion. RESULTS Overall, 374 chronic MS lesions (155 chronic active and 219 chronic stable lesions) from 60 MS patients were included in the final analysis. Multiple texture features including "DISCRETIZED_HISTO_Energy", "GLCM_Energy", "GLCM_Contrast" and "GLCM_Dissimilarity" were significantly higher in chronic active as compared to chronic stable lesions. Partial least squares regression yielded an area under the curve of 0.7 to differentiate both lesion types. CONCLUSION Our results suggest that multiple texture features extracted from MPRAGE images indicate higher intralesional heterogeneity, however they demonstrate only a fair accuracy to differentiate chronic active from chronic stable MS lesions.
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Affiliation(s)
- Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Matthias Wittayer
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Matthias Kraemer
- Hospital zum Heiligen Geist, Department of Neurology and Neurological Early Rehabilitation, 47906 Kempen, Germany; Brainalyze GbR, Unterste Sauerwiese 9, 51069 Köln, Germany
| | | | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167 Mannheim, Germany.
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12
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Buch S, Subramanian K, Jella PK, Chen Y, Wu Z, Shah K, Bernitsas E, Ge Y, Haacke EM. Revealing vascular abnormalities and measuring small vessel density in multiple sclerosis lesions using USPIO. Neuroimage Clin 2020; 29:102525. [PMID: 33338965 PMCID: PMC7750444 DOI: 10.1016/j.nicl.2020.102525] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Multiple Sclerosis (MS) is a progressive, inflammatory, neuro-degenerative disease of the central nervous system (CNS) characterized by a wide range of histopathological features including vascular abnormalities. In this study, an ultra-small superparamagnetic iron oxide (USPIO) contrast agent, Ferumoxytol, was administered to induce an increase in susceptibility for both arteries and veins to help better reveal the cerebral microvasculature. The purpose of this work was to examine the presence of vascular abnormalities and vascular density in MS lesions using high-resolution susceptibility weighted imaging (SWI). METHODS Six subjects with relapsing remitting MS (RRMS, age = 47.3 ± 11.8 years with 3 females and 3 males) and fourteen age-matched healthy controls were scanned at 3 T with SWI acquired before and after the infusion of Ferumoxytol. Composite data was generated by registering the FLAIR data to the high resolution SWI data in order to highlight the vascular information in MS lesions. Both the central vein sign (CVS) and, a new measure, the multiple vessel sign (MVS) were identified, along with any vascular abnormalities, in the lesions on pre- and post-contrast SWI-FLAIR fusion data. The small vessel density within the periventricular normal-appearing white matter (NAWM) and the periventricular lesions were compared for all subjects. RESULTS Averaged across two independent raters, a total of 530 lesions were identified across all patients. The total number of lesions with vascularity on pre- and post-contrast data were 287 and 488, respectively. The lesions with abnormal vascular behavior were broken up into following categories: small lesions appearing only at the vessel boundary; dilated vessels within the lesions; and developmental venous angiomas. These vessel abnormalities observed within lesions increased from 55 on pre-contrast data to 153 on post-contrast data. Finally, across all the patients, the periventricular lesional vessel density was significantly higher (p < 0.05) than that of the periventricular NAWM. CONCLUSIONS By inducing a super-paramagnetic susceptibility in the blood using Ferumoxytol, the vascular abnormalities in the RRMS patients were revealed and small vessel densities were obtained. This approach has the potential to monitor the venous vasculature present in MS lesions, catalogue their characteristics and compare the vascular structures spatially to the presence of lesions. These enhanced vascular features may provide new insight into the pathophysiology of MS.
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Affiliation(s)
- Sagar Buch
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | | | - Pavan K Jella
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Yongsheng Chen
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Zhen Wu
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Kamran Shah
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | | | - Yulin Ge
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - E Mark Haacke
- Department of Radiology, Wayne State University, Detroit, MI, USA; Department of Neurology, Wayne State University, Detroit, MI, USA.
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13
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Weber CE, Kraemer M, Dabringhaus A, Ebert A, Platten M, Gass A, Eisele P. Venous Diameter Changes in Chronic Active Multiple Sclerosis Lesions. J Neuroimaging 2020; 31:394-400. [PMID: 33270952 DOI: 10.1111/jon.12818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE To investigate the temporal evolution of venous diameter in chronic active and nonenhancing shrinking multiple sclerosis (MS) lesions in a longitudinal magnetic resonance imaging (MRI) study including susceptibility-weighted images (SWI). METHODS We compared the venous diameter in chronic active and nonenhancing shrinking lesions to the venous diameter in nonenhancing stable lesions on two 3 T MRI data sets obtained 12 months apart. Chronic active and nonenhancing shrinking lesions were identified by Voxel-Guided Morphometry. Coregistered, overlaid fluid-attenuated inversion recovery/SWI were analyzed for the presence of a central vein. Quantitative calculation of the venous diameter for each time point was performed on the reconstructed veins. RESULTS Sixty-two relapsing-remitting MS patients (50 women; mean age: 36 ± 11 years; mean disease duration: 4 ± 7 years) were included in the study. Overall, we identified 222 chronic MS lesions (48 chronic active, 48 shrinking, 126 stable) with a corresponding intralesional central vein. On baseline MRI, the mean venous diameter did not statistically differ between all subgroups, whereas on follow-up MRI, the mean intralesional venous diameter was smaller in chronic active (0.92 ± 0.15 mm) and shrinking lesions (0.90 ± 0.19 mm) compared to stable lesions (1.10 ± 0.18 mm; P < .001). CONCLUSION Our findings demonstrate venous narrowing in chronic active and nonenhancing shrinking MS lesions. The smaller diameter of intralesional veins during follow up in these lesions may reflect structural, degenerative, and metabolic changes due to chronic inflammation, (perivascular) fibrosis, collagenous thickening, and increased levels of oxygenated hemoglobin.
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Affiliation(s)
- Claudia E Weber
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Matthias Kraemer
- Department of Neurology and Neurological Early Rehabilitation, Hospital zum Heiligen Geist, Kempen, Germany
| | - Andreas Dabringhaus
- Deutsches Institut für Medizinische Dokumentation und Information, Köln, Germany
| | - Anne Ebert
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
| | - Philipp Eisele
- Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), University of Heidelberg, Mannheim, Germany
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14
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Castellaro M, Tamanti A, Pisani AI, Pizzini FB, Crescenzo F, Calabrese M. The Use of the Central Vein Sign in the Diagnosis of Multiple Sclerosis: A Systematic Review and Meta-analysis. Diagnostics (Basel) 2020; 10:diagnostics10121025. [PMID: 33260401 PMCID: PMC7760678 DOI: 10.3390/diagnostics10121025] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 02/01/2023] Open
Abstract
Background: The central vein sign (CVS) is a radiological feature proposed as a multiple sclerosis (MS) imaging biomarker able to accurately differentiate MS from other white matter diseases of the central nervous system. In this work, we evaluated the pooled proportion of the CVS in brain MS lesions and to estimate the diagnostic performance of CVS to perform a diagnosis of MS and propose an optimal cut-off value. Methods: A systematic search was performed on publicly available databases (PUBMED/MEDLINE and Web of Science) up to 24 August 2020. Analysis of the proportion of white matter MS lesions with a central vein was performed using bivariate random-effect models. A meta-regression analysis was performed and the impact of using particular sequences (such as 3D echo-planar imaging) and post-processing techniques (such as FLAIR*) was investigated. Pooled sensibility and specificity were estimated using bivariate models and meta-regression was performed to address heterogeneity. Inclusion and publication bias were assessed using asymmetry tests and a funnel plot. A hierarchical summary receiver operating curve (HSROC) was used to estimate the summary accuracy in diagnostic performance. The Youden index was employed to estimate the optimal cut-off value using individual patient data. Results: The pooled proportion of lesions showing a CVS in the MS population was 73%. The use of the CVS showed a remarkable diagnostic performance in MS cases, providing a pooled specificity of 92% and a sensitivity of 95%. The optimal cut-off value obtained from the individual patient data pooled together was 40% with excellent accuracy calculated by the area under the ROC (0.946). The 3D-EPI sequences showed both a higher pooled proportion compared to other sequences and explained heterogeneity in the meta-regression analysis of diagnostic performances. The 1.5 Tesla (T) scanners showed a lower (58%) proportion of MS lesions with a CVS compared to both 3T (74%) and 7T (82%). Conclusions: The meta-analysis we have performed shows that the use of the CVS in differentiating MS from other mimicking diseases is encouraged; moreover, the use of dedicated sequences such as 3D-EPI and the high MRI field is beneficial.
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Affiliation(s)
- Marco Castellaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
- Correspondence:
| | - Agnese Tamanti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
| | - Anna Isabella Pisani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
| | | | - Francesco Crescenzo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; (A.T.); (A.I.P.); (F.C.); (M.C.)
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15
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Investigation of the “central vein sign” in infratentorial multiple sclerosis lesions. Mult Scler Relat Disord 2020; 45:102409. [DOI: 10.1016/j.msard.2020.102409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022]
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16
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Suh CH, Kim SJ, Jung SC, Choi CG, Kim HS. The "Central Vein Sign" on T2*-weighted Images as a Diagnostic Tool in Multiple Sclerosis: A Systematic Review and Meta-analysis using Individual Patient Data. Sci Rep 2019; 9:18188. [PMID: 31796822 PMCID: PMC6890741 DOI: 10.1038/s41598-019-54583-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022] Open
Abstract
We aimed to evaluate the pooled incidence of central vein sign on T2*-weighted images from patients with multiple sclerosis (MS), and to determine the diagnostic performance of this central vein sign for differentiating MS from other white matter lesions and provide an optimal cut-off value. A computerized systematic search of the literature in PUBMED and EMBASE was conducted up to December 14, 2018. Original articles investigating central vein sign on T2*-weighted images of patients with MS were selected. The pooled incidence was obtained using random-effects model. The pooled sensitivity and specificity were obtained using a bivariate random-effects model. An optimal cut-off value for the proportion of lesions with a central vein sign was calculated from those studies providing individual patient data. Twenty-one eligible articles covering 501 patients with MS were included. The pooled incidence of central vein sign at the level of individual lesion in patients with MS was 74% (95% CI, 65-82%). The pooled sensitivity and pooled specificity for the diagnostic performance of the central vein sign were 98% (95% CI, 92-100%) and 97% (95% CI, 91-99%), respectively. The area under the HSROC curve was 1.00 (95% CI, 0.99-1.00). The optimal cut-off value for the proportion of lesions with a central vein sign was found to be 45%. Although various T2*-weighted images have been used across studies, the current evidence supports the use of the central vein sign on T2*-weighted images to differentiate MS from other white matter lesions.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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17
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Eisele P, Fischer K, Szabo K, Platten M, Gass A. Characterization of Contrast-Enhancing and Non-contrast-enhancing Multiple Sclerosis Lesions Using Susceptibility-Weighted Imaging. Front Neurol 2019; 10:1082. [PMID: 31681152 PMCID: PMC6813212 DOI: 10.3389/fneur.2019.01082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/25/2019] [Indexed: 01/14/2023] Open
Abstract
Susceptibility-weighted magnetic resonance imaging (MRI) (SWI) offers additional information on conventional MRI contrasts. Central veins can be identified within lesions, and recently, it has been suggested that multiple sclerosis (MS) lesions with slowly expanding demyelination, so-called smoldering lesions, can be identified by a phase rim surrounding the lesion. We analyzed post-contrast SWI in regard to intrinsic lesion characteristics in a cohort of MS patients. A total of 294 MS patients were evaluated using a 3-T MRI. A comprehensive MRI protocol was used including post-contrast SWI. Lesions of at least 5 mm in size were analyzed on conventional MRI and SWI with a structured reporting scheme with a focus on SWI lesion characteristics. A total of 1,323 lesions were analyzed: 1,246/1,323 (94%) were non-enhancing and 77/1,323 (6%) were contrast-enhancing (CE) lesions. In CE lesions, the following patterns were seen: contrast enhancement was nodular in 34/77, ring-shaped enhancement was present in 33/77, and areas of peripheral enhancement were present in 10/77. In CE lesions, an association with central veins was found in 38/77 (50%). In 75/1,246 (6%) non-enhancing lesions, a central dark dot in keeping with a central vein was seen, whereas 162/1,246 (13%) showed peripheral hypointense dots/rims, 199/1,246 (16%) showed scattered hypointense dots mainly within the lesion area, and in 374/1,246 (30%), no SWI hypointensity was detected. Furthermore, 436/1,246 (35%) lesions showed isointensity to the surrounding tissue and were not visible on SWI. SWI is able to offer additional aspects of MS pathology also when used after the application of a contrast agent. Veins connected to lesions, a potentially useful marker in the differential diagnosis of MS, were seen in about 50% of enhancing lesions. Susceptibility artifacts, suggested to mark the presence of myelin-laden macrophages and smoldering inflammation, were visible in 28% of lesions as hypointense dots in and in the periphery of the lesion. Given those results, SWI may provide practical useful additional information in the evaluation of the lesion status in MS patients.
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Affiliation(s)
- Philipp Eisele
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katja Fischer
- Department of Neurology, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
| | - Kristina Szabo
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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18
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Haacke EM, Chen Y, Utriainen D, Wu B, Wang Y, Xia S, He N, Zhang C, Wang X, Lagana MM, Luo Y, Fatemi A, Liu S, Gharabaghi S, Wu D, Sethi SK, Huang F, Sun T, Qu F, Yadav BK, Ma X, Bai Y, Wang M, Cheng J, Yan F. STrategically Acquired Gradient Echo (STAGE) imaging, part III: Technical advances and clinical applications of a rapid multi-contrast multi-parametric brain imaging method. Magn Reson Imaging 2019; 65:15-26. [PMID: 31629075 DOI: 10.1016/j.mri.2019.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/15/2022]
Abstract
One major thrust in radiology today is image standardization with a focus on rapidly acquired quantitative multi-contrast information. This is critical for multi-center trials, for the collection of big data and for the use of artificial intelligence in evaluating the data. Strategically acquired gradient echo (STAGE) imaging is one such method that can provide 8 qualitative and 7 quantitative pieces of information in 5 min or less at 3 T. STAGE provides qualitative images in the form of proton density weighted images, T1 weighted images, T2* weighted images and simulated double inversion recovery (DIR) images. STAGE also provides quantitative data in the form of proton spin density, T1, T2* and susceptibility maps as well as segmentation of white matter, gray matter and cerebrospinal fluid. STAGE uses vendors' product gradient echo sequences. It can be applied from 0.35 T to 7 T across all manufacturers producing similar results in contrast and quantification of the data. In this paper, we discuss the strengths and weaknesses of STAGE, demonstrate its contrast-to-noise (CNR) behavior relative to a large clinical data set and introduce a few new image contrasts derived from STAGE, including DIR images and a new concept referred to as true susceptibility weighted imaging (tSWI) linked to fluid attenuated inversion recovery (FLAIR) or tSWI-FLAIR for the evaluation of multiple sclerosis lesions. The robustness of STAGE T1 mapping was tested using the NIST/NIH phantom, while the reproducibility was tested by scanning a given individual ten times in one session and the same subject scanned once a week over a 12-week period. Assessment of the CNR for the enhanced T1W image (T1WE) showed a significantly better contrast between gray matter and white matter than conventional T1W images in both patients with Parkinson's disease and healthy controls. We also present some clinical cases using STAGE imaging in patients with stroke, metastasis, multiple sclerosis and a fetus with ventriculomegaly. Overall, STAGE is a comprehensive protocol that provides the clinician with numerous qualitative and quantitative images.
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Affiliation(s)
- E Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA.
| | - Yongsheng Chen
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - David Utriainen
- The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Bo Wu
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Yu Wang
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China; Neusoft Medical Systems Co., Ltd., Shanghai, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Yu Luo
- Department of Radiology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Ali Fatemi
- Departments of Radiology and Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Saifeng Liu
- The MRI Institute for Biomedical Research, Bingham Farms, MI, USA
| | - Sara Gharabaghi
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Sean K Sethi
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Feng Huang
- Neusoft Medical Systems Co., Ltd., Shanghai, China
| | - Taotao Sun
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feifei Qu
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brijesh K Yadav
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaoyue Ma
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yan Bai
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Saade C, Bou-Fakhredin R, Yousem DM, Asmar K, Naffaa L, El-Merhi F. Gadolinium and Multiple Sclerosis: Vessels, Barriers of the Brain, and Glymphatics. AJNR Am J Neuroradiol 2018; 39:2168-2176. [PMID: 30385472 DOI: 10.3174/ajnr.a5773] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 06/05/2018] [Indexed: 01/10/2023]
Abstract
The pathogenesis of multiple sclerosis is characterized by a cascade of pathobiologic events, ranging from focal lymphocytic infiltration and microglia activation to demyelination and axonal degeneration. MS has several of the hallmarks of an inflammatory autoimmune disorder, including breakdown of the BBB. Gadolinium-enhanced MR imaging is currently the reference standard to detect active inflammatory lesions in MS. Knowledge of the patterns and mechanisms of contrast enhancement is vital to limit the radiologic differential diagnosis in the staging and evaluation of MS lesion activity. The aim of this review was the following: 1) to outline the pathophysiology of the effect of lymphocyte-driven inflammation in MS, 2) to describe the effects of gadolinium on the BBB and glymphatic system, and 3) to describe gadolinium enhancement patterns and artifacts that can mimic lesions in MS.
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Affiliation(s)
- C Saade
- From the Diagnostic Radiology Department (C.S., R.B.-F., K.A., L.N., F.E.-M.), American University of Beirut Medical Center, Beirut, Lebanon
| | - R Bou-Fakhredin
- From the Diagnostic Radiology Department (C.S., R.B.-F., K.A., L.N., F.E.-M.), American University of Beirut Medical Center, Beirut, Lebanon
| | - D M Yousem
- The Russell H. Morgan Department of Radiology and Radiological Science (D.M.Y.), Neuroradiology Division, Johns Hopkins Hospital, Baltimore, Maryland
| | - K Asmar
- From the Diagnostic Radiology Department (C.S., R.B.-F., K.A., L.N., F.E.-M.), American University of Beirut Medical Center, Beirut, Lebanon
| | - L Naffaa
- From the Diagnostic Radiology Department (C.S., R.B.-F., K.A., L.N., F.E.-M.), American University of Beirut Medical Center, Beirut, Lebanon
| | - F El-Merhi
- From the Diagnostic Radiology Department (C.S., R.B.-F., K.A., L.N., F.E.-M.), American University of Beirut Medical Center, Beirut, Lebanon
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20
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Gabr RE, Pednekar AS, Kamali A, Lincoln JA, Nelson FM, Wolinsky JS, Narayana PA. Interleaved susceptibility-weighted and FLAIR MRI for imaging lesion-penetrating veins in multiple sclerosis. Magn Reson Med 2018; 80:1132-1137. [PMID: 29334139 PMCID: PMC5980669 DOI: 10.1002/mrm.27091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 11/10/2022]
Abstract
Purpose To simultaneously image brain lesions and veins in multiple sclerosis. Methods An interleaved sequence was developed to simultaneously acquire 3D T2*-weighted (or susceptibility-weighted, SW) and fluid-attenuated inversion recovery (FLAIR) images on a 3.0T MRI system. The pulse sequence parameters were calculated to minimize signal perturbation from steady state while maintaining acceptable image contrast and scan time. Fifteen multiple sclerosis patients were enrolled in this prospective study and underwent a standard MS imaging protocol. In addition, SW and FLAIR images were acquired separately and also in an interleaved manner. The SW and FLAIR images were combined into one image to visualize lesions and penetrating veins. The contrast ratios between white matter lesions and penetrating veins were compared between the interleaved sequence and the individual non-interleaved acquisitions. Results Interleaved scanning of the FLAIR and the SW pulse sequences was achieved, producing aligned images, and with similar image contrast as in the non-interleaved images. A total of 1076 lesions were identified in all patients on the combined SW-FLAIR image, of which 968 lesions (90%) had visible penetrating veins. Lesion-to-vein contrast ratio was 32.7 ± 17.9 (mean ± standard deviation) for the interleaved sequence compared to 28.1 ± 13.7 using the separate acquisitions (P<0.001). Conclusion The feasibility of interleaved acquisition of susceptibility-weighted and FLAIR images was demonstrated. This sequence provides self-registered images and facilitates the visualization of veins in brain lesions.
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Affiliation(s)
- Refaat E. Gabr
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
| | - Amol S. Pednekar
- Philips Healthcare, Cleveland, OH
- Texas Children’s Hospital, Houston, TX
| | - Arash Kamali
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
| | - John A Lincoln
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Flavia M. Nelson
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Jerry S. Wolinsky
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Ponnada A. Narayana
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
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21
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Hosseini Z, Matusinec J, Rudko DA, Liu J, Kwan BYM, Salehi F, Sharma M, Kremenchutzky M, Menon RS, Drangova M. Morphology-Specific Discrimination between MS White Matter Lesions and Benign White Matter Hyperintensities Using Ultra-High-Field MRI. AJNR Am J Neuroradiol 2018; 39:1473-1479. [PMID: 29930096 DOI: 10.3174/ajnr.a5705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/05/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recently published North American Imaging in Multiple Sclerosis guidelines call for derivation of a specific radiologic definition of MS WM lesions and mimics. The purpose of this study was to use SWI and magnetization-prepared FLAIR images for sensitive differentiation of MS from benign WM lesions using the morphologic characteristics of WM lesions. MATERIALS AND METHODS Seventeen patients with relapsing-remitting MS and 18 healthy control subjects were enrolled retrospectively. For each subject, FLAIR and multiecho gradient-echo images were acquired using 7T MR imaging. Optimized postprocessing was used to generate single-slice SWI of cerebral veins. SWI/FLAIR images were registered, and 3 trained readers performed lesion assessment. Morphology, location of lesions, and the time required for assessment were recorded. Analyses were performed on 3 different pools: 1) lesions of >3 mm, 2) nonconfluent lesions of >3 mm, and 3) nonconfluent lesions of >3 mm with no or a single central vein. RESULTS The SWI/FLAIR acquisition and processing protocol enabled effective assessment of central veins and hypointense rims in WM lesions. Assessment of nonconfluent lesions with ≥1 central vein enabled the most specific and sensitive differentiation of patients with MS from controls. A threshold of 67% perivenous WM lesions separated patients with MS from controls with a sensitivity of 94% and specificity of 100%. Lesion assessment took an average of 12 minutes 10 seconds and 4 minutes 33 seconds for patients with MS and control subjects, respectively. CONCLUSIONS Nonconfluent lesions of >3 mm with ≥1 central vein were the most sensitive and specific differentiators between patients with MS and control subjects.
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Affiliation(s)
- Z Hosseini
- From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.).,Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute
| | | | - D A Rudko
- Department of Neurology and Neurosurgery (D.A.R.), McConnell Brain Imaging Centre, Montreal Neurological Institute.,Department of Biomedical Engineering (D.A.R.), McGill University, Montreal, Quebec, Canada
| | - J Liu
- Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute
| | | | - F Salehi
- Medical Imaging (B.Y.M.K., F.S., M.S.)
| | - M Sharma
- Medical Imaging (B.Y.M.K., F.S., M.S.).,Department of Clinical Neurological Sciences (M.S., M.K.), Western University and London Health Sciences Centre, London, Ontario, Canada
| | - M Kremenchutzky
- Department of Clinical Neurological Sciences (M.S., M.K.), Western University and London Health Sciences Centre, London, Ontario, Canada
| | - R S Menon
- From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.).,Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute.,Medical Biophysics (R.S.M., M.D.), Schulich School of Medicine and Dentistry; Western University, London, Ontario, Canada
| | - M Drangova
- From the Biomedical Engineering Graduate Program (Z.H., R.S.M., M.D.) .,Imaging Research Laboratories (Z.H., J.L., R.S.M., M.D.), Robarts Research Institute.,Medical Biophysics (R.S.M., M.D.), Schulich School of Medicine and Dentistry; Western University, London, Ontario, Canada
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Value of central vein sign in discriminating multiple sclerosis plaques from other white matter lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Trattnig S, Springer E, Bogner W, Hangel G, Strasser B, Dymerska B, Cardoso PL, Robinson SD. Key clinical benefits of neuroimaging at 7T. Neuroimage 2018; 168:477-489. [PMID: 27851995 PMCID: PMC5832016 DOI: 10.1016/j.neuroimage.2016.11.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/06/2016] [Accepted: 11/12/2016] [Indexed: 01/15/2023] Open
Abstract
The growing interest in ultra-high field MRI, with more than 35.000 MR examinations already performed at 7T, is related to improved clinical results with regard to morphological as well as functional and metabolic capabilities. Since the signal-to-noise ratio increases with the field strength of the MR scanner, the most evident application at 7T is to gain higher spatial resolution in the brain compared to 3T. Of specific clinical interest for neuro applications is the cerebral cortex at 7T, for the detection of changes in cortical structure, like the visualization of cortical microinfarcts and cortical plaques in Multiple Sclerosis. In imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology may be visualized with excellent spatial resolution. Using Susceptibility Weighted Imaging, the plaque-vessel relationship and iron accumulations in Multiple Sclerosis can be visualized, which may provide a prognostic factor of disease. Vascular imaging is a highly promising field for 7T which is dealt with in a separate dedicated article in this special issue. The static and dynamic blood oxygenation level-dependent contrast also increases with the field strength, which significantly improves the accuracy of pre-surgical evaluation of vital brain areas before tumor removal. Improvement in acquisition and hardware technology have also resulted in an increasing number of MR spectroscopic imaging studies in patients at 7T. More recent parallel imaging and short-TR acquisition approaches have overcome the limitations of scan time and spatial resolution, thereby allowing imaging matrix sizes of up to 128×128. The benefits of these acquisition approaches for investigation of brain tumors and Multiple Sclerosis have been shown recently. Together, these possibilities demonstrate the feasibility and advantages of conducting routine diagnostic imaging and clinical research at 7T.
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Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MRI, Vienna, Austria.
| | - Elisabeth Springer
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MRI, Vienna, Austria.
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Gilbert Hangel
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Bernhard Strasser
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Barbara Dymerska
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Pedro Lima Cardoso
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Simon Daniel Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
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Eisele P, Szabo K, Ebert A, Brueck W, Platten M, Gass A. Spatiotemporal evolution of venous narrowing in acute MS lesions. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e440. [PMID: 29359176 PMCID: PMC5773855 DOI: 10.1212/nxi.0000000000000440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/06/2017] [Indexed: 01/14/2023]
Abstract
Objective To investigate the spatiotemporal evolution of venous narrowing in newly developing MS lesions in a longitudinal MRI study including susceptibility-weighted images (SWIs). Methods We retrospectively investigated serial MR examinations of 18 patients with MS acquired on a 3T MRI system including SWI for acute contrast-enhancing lesions with at least 1 MRI examination before contrast enhancement. The mean diameter of veins at the time point of contrast enhancement was compared with the mean diameter of veins before and after contrast enhancement. Results A total of 40 acute contrast-enhancing lesions with a corresponding intralesional central vein were included in the study. The mean diameter of intralesional veins at the time of contrast enhancement (0.80 ± 0.12 mm) was smaller than that at before (1.16 ± 0.19 mm) and after contrast enhancement (1.07 ± 0.15 mm; p < 0.001 for all comparisons). Conclusions Our findings contribute to the increasing database of plaque development and evolution. The smaller diameter of intralesional veins on SWI at the time of blood-brain barrier breakdown may reflect morphologic changes because of perivascular inflammation and/or decreased levels of deoxygenated hemoglobin.
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Affiliation(s)
- Philipp Eisele
- Department of Neurology (P.E., K.S., A.E., M.P., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim; and Institute for Neuropathology (W.B.), Universitätsmedizin Göttingen, Germany
| | - Kristina Szabo
- Department of Neurology (P.E., K.S., A.E., M.P., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim; and Institute for Neuropathology (W.B.), Universitätsmedizin Göttingen, Germany
| | - Anne Ebert
- Department of Neurology (P.E., K.S., A.E., M.P., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim; and Institute for Neuropathology (W.B.), Universitätsmedizin Göttingen, Germany
| | - Wolfgang Brueck
- Department of Neurology (P.E., K.S., A.E., M.P., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim; and Institute for Neuropathology (W.B.), Universitätsmedizin Göttingen, Germany
| | - Michael Platten
- Department of Neurology (P.E., K.S., A.E., M.P., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim; and Institute for Neuropathology (W.B.), Universitätsmedizin Göttingen, Germany
| | - Achim Gass
- Department of Neurology (P.E., K.S., A.E., M.P., A.G.), Universitätsmedizin Mannheim, University of Heidelberg, Mannheim; and Institute for Neuropathology (W.B.), Universitätsmedizin Göttingen, Germany
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Schranzer R, Rauscher A, Haimburger E, Bredies K, Reishofer G, Grabner G. Noise reduction in FLAIR 2 images using total generalized variation, Gaussian and Wiener filtering. Z Med Phys 2017; 28:286-292. [PMID: 29233600 DOI: 10.1016/j.zemedi.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/31/2017] [Accepted: 11/21/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Multiplication of FLAIR and T2-weighted MRI scans results in images (called FLAIR2) with an improved contrast-to-noise ratio (CNR) for multiple sclerosis (MS) lesions but with a reduced signal-to-noise ratio (SNR). Denoising of these images may therefore further improve FLAIR2 image quality. The purpose of this work is to present a systematic investigation of FLAIR2 image denoising methods using Gaussian, Wiener and Total Generalized Variation (TGV) filtering approaches. MATERIALS AND METHODS T2-weighted and FLAIR data of four MS patients were used. For CNR and SNR measurements, each scan was performed up to three times. TGV, Gaussian and Wiener filtering was applied to T2, FLAIR and the FLAIR2 data. FLAIR2 images were afterwards additionally created using all combinations of input data (native, filtered T2 and filtered FLAIR). SNR and CNR measurements were performed using the subtraction method for all FLAIR2 approaches (native and filtered input data) and for twenty MS lesions. Additionally, quantitative analysis of filtering based image blurring was performed on all data sets. RESULTS FLAIR2 images denoised with TGV showed the highest SNR and CNR, while SNR values were similar for Gaussian and Wiener filtered images. The average CNR over 20 MS lesions within the native FLAIR2 (32.99) achieved an improvement to 91.17, 82.33 and 56.07 corresponding to TGV, Wiener and Gaussian filtering. FLAIR multiplied with T2.denoised showed no improvement, while FLAIR.denoised multiplied with T2 showed an increase by a factor of two to the native, not filtered FLAIR2. Blurring was most pronounced in Gaussian filtered images and similar in TGV and Wiener filtered images. CONCLUSION FLAIR images filtered with Wiener or TGV multiplied with the unfiltered T2 results in FLAIR2 images with increased SNR and CNR and with minimal edge blurring.
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Affiliation(s)
- René Schranzer
- Department of Radiologic Technology, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | - Alexander Rauscher
- UBC MRI Research Centre, University of British Columbia, Vancouver, BC, Canada.
| | - Evelin Haimburger
- Department of Radiologic Technology, Carinthia University of Applied Sciences, Klagenfurt, Austria
| | - Kristian Bredies
- Institute for Mathematics and Scientific Computing, University of Graz, Graz, Austria
| | - Gernot Reishofer
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Günther Grabner
- Department of Radiologic Technology, Carinthia University of Applied Sciences, Klagenfurt, Austria; Institute for Applied Research on Ageing, Carinthia University of Applied Sciences, Klagenfurt, Austria
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Springer E, Dymerska B, Cardoso PL, Robinson SD, Weisstanner C, Wiest R, Schmitt B, Trattnig S. Comparison of Routine Brain Imaging at 3 T and 7 T. Invest Radiol 2017; 51:469-82. [PMID: 26863580 DOI: 10.1097/rli.0000000000000256] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to compare quantitative and semiquantitative parameters (signal-to-noise ratio [SNR], contrast-to-noise ratio [CNR], image quality, diagnostic confidence) from a standard brain magnetic resonance imaging examination encompassing common neurological disorders such as demyelinating disease, gliomas, cerebrovascular disease, and epilepsy, with comparable sequence protocols and acquisition times at 3 T and at 7 T. MATERIALS AND METHODS Ten healthy volunteers and 4 subgroups of 40 patients in total underwent comparable magnetic resonance protocols with standard diffusion-weighted imaging, 2D and 3D turbo spin echo, 2D and 3D gradient echo and susceptibility-weighted imaging of the brain (10 sequences) at 3 T and 7 T. The subgroups comprised patients with either lesional (n = 5) or nonlesional (n = 4) epilepsy, intracerebral tumors (n = 11), demyelinating disease (n = 11) (relapsing-remitting multiple sclerosis [MS, n = 9], secondary progressive MS [n = 1], demyelinating disease not further specified [n = 1]), or chronic cerebrovascular disorders [n = 9]). For quantitative analysis, SNR and CNR were determined. For a semiquantitative assessment of the diagnostic confidence, a 10-point scale diagnostic confidence score (DCS) was applied. Two experienced radiologists with additional qualification in neuroradiology independently assessed, blinded to the field strength, 3 pathology-specific imaging criteria in each of the 4 disease groups and rated their diagnostic confidence. The overall image quality was semiquantitatively assessed using a 4-point scale taking into account whether diagnostic decision making was hampered by artifacts or not. RESULTS Without correction for spatial resolution, SNR was higher at 3 T except in the T2 SPACE 3D, DWI single shot, and DIR SPACE 3D sequences. The SNR corrected by the ratio of 3 T/7 T voxel sizes was higher at 7 T than at 3 T in 10 of 11 sequences (all except for T1 MP2RAGE 3D).In CNR, there was a wide variation between sequences and patient cohorts, but average CNR values were broadly similar at 3 T and 7 T.DCS values for all 4 pathologic entities were higher at 7 T than at 3 T. The DCS was significantly higher at 7 T for diagnosis and exclusion of cortical lesions in vascular disease. A tendency to higher DCS at 7 T for cortical lesions in MS was observed, and for the depiction of a central vein and iron deposits within MS lesions. Despite motion artifacts, DCS values were higher at 7 T for the diagnosis and exclusion of hippocampal sclerosis in mesial temporal lobe epilepsy (improved detection of the hippocampal subunits). Interrater agreement was 69.7% at 3 T and 93.3% at 7 T. There was no significant difference in the overall image quality score between 3 T and 7 T taking into account whether diagnostic decision making was hampered by artifacts or not. CONCLUSIONS Ultra-high-field magnetic resonance imaging at 7 T compared with 3 T yielded an improved diagnostic confidence in the most frequently encountered neurologic disorders. Higher spatial resolution and contrast were identified as the main contributory factors.
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Affiliation(s)
- Elisabeth Springer
- From the *High Field MR Center, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria; †Support Center of Advanced Neuroimaging, University Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern and Inselspital, University of Bern, Bern, Switzerland; ‡Siemens Healthcare Pty Ltd Australia, Imaging and Therapy Systems, Magnetic Resonance, Macquarie Park, New South Wales, Australia; §Siemens Healthcare, Erlangen, Germany; and ∥CD Laboratory for Molecular Clinical MR Imaging, Vienna, Austria
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Understanding a role for hypoxia in lesion formation and location in the deep and periventricular white matter in small vessel disease and multiple sclerosis. Clin Sci (Lond) 2017; 131:2503-2524. [PMID: 29026001 DOI: 10.1042/cs20170981] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/01/2017] [Accepted: 08/15/2017] [Indexed: 12/28/2022]
Abstract
The deep and periventricular white matter is preferentially affected in several neurological disorders, including cerebral small vessel disease (SVD) and multiple sclerosis (MS), suggesting that common pathogenic mechanisms may be involved in this injury. Here we consider the potential pathogenic role of tissue hypoxia in lesion development, arising partly from the vascular anatomy of the affected white matter. Specifically, these regions are supplied by a sparse vasculature fed by long, narrow end arteries/arterioles that are vulnerable to oxygen desaturation if perfusion is reduced (as in SVD, MS and diabetes) or if the surrounding tissue is hypoxic (as in MS, at least). The oxygen crisis is exacerbated by a local preponderance of veins, as these can become highly desaturated 'sinks' for oxygen that deplete it from surrounding tissues. Additional haemodynamic deficiencies, including sluggish flow and impaired vasomotor reactivity and vessel compliance, further exacerbate oxygen insufficiency. The cells most vulnerable to hypoxic damage, including oligodendrocytes, die first, resulting in demyelination. Indeed, in preclinical models, demyelination is prevented if adequate oxygenation is maintained by raising inspired oxygen concentrations. In agreement with this interpretation, there is a predilection of lesions for the anterior and occipital horns of the lateral ventricles, namely regions located at arterial watersheds, or border zones, known to be especially susceptible to hypoperfusion and hypoxia. Finally, mitochondrial dysfunction due to genetic causes, as occurs in leucodystrophies or due to free radical damage, as occurs in MS, will compound any energy insufficiency resulting from hypoxia. Viewing lesion formation from the standpoint of tissue oxygenation not only reveals that lesion distribution is partly predictable, but may also inform new therapeutic strategies.
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Sarbu N, Shih RY, Jones RV, Horkayne-Szakaly I, Oleaga L, Smirniotopoulos JG. White Matter Diseases with Radiologic-Pathologic Correlation. Radiographics 2017; 36:1426-47. [PMID: 27618323 DOI: 10.1148/rg.2016160031] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
White matter diseases include a wide spectrum of disorders that have in common impairment of normal myelination, either by secondary destruction of previously myelinated structures (demyelinating processes) or by primary abnormalities of myelin formation (dysmyelinating processes). The pathogenesis of many white matter diseases remains poorly understood. Demyelinating disorders are the object of this review and will be further divided into autoimmune, infectious, vascular, and toxic-metabolic processes. Autoimmune processes include multiple sclerosis and related diseases: tumefactive demyelinating lesions, Balo concentric sclerosis, Marburg and Schilder variants, neuromyelitis optica (Devic disease), acute disseminated encephalomyelitis, and acute hemorrhagic leukoencephalopathy (Hurst disease). Infectious processes include Lyme disease (neuroborreliosis), progressive multifocal leukoencephalopathy, and human immunodeficiency virus (HIV) encephalopathy. Vascular processes include different types of small-vessel disease: arteriolosclerosis, cerebral amyloid angiopathy, cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), primary angiitis of the central nervous system, Susac syndrome, and neurolupus. Toxic-metabolic processes include osmotic myelinolysis, methotrexate leukoencephalopathy, and posterior reversible encephalopathy syndrome. The imaging spectrum can vary widely from small multifocal white matter lesions to confluent or extensive white matter involvement. Understanding the pathologic substrate is fundamental for understanding the radiologic manifestations, and a systematic approach to the radiologic findings, in correlation with clinical and laboratory data, is crucial for narrowing the differential diagnosis. (©)RSNA, 2016.
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Affiliation(s)
- Nicolae Sarbu
- From the Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (N.S., L.O.); and American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., R.V.J., I.H.S., J.G.S.)
| | - Robert Y Shih
- From the Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (N.S., L.O.); and American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., R.V.J., I.H.S., J.G.S.)
| | - Robert V Jones
- From the Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (N.S., L.O.); and American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., R.V.J., I.H.S., J.G.S.)
| | - Iren Horkayne-Szakaly
- From the Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (N.S., L.O.); and American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., R.V.J., I.H.S., J.G.S.)
| | - Laura Oleaga
- From the Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (N.S., L.O.); and American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., R.V.J., I.H.S., J.G.S.)
| | - James G Smirniotopoulos
- From the Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (N.S., L.O.); and American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., R.V.J., I.H.S., J.G.S.)
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Dal-Bianco A, Grabner G, Kronnerwetter C, Weber M, Höftberger R, Berger T, Auff E, Leutmezer F, Trattnig S, Lassmann H, Bagnato F, Hametner S. Slow expansion of multiple sclerosis iron rim lesions: pathology and 7 T magnetic resonance imaging. Acta Neuropathol 2017; 133:25-42. [PMID: 27796537 PMCID: PMC5209400 DOI: 10.1007/s00401-016-1636-z] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/17/2016] [Accepted: 10/18/2016] [Indexed: 12/14/2022]
Abstract
In multiple sclerosis (MS), iron accumulates inside activated microglia/macrophages at edges of some chronic demyelinated lesions, forming rims. In susceptibility-based magnetic resonance imaging at 7 T, iron-laden microglia/macrophages induce a rim of decreased signal at lesion edges and have been associated with slowly expanding lesions. We aimed to determine (1) what lesion types and stages are associated with iron accumulation at their edges, (2) what cells at the lesion edges accumulate iron and what is their activation status, (3) how reliably can iron accumulation at the lesion edge be detected by 7 T magnetic resonance imaging (MRI), and (4) if lesions with rims enlarge over time in vivo, when compared to lesions without rims. Double-hemispheric brain sections of 28 MS cases were stained for iron, myelin, and microglia/macrophages. Prior to histology, 4 of these 28 cases were imaged at 7 T using post-mortem susceptibility-weighted imaging. In vivo, seven MS patients underwent annual neurological examinations and 7 T MRI for 3.5 years, using a fluid attenuated inversion recovery/susceptibility-weighted imaging fusion sequence. Pathologically, we found iron rims around slowly expanding and some inactive lesions but hardly around remyelinated shadow plaques. Iron in rims was mainly present in microglia/macrophages with a pro-inflammatory activation status, but only very rarely in astrocytes. Histological validation of post-mortem susceptibility-weighted imaging revealed a quantitative threshold of iron-laden microglia when a rim was visible. Slowly expanding lesions significantly exceeded this threshold, when compared with inactive lesions (p = 0.003). We show for the first time that rim lesions significantly expanded in vivo after 3.5 years, compared to lesions without rims (p = 0.003). Thus, slow expansion of MS lesions with rims, which reflects chronic lesion activity, may, in the future, become an MRI marker for disease activity in MS.
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30
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Sati P, Oh J, Constable RT, Evangelou N, Guttmann CRG, Henry RG, Klawiter EC, Mainero C, Massacesi L, McFarland H, Nelson F, Ontaneda D, Rauscher A, Rooney WD, Samaraweera APR, Shinohara RT, Sobel RA, Solomon AJ, Treaba CA, Wuerfel J, Zivadinov R, Sicotte NL, Pelletier D, Reich DS. The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative. Nat Rev Neurol 2016; 12:714-722. [DOI: 10.1038/nrneurol.2016.166] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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31
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Trattnig S, Bogner W, Gruber S, Szomolanyi P, Juras V, Robinson S, Zbýň Š, Haneder S. Clinical applications at ultrahigh field (7 T). Where does it make the difference? NMR IN BIOMEDICINE 2016; 29:1316-34. [PMID: 25762432 DOI: 10.1002/nbm.3272] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 05/11/2023]
Abstract
Presently, three major MR vendors provide commercial 7-T units for clinical research under ethical permission, with the number of operating 7-T systems having increased to over 50. This rapid increase indicates the growing interest in ultrahigh-field MRI because of improved clinical results with regard to morphological as well as functional and metabolic capabilities. As the signal-to-noise ratio scales linearly with the field strength (B0 ) of the scanner, the most obvious application at 7 T is to obtain higher spatial resolution in the brain, musculoskeletal system and breast. Of specific clinical interest for neuro-applications is the cerebral cortex at 7 T, for the detection of changes in cortical structure as a sign of early dementia, as well as for the visualization of cortical microinfarcts and cortical plaques in multiple sclerosis. In the imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology can be visualized with excellent resolution. The dynamic and static blood oxygenation level-dependent contrast increases linearly with the field strength, which significantly improves the pre-surgical evaluation of eloquent areas before tumor removal. Using susceptibility-weighted imaging, the plaque-vessel relationship and iron accumulation in multiple sclerosis can be visualized for the first time. Multi-nuclear clinical applications, such as sodium imaging for the evaluation of repair tissue quality after cartilage transplantation and (31) P spectroscopy for the differentiation between non-alcoholic benign liver disease and potentially progressive steatohepatitis, are only possible at ultrahigh fields. Although neuro- and musculoskeletal imaging have already demonstrated the clinical superiority of ultrahigh fields, whole-body clinical applications at 7 T are still limited, mainly because of the lack of suitable coils. The purpose of this article was therefore to review the clinical studies that have been performed thus far at 7 T, compared with 3 T, as well as those studies performed at 7 T that cannot be routinely performed at 3 T. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- CD Laboratory for Clinical Molecular MR Imaging
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Gruber
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vladimir Juras
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Simon Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Štefan Zbýň
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Haneder
- Vascular and Abdominal Imaging, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
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32
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Grabner G, Kiesel B, Wöhrer A, Millesi M, Wurzer A, Göd S, Mallouhi A, Knosp E, Marosi C, Trattnig S, Wolfsberger S, Preusser M, Widhalm G. Local image variance of 7 Tesla SWI is a new technique for preoperative characterization of diffusely infiltrating gliomas: correlation with tumour grade and IDH1 mutational status. Eur Radiol 2016; 27:1556-1567. [PMID: 27300198 PMCID: PMC5334387 DOI: 10.1007/s00330-016-4451-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/29/2016] [Accepted: 05/25/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the value of local image variance (LIV) as a new technique for quantification of hypointense microvascular susceptibility-weighted imaging (SWI) structures at 7 Tesla for preoperative glioma characterization. METHODS Adult patients with neuroradiologically suspected diffusely infiltrating gliomas were prospectively recruited and 7 Tesla SWI was performed in addition to standard imaging. After tumour segmentation, quantification of intratumoural SWI hypointensities was conducted by the SWI-LIV technique. Following surgery, the histopathological tumour grade and isocitrate dehydrogenase 1 (IDH1)-R132H mutational status was determined and SWI-LIV values were compared between low-grade gliomas (LGG) and high-grade gliomas (HGG), IDH1-R132H negative and positive tumours, as well as gliomas with significant and non-significant contrast-enhancement (CE) on MRI. RESULTS In 30 patients, 9 LGG and 21 HGG were diagnosed. The calculation of SWI-LIV values was feasible in all tumours. Significantly higher mean SWI-LIV values were found in HGG compared to LGG (92.7 versus 30.8; p < 0.0001), IDH1-R132H negative compared to IDH1-R132H positive gliomas (109.9 versus 38.3; p < 0.0001) and tumours with significant CE compared to non-significant CE (120.1 versus 39.0; p < 0.0001). CONCLUSIONS Our data indicate that 7 Tesla SWI-LIV might improve preoperative characterization of diffusely infiltrating gliomas and thus optimize patient management by quantification of hypointense microvascular structures. KEY POINTS • 7 Tesla local image variance helps to quantify hypointense susceptibility-weighted imaging structures. • SWI-LIV is significantly increased in high-grade and IDH1-R132H negative gliomas. • SWI-LIV is a promising technique for improved preoperative glioma characterization. • Preoperative management of diffusely infiltrating gliomas will be optimized.
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Affiliation(s)
- Günther Grabner
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Health Sciences and Social Work, Carinthia University of Applied Sciences, St. Veiterstraße 47, 9020, Klagenfurt am Wörthersee, Austria
| | - Barbara Kiesel
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Adelheid Wöhrer
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Institute of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Matthias Millesi
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Aygül Wurzer
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Sabine Göd
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Ammar Mallouhi
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Engelbert Knosp
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Christine Marosi
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Siegfried Trattnig
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Stefan Wolfsberger
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Matthias Preusser
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.,Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Georg Widhalm
- Comprehensive Cancer Center, Central Nervous System Tumours Unit (CCC-CNS), Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria. .,Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.
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Cronin MJ, Wharton S, Al-Radaideh A, Constantinescu C, Evangelou N, Bowtell R, Gowland PA. A comparison of phase imaging and quantitative susceptibility mapping in the imaging of multiple sclerosis lesions at ultrahigh field. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 29:543-57. [PMID: 27112155 PMCID: PMC4891374 DOI: 10.1007/s10334-016-0560-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/09/2016] [Accepted: 02/26/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare the use of high-resolution phase and QSM images acquired at ultra-high field in the investigation of multiple sclerosis (MS) lesions with peripheral rings, and to discuss their usefulness for drawing inferences about underlying tissue composition. MATERIALS AND METHODS Thirty-nine Subjects were scanned at 7 T, using 3D T 2*-weighted and T 1-weighted sequences. Phase images were then unwrapped and filtered, and quantitative susceptibility maps were generated using a thresholded k-space division method. Lesions were compared visually and using a 1D profiling algorithm. RESULTS Lesions displaying peripheral rings in the phase images were identified in 10 of the 39 subjects. Dipolar projections were apparent in the phase images outside of the extent of several of these lesions; however, QSM images showed peripheral rings without such projections. These projections appeared ring-like in a small number of phase images where no ring was observed in QSM. 1D profiles of six well-isolated example lesions showed that QSM contrast corresponds more closely to the magnitude images than phase contrast. CONCLUSIONS Phase images contain dipolar projections, which confounds their use in the investigation of tissue composition in MS lesions. Quantitative susceptibility maps correct these projections, providing insight into the composition of MS lesions showing peripheral rings.
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Affiliation(s)
- Matthew John Cronin
- Brain Imaging and Analysis Centre, Duke University, Durham, NC, 27710, USA
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Samuel Wharton
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Ali Al-Radaideh
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- Department of Medical Imaging, Faculty of Allied Health Sciences, Hashemite University, Zarqa, Jordan
| | - Cris Constantinescu
- Sir Peter Mansfield Imaging Centre, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Nikos Evangelou
- Sir Peter Mansfield Imaging Centre, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Penny Anne Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
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34
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Wiggermann V, Hernández-Torres E, Traboulsee A, Li DKB, Rauscher A. FLAIR2: A Combination of FLAIR and T2 for Improved MS Lesion Detection. AJNR Am J Neuroradiol 2016; 37:259-65. [PMID: 26450539 DOI: 10.3174/ajnr.a4514] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/21/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE FLAIR and double inversion recovery are important MR imaging scans for MS. The suppression of signal from CSF in FLAIR and the additional suppression of WM signal in double inversion recovery improve contrast between lesions, WM and GM, albeit at a reduced SNR. However, whether the acquisition of double inversion recovery is necessary is still debated. Here, we present an approach that allows obtaining CSF-suppressed images with improved contrast between lesions, WM and GM without strongly penalizing SNR. MATERIALS AND METHODS 3D T2-weighted and 3D-FLAIR data acquired from September 2014 to April 2015 in healthy volunteers (23.4 ± 2.4 years of age; female/male ratio, 3:2) and patients (44.1 ± 14.0 years of age; female/male ratio, 4:5) with MS were coregistered and multiplied (FLAIR(2)). SNR and contrast-to-noise measurements were performed for focal lesions and GM and WM. Furthermore, data from 24 subjects with relapsing-remitting and progressive MS were analyzed retrospectively (52.7 ± 8.1 years of age; female/male ratio, 14:10). RESULTS The GM-WM contrast-to-noise ratio was by 133% higher in FLAIR(2) than in FLAIR and improved between lesions and WM by 31%, 93%, and 158% compared with T2, DIR, and FLAIR, respectively. Cortical and juxtacortical lesions were more conspicuous in FLAIR(2). Furthermore, the 3D nature of FLAIR(2) allowed reliable visualization of callosal and infratentorial lesions. CONCLUSIONS We present a simple approach for obtaining CSF suppression with an improved contrast-to-noise ratio compared with conventional FLAIR and double inversion recovery without the acquisition of additional data. FLAIR(2) can be computed retrospectively if T2 and FLAIR scans are available.
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Affiliation(s)
- V Wiggermann
- From the Departments of Physics and Astronomy (V.W.) Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | - E Hernández-Torres
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.)
| | | | - D K B Li
- Medicine (Neurology) (A.T., D.K.B.L.) Radiology (D.K.B.L.) Centre for Brain Health (D.K.B.L., A.R.)
| | - A Rauscher
- Pediatrics (V.W., E.H.T., A.R.) University of British Columbia MRI Research Centre (V.W., E.H.T., A.R.) Centre for Brain Health (D.K.B.L., A.R.) Child and Family Research Institute (A.R.), University of British Columbia, Vancouver, British Columbia, Canada.
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35
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Stüber C, Pitt D, Wang Y. Iron in Multiple Sclerosis and Its Noninvasive Imaging with Quantitative Susceptibility Mapping. Int J Mol Sci 2016; 17:ijms17010100. [PMID: 26784172 PMCID: PMC4730342 DOI: 10.3390/ijms17010100] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 01/06/2023] Open
Abstract
Iron is considered to play a key role in the development and progression of Multiple Sclerosis (MS). In particular, iron that accumulates in myeloid cells after the blood-brain barrier (BBB) seals may contribute to chronic inflammation, oxidative stress and eventually neurodegeneration. Magnetic resonance imaging (MRI) is a well-established tool for the non-invasive study of MS. In recent years, an advanced MRI method, quantitative susceptibility mapping (QSM), has made it possible to study brain iron through in vivo imaging. Moreover, immunohistochemical investigations have helped defining the lesional and cellular distribution of iron in MS brain tissue. Imaging studies in MS patients and of brain tissue combined with histological studies have provided important insights into the role of iron in inflammation and neurodegeneration in MS.
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Affiliation(s)
- Carsten Stüber
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - David Pitt
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA.
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36
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Stüber C, Pitt D, Wang Y. Iron in Multiple Sclerosis and Its Noninvasive Imaging with Quantitative Susceptibility Mapping. Int J Mol Sci 2016. [PMID: 26784172 DOI: 10.3390/ijmsl17010100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Iron is considered to play a key role in the development and progression of Multiple Sclerosis (MS). In particular, iron that accumulates in myeloid cells after the blood-brain barrier (BBB) seals may contribute to chronic inflammation, oxidative stress and eventually neurodegeneration. Magnetic resonance imaging (MRI) is a well-established tool for the non-invasive study of MS. In recent years, an advanced MRI method, quantitative susceptibility mapping (QSM), has made it possible to study brain iron through in vivo imaging. Moreover, immunohistochemical investigations have helped defining the lesional and cellular distribution of iron in MS brain tissue. Imaging studies in MS patients and of brain tissue combined with histological studies have provided important insights into the role of iron in inflammation and neurodegeneration in MS.
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Affiliation(s)
- Carsten Stüber
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - David Pitt
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA.
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37
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Solomon AJ, Schindler MK, Howard DB, Watts R, Sati P, Nickerson JP, Reich DS. "Central vessel sign" on 3T FLAIR* MRI for the differentiation of multiple sclerosis from migraine. Ann Clin Transl Neurol 2015; 3:82-7. [PMID: 26900578 PMCID: PMC4748312 DOI: 10.1002/acn3.273] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/26/2015] [Accepted: 11/11/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The diagnosis of multiple sclerosis (MS) presently relies on radiographic assessments of imperfect specificity. Recent data using T2* methodology for the detection of the "central vessel sign" (CVS) in MS lesions suggests this novel MRI technique may distinguish MS from other disorders. Our aim was to determine if evaluation for CVS on 3T FLAIR* MRI differentiates MS from migraine. METHODS Patients with MS or migraine and a prior brain MRI demonstrating at least two hyperintense lesions ≥3 mm were recruited. Exclusion criteria included any additional comorbidity known to cause brain MRI abnormalities. 3T MRI was performed in each participant with administration of gadopentetate dimeglumine, and FLAIR* images were generated in postprocessing. The total number of discrete ovoid lesions ≥3 mm were counted on FLAIR, per participant, and subsequently evaluated for presence of CVS on FLAIR*. An exploratory method evaluating for CVS in a maximum of 12 lesions per subject was also completed. RESULTS Ten participants with MS and 10 with migraine completed the study. The median percentage (quartiles) of lesions in MS participants with CVS was 84 (79, 94) compared to 22 (15, 54) in migraine (P = 0.008). In a subanalysis by brain region, in the subcortical and deep white matter, the median percentage (quartiles) of lesions in MS participants with CVS was 88 (81, 100) compared to 19 (11, 54) in migraine (P = 0.004). This difference was not identified in juxtacortical, periventricular, or infratentorial regions. INTERPRETATION Identification of CVS using FLAIR* on 3T MRI helps differentiate MS from migraine, particularly in the subcortical and deep white matter.
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Affiliation(s)
- Andrew J Solomon
- Department of Neurological Sciences University of Vermont College of Medicine Burlington Vermont
| | - Matthew K Schindler
- Translational Neuroradiology Unit Division of Neuroimmunology and Neurovirology National Institute of Neurological Disorders and Stroke Bethesda Maryland
| | - Diantha B Howard
- Vermont Center for Clinical and Translational Science Burlington Vermont
| | - Richard Watts
- Department of Radiology University of Vermont College of Medicine Burlington Vermont
| | - Pascal Sati
- Translational Neuroradiology Unit Division of Neuroimmunology and Neurovirology National Institute of Neurological Disorders and Stroke Bethesda Maryland
| | - Joshua P Nickerson
- Department of Radiology University of Vermont College of Medicine Burlington Vermont
| | - Daniel S Reich
- Translational Neuroradiology Unit Division of Neuroimmunology and Neurovirology National Institute of Neurological Disorders and Stroke Bethesda Maryland
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Sinnecker T, Kuchling J, Dusek P, Dörr J, Niendorf T, Paul F, Wuerfel J. Ultrahigh field MRI in clinical neuroimmunology: a potential contribution to improved diagnostics and personalised disease management. EPMA J 2015; 6:16. [PMID: 26312125 PMCID: PMC4549950 DOI: 10.1186/s13167-015-0038-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 07/20/2015] [Indexed: 12/29/2022]
Abstract
Conventional magnetic resonance imaging (MRI) at 1.5 Tesla (T) is limited by modest spatial resolution and signal-to-noise ratio (SNR), impeding the identification and classification of inflammatory central nervous system changes in current clinical practice. Gaining from enhanced susceptibility effects and improved SNR, ultrahigh field MRI at 7 T depicts inflammatory brain lesions in great detail. This review summarises recent reports on 7 T MRI in neuroinflammatory diseases and addresses the question as to whether ultrahigh field MRI may eventually improve clinical decision-making and personalised disease management.
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Affiliation(s)
- Tim Sinnecker
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Department of Neurology, Asklepios Fachklinikum Teupitz, Buchholzer Str. 21, 15755 Teupitz, Germany
| | - Joseph Kuchling
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Petr Dusek
- Institute of Neuroradiology, Universitaetsmedizin Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.,Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Kateřinská 30, 128 21 Praha 2, Czech Republic
| | - Jan Dörr
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany.,Experimental and Clinical Research Center, Charité - Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Experimental and Clinical Research Center, Charité - Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany.,Department of Neurology, Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center (NCRC), Charité - Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.,Institute of Neuroradiology, Universitaetsmedizin Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.,Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Robert-Roessle-Strasse 10, 13125 Berlin, Germany.,Medical Image Analysis Center, Mittlere Strasse 83, CH-4031 Basel, Switzerland
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Di Ieva A, Lam T, Alcaide-Leon P, Bharatha A, Montanera W, Cusimano MD. Magnetic resonance susceptibility weighted imaging in neurosurgery: current applications and future perspectives. J Neurosurg 2015. [PMID: 26207600 DOI: 10.3171/2015.1.jns142349] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Susceptibility weighted imaging (SWI) is a relatively new imaging technique. Its high sensitivity to hemorrhagic components and ability to depict microvasculature by means of susceptibility effects within the veins allow for the accurate detection, grading, and monitoring of brain tumors. This imaging modality can also detect changes in blood flow to monitor stroke recovery and reveal specific subtypes of vascular malformations. In addition, small punctate lesions can be demonstrated with SWI, suggesting diffuse axonal injury, and the location of these lesions can help predict neurological outcome in patients. This imaging technique is also beneficial for applications in functional neurosurgery given its ability to clearly depict and differentiate deep midbrain nuclei and close submillimeter veins, both of which are necessary for presurgical planning of deep brain stimulation. By exploiting the magnetic susceptibilities of substances within the body, such as deoxyhemoglobin, calcium, and iron, SWI can clearly visualize the vasculature and hemorrhagic components even without the use of contrast agents. The high sensitivity of SWI relative to other imaging techniques in showing tumor vasculature and microhemorrhages suggests that it is an effective imaging modality that provides additional information not shown using conventional MRI. Despite SWI's clinical advantages, its implementation in MRI protocols is still far from consistent in clinical usage. To develop a deeper appreciation for SWI, the authors here review the clinical applications in 4 major fields of neurosurgery: neurooncology, vascular neurosurgery, neurotraumatology, and functional neurosurgery. Finally, they address the limitations of and future perspectives on SWI in neurosurgery.
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Affiliation(s)
| | - Timothy Lam
- Division of Neurosurgery, Department of Surgery; and
| | - Paula Alcaide-Leon
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Aditya Bharatha
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Walter Montanera
- Division of Neuroradiology, Department of Radiology, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Bozin I, Ge Y, Kuchling J, Dusek P, Chawla S, Harms L, Ruprecht K, Niendorf T, Paul F, Kister I, Sinnecker T, Wuerfel J. Magnetic Resonance Phase Alterations in Multiple Sclerosis Patients with Short and Long Disease Duration. PLoS One 2015; 10:e0128386. [PMID: 26186349 PMCID: PMC4506094 DOI: 10.1371/journal.pone.0128386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/24/2015] [Indexed: 11/19/2022] Open
Abstract
Objective The analysis of the MR phase provides additional information on the tissue microstructure. In multiple sclerosis (MS) lesions phase alterations may reflect different stages of inflammatory activity. Here we investigated lesion morphology in MS patients with short and long disease duration on T2* weighted, phase, magnitude and susceptibility weighted imaging (SWI) at 7 Tesla (T). Methods 17 MS or clinically isolated syndrome patients with short (<60 months) and 11 with long (>60 months) disease duration underwent 7T MRI. Lesions were subsequently analyzed side-by-side with regard to morphology and visibility on T2* weighted, SWI, magnitude and SWI-filtered phase images. Results 126 of 192 T2* weighted lesions (65.6%) were characterized by a phase alteration pattern, and hence could be differentiated on phase images. In detail, a significantly reduced proportion of lesions showing phase alterations was detectable in patients with longer disease duration (mean±SD 51±37%, range 0–100%) compared to patients with short disease duration (mean±SD 90±19.5%, range 50–100%, p = 0.003). Conclusion This cross-sectional study identified different patterns of phase changes in lesions of MS patients with short and long standing disease. Longitudinal studies are warranted to prove that MR phase imaging is useful in determining the activity and the developmental stage of individual MS plaques.
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Affiliation(s)
- Ivan Bozin
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
| | - Yulin Ge
- Department of Radiology, NYU School of Medicine, New York, New York, United States of America
| | - Joseph Kuchling
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
| | - Petr Dusek
- Institute of Neuroradiology, Universitaetsmedizin Goettingen, Goettingen, Germany
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Sanjeev Chawla
- Department of Radiology, NYU School of Medicine, New York, New York, United States of America
| | - Lutz Harms
- Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Klemens Ruprecht
- Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité—Universitaetsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
- Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité—Universitaetsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
- * E-mail:
| | - Ilya Kister
- Multiple Sclerosis Care Center, Department of Neurology, NYU School of Medicine, New York, New York, United States of America
| | - Tim Sinnecker
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité –Universitaetsmedizin Berlin, Berlin, Germany
- Institute of Neuroradiology, Universitaetsmedizin Goettingen, Goettingen, Germany
- Berlin Ultrahigh Field Facility, Max Delbrueck Center for Molecular Medicine, Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitaetsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
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Rovira À, Wattjes MP, Tintoré M, Tur C, Yousry TA, Sormani MP, De Stefano N, Filippi M, Auger C, Rocca MA, Barkhof F, Fazekas F, Kappos L, Polman C, Miller D, Montalban X. Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis-clinical implementation in the diagnostic process. Nat Rev Neurol 2015; 11:471-82. [PMID: 26149978 DOI: 10.1038/nrneurol.2015.106] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The clinical use of MRI in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Technical improvements and continuously emerging data from clinical trials and observational studies have contributed to the enhanced performance of this tool for achieving a prompt diagnosis in patients with MS. The aim of this article is to provide guidelines for the implementation of MRI of the brain and spinal cord in the diagnosis of patients who are suspected of having MS. These guidelines are based on an extensive review of the recent literature, as well as on the personal experience of the members of the MAGNIMS (Magnetic Resonance Imaging in MS) network. We address the indications, timing, coverage, reporting and interpretation of MRI studies in patients with suspected MS. Our recommendations are intended to help radiologists and neurologists standardize and optimize the use of MRI in clinical practice for the diagnosis of MS.
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Affiliation(s)
- Àlex Rovira
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Mike P Wattjes
- MS Centre Amsterdam, VU University Medical Centre, Netherlands
| | - Mar Tintoré
- Neurology/Neuroimmunology Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Carmen Tur
- Neurology/Neuroimmunology Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Tarek A Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, University College London Institute of Neurology, UK
| | - Maria P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - Nicola De Stefano
- Department of Neurological and Behavioural Sciences, University of Siena, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | - Cristina Auger
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Italy
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria
| | - Ludwig Kappos
- Department of Neurology, University of Basel, Switzerland
| | - Chris Polman
- MS Centre Amsterdam, VU University Medical Centre, Netherlands
| | - David Miller
- NMR Research Unit, Queen Square MS Centre, University College London Institute of Neurology, UK
| | - Xavier Montalban
- Magnetic Resonance Unit, Cemcat, Hospital Vall d'Hebron, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Abakumova TO, Nukolova NV, Gusev EI, Chekhonin VP. [Contrast agents in MRI-diagnosis of multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:58-65. [PMID: 25909791 DOI: 10.17116/jnevro20151151158-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging using contrast agents plays an important role in diagnosis and assessment of treatment efficacy in multiple sclerosis. The development of contrast agents on the basis of gadolinium or iron oxide nanoparticles has potential for diagnosis of pathological foci (tumors, amyloid plaques, inflammation and foci of demyelination or necrosis) in nervous system diseases. Newly developing types of diagnostic substances for visualization of pathological foci in multiple sclerosis are presented in this review.
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Affiliation(s)
- T O Abakumova
- Pirogov Russian National Research Medical University, Moscow
| | - N V Nukolova
- Pirogov Russian National Research Medical University, Moscow
| | - E I Gusev
- Pirogov Russian National Research Medical University, Moscow
| | - V P Chekhonin
- Pirogov Russian National Research Medical University, Moscow
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Dal-Bianco A, Hametner S, Grabner G, Schernthaner M, Kronnerwetter C, Reitner A, Vass C, Kircher K, Auff E, Leutmezer F, Vass K, Trattnig S. Veins in plaques of multiple sclerosis patients – a longitudinal magnetic resonance imaging study at 7 Tesla –. Eur Radiol 2015; 25:2913-20. [DOI: 10.1007/s00330-015-3719-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
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Hagemeier J, Heininen-Brown M, Gabelic T, Guttuso T, Silvestri N, Lichter D, Fugoso LE, Bergsland N, Carl E, Geurts JJG, Weinstock-Guttman B, Zivadinov R. Phase white matter signal abnormalities in patients with clinically isolated syndrome and other neurologic disorders. AJNR Am J Neuroradiol 2014; 35:1916-23. [PMID: 24874536 DOI: 10.3174/ajnr.a3969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Identifying MRI biomarkers that can differentiate multiple sclerosis patients from other neurological disorders is a subject of intense research. Our aim was to investigate phase WM signal abnormalities for their presence, prevalence, location, and diagnostic value among patients with clinically isolated syndrome and other neurologic disorders and age-, sex-, and group-matched healthy controls. MATERIALS AND METHODS Forty-eight patients with clinically isolated syndrome and 30 patients with other neurologic diseases and a healthy control group (n = 47) were included in the study. Subjects were scanned at 3T by using SWI-filtered phase and T2WI, with WM signal abnormalities ≥3 mm being classified. RESULTS Patients with clinically isolated syndrome had significantly more phase and T2 WM signal abnormalities than healthy controls (P < .001). Phase WM signal abnormalities were more prevalent among patients with clinically isolated syndrome compared with patients with other neurologic disorders (4:1 ratio), whereas T2 WM signal abnormalities were more ubiquitous with a 2:1 ratio. The presence of phase WM signal abnormalities was sensitive for clinically isolated syndrome (70.8%) and achieved a moderate-to-high specificity for differentiating patients with clinically isolated syndrome and healthy controls, patients with other neurologic disorders, and patients with other neurologic disorders of other autoimmune origin (specificity, 70%-76.7%). Combining the presence of ≥2 phase lesions with the McDonald 2005 and 2010 criteria for dissemination in space improved the specificity (90%), but not the accuracy, in differentiating patients with clinically isolated syndrome from those with other neurologic disorders. In subanalyses among patients with clinically isolated syndrome who converted to clinically definite multiple sclerosis versus those who did not within a 3-year follow-up period, converters had significantly more phase (P = .008) but not T2 or T1 WM signal abnormalities. CONCLUSIONS Phase WM signal abnormalities are prevalent among patients with clinically isolated syndrome. The presence of (multiple) phase WM signal abnormalities tended to be more predictive of conversion to clinically definite multiple sclerosis and was specific in differentiating patients with clinically isolated syndrome and other neurologic disorders, compared with T2 WM signal abnormalities; however, the accuracy remains similar to that of the current McDonald criteria.
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Affiliation(s)
- J Hagemeier
- From the Buffalo Neuroimaging Analysis Center (J.H., M.H.-B., T. Gabelic, N.B., E.C., R.Z.)
| | - M Heininen-Brown
- From the Buffalo Neuroimaging Analysis Center (J.H., M.H.-B., T. Gabelic, N.B., E.C., R.Z.)
| | - T Gabelic
- From the Buffalo Neuroimaging Analysis Center (J.H., M.H.-B., T. Gabelic, N.B., E.C., R.Z.) Department of Neurology (T. Gabelic), Referral Centre for Demyelinating Disease of the Central Nervous System, University Hospital Centre Zagreb, Zagreb, Croatia
| | - T Guttuso
- Baird MS Center (T. Guttuso, N.S., D.L., L.E.F., B.W.-G., R.Z.), Department of Neurology, University at Buffalo, Buffalo, New York
| | - N Silvestri
- Baird MS Center (T. Guttuso, N.S., D.L., L.E.F., B.W.-G., R.Z.), Department of Neurology, University at Buffalo, Buffalo, New York
| | - D Lichter
- Baird MS Center (T. Guttuso, N.S., D.L., L.E.F., B.W.-G., R.Z.), Department of Neurology, University at Buffalo, Buffalo, New York
| | - L E Fugoso
- Baird MS Center (T. Guttuso, N.S., D.L., L.E.F., B.W.-G., R.Z.), Department of Neurology, University at Buffalo, Buffalo, New York
| | - N Bergsland
- From the Buffalo Neuroimaging Analysis Center (J.H., M.H.-B., T. Gabelic, N.B., E.C., R.Z.) Istituto Di Ricovero e Cura a Carattere Scientifico (N.B.), Don Gnocchi Foundation, Milan, Italy
| | - E Carl
- From the Buffalo Neuroimaging Analysis Center (J.H., M.H.-B., T. Gabelic, N.B., E.C., R.Z.)
| | - J J G Geurts
- Department of Anatomy and Neurosciences (J.J.G.G.), Section of Clinical Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
| | - B Weinstock-Guttman
- Baird MS Center (T. Guttuso, N.S., D.L., L.E.F., B.W.-G., R.Z.), Department of Neurology, University at Buffalo, Buffalo, New York
| | - R Zivadinov
- From the Buffalo Neuroimaging Analysis Center (J.H., M.H.-B., T. Gabelic, N.B., E.C., R.Z.) Baird MS Center (T. Guttuso, N.S., D.L., L.E.F., B.W.-G., R.Z.), Department of Neurology, University at Buffalo, Buffalo, New York
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Pathology of multiple sclerosis and related inflammatory demyelinating diseases. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:15-58. [PMID: 24507512 DOI: 10.1016/b978-0-444-52001-2.00002-9] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This article provides a comprehensive overview of the pathology of multiple sclerosis (MS), including recent insights into its molecular neuropathology and immunology. It shows that all clinical manifestations of relapsing and progressive MS display the same basic features of pathology, such as chronic inflammation, demyelination in the white and gray matter, and diffuse neurodegeneration within the entire central nervous system. However, the individual components of the pathological spectrum vary quantitatively between early relapsing and late progressive MS. Widespread confluent and plaque-like demyelination with oligodendrocyte destruction is the unique pathological hallmark of the disease, but axonal injury and neurodegeneration are additionally present and in part extensive. Remyelination of existing lesions may occur in MS brains; it is extensive in a subset of patients, while it fails in others. Active tissue injury in MS is always associated with inflammation, consistent with T-cell and macrophage infiltration and microglia activation. Recent data suggest that oxidative injury and subsequent mitochondrial damage play a major pathogenetic role in neurodegeneration. Finally we discuss similarities and differences of the pathology between classical MS and other inflammatory demyelinating diseases, such as neuromyelitis optica, concentric sclerosis, or acute disseminated encephalomyelitis.
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Morphological features of MS lesions on FLAIR* at 7 T and their relation to patient characteristics. J Neurol 2014; 261:1356-64. [DOI: 10.1007/s00415-014-7351-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 01/10/2023]
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Filippi M, Evangelou N, Kangarlu A, Inglese M, Mainero C, Horsfield MA, Rocca MA. Ultra-high-field MR imaging in multiple sclerosis. J Neurol Neurosurg Psychiatry 2014; 85:60-6. [PMID: 23813636 DOI: 10.1136/jnnp-2013-305246] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In multiple sclerosis (MS), MRI is the most important paraclinical tool used to inform diagnosis and for monitoring disease evolution, either natural or modified by treatment. The increased availability of ultra-high-field magnets (7 Tesla or higher) gives rise to questions about the main benefits of and challenges for their use in patients with MS. The main advantages of ultra-high-field MRI are the improved signal-to-noise ratio, greater chemical shift dispersion, and improved contrast due to magnetic susceptibility variations, which lead to increased sensitivity to the heterogeneous pathological substrates of the disease. At present, ultra-high-field MRI is mainly used to improve our understanding of MS pathogenesis. This review discusses the main achievements that have so far come from the use of these scanners, which are: better visualisation of white matter lesions and their morphological characteristics; an improvement in the ability to visualise grey matter lesions and their exact location; the quantification of 'novel' metabolites which may have a role in axonal degeneration; and greater sensitivity to iron accumulation. The application of ultra-high-field systems in standard clinical practice is still some way off since their role in the diagnostic work-up of patients at presentation with clinically isolated syndromes, or in monitoring disease progression or treatment response in patients with definite MS, needs to be established. Additional challenges remain in the development of morphological, quantitative and functional imaging methods at these field strengths, techniques which may ultimately lead to novel biomarkers for monitoring disease evolution and treatment response.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, , San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Kilsdonk ID, Wattjes MP, Lopez-Soriano A, Kuijer JPA, de Jong MC, de Graaf WL, Conijn MMA, Polman CH, Luijten PR, Geurts JJG, Geerlings MI, Barkhof F. Improved differentiation between MS and vascular brain lesions using FLAIR* at 7 Tesla. Eur Radiol 2013; 24:841-9. [PMID: 24317461 DOI: 10.1007/s00330-013-3080-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/28/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate whether a new magnetic resonance image (MRI) technique called T2*-weighted fluid attenuation inversion recovery (FLAIR*) can differentiate between multiple sclerosis (MS) and vascular brain lesions, at 7 Tesla (T). METHODS We examined 16 MS patients and 16 age-matched patients with (risk factors for) vascular disease. 3D-FLAIR and T2*-weighted images were combined into FLAIR* images. Lesion type and intensity, perivascular orientation and presence of a hypointense rim were analysed. RESULTS In total, 433 cerebral lesions were detected in MS patients versus 86 lesions in vascular patients. Lesions in MS patients were significantly more often orientated in a perivascular manner: 74 % vs. 47 % (P < 0.001). Ten MS lesions (2.3 %) were surrounded by a hypointense rim on FLAIR*, and 24 MS lesions (5.5 %) were hypointense on T2*. No lesions in vascular patients showed any rim or hypointensity. Specificity of differentiating MS from vascular lesions on 7-T FLAIR* increased when the presence of a central vessel was taken into account (from 63 % to 88 %), most obviously for deep white matter lesions (from 69 % to 94 %). High sensitivity remained (81 %). CONCLUSION 7-T FLAIR* improves differentiation between MS and vascular lesions based on lesion location, perivascular orientation and presence of hypointense (rims around) lesions. KEY POINTS • A new MRI technique T2*-weighted fluid attenuation inversion recovery (FLAIR*) was investigated. • FLAIR* at 7-T MRI combines FLAIR and T2* images into a single image. • FLAIR* at 7 T does not require enhancement with contrast agents. •High-resolution 7-T FLAIR* improves differentiation between MS and vascular brain lesions. • FLAIR* revealed a central vessel more frequently in MS than vascular lesions.
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Affiliation(s)
- Iris D Kilsdonk
- Department of Radiology, VU University Medical Center, De Boelelaan 1118, 1081, HZ, Amsterdam, The Netherlands,
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Chen W, Gauthier SA, Gupta A, Comunale J, Liu T, Wang S, Pei M, Pitt D, Wang Y. Quantitative susceptibility mapping of multiple sclerosis lesions at various ages. Radiology 2013; 271:183-92. [PMID: 24475808 DOI: 10.1148/radiol.13130353] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess multiple sclerosis (MS) lesions at various ages by using quantitative susceptibility mapping (QSM) and conventional magnetic resonance (MR) imaging. MATERIALS AND METHODS Retrospectively selected were 32 clinically confirmed MS patients (nine men and 23 women; 39.3 years ± 10.9) who underwent two MR examinations (interval, 0.43 years ± 0.16) with three-dimensional gradient-echo sequence from August 2011 to August 2012. To estimate the ages of MS lesions, MR examinations performed 0.3-10.6 years before study examinations were studied. Hyperintensity on T2-weighted images was used to define MS lesions. QSM images were reconstructed from gradient-echo data. Susceptibility of MS lesions and temporal rates of change were obtained from QSM images. Lesion susceptibilities were analyzed by t test with intracluster correlation adjustment and Bonferroni correction in multiple comparisons. RESULTS MR imaging of 32 patients depicted 598 MS lesions, of which 162 lesions (27.1%) in 23 patients were age measurable and six (1.0%) were only visible at QSM. The susceptibilities relative to normal-appearing white matter (NAWM) were 0.53 ppb ± 3.34 for acute enhanced lesions, 38.43 ppb ± 13.0 (positive; P < .01) for early to intermediately aged nonenhanced lesions, and 4.67 ppb ± 3.18 for chronic nonenhanced lesions. Temporal rates of susceptibility changes relative to cerebrospinal fluid were 12.49 ppb/month ± 3.15 for acute enhanced lesions, 1.27 ppb/month ± 2.31 for early to intermediately aged nonenhanced lesions, and -0.004 ppb/month ± 0 for chronic nonenhanced lesions. CONCLUSION Magnetic susceptibility of MS lesions increased rapidly as it changed from enhanced to nonenhanced, it attained a high susceptibility value relative to NAWM during its initial few years (approximately 4 years), and it gradually dissipated back to susceptibility similar to that of NAWM as it aged, which may provide new insight into pathophysiologic features of MS lesions. Online supplemental material is available for this article.
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Affiliation(s)
- Weiwei Chen
- From the Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China (W.C.); Departments of Neurology (S.A.G.) and Radiology (W.C., A.G., J.C., T.L., S.W., M.P., Y.W.), Weill Cornell Medical College, 515 E 71st St, New York, NY 10021; Department of Biomedical Engineering, Cornell University, Ithaca, NY (T.L., Y.W.); Department of Biomedical Engineering, Kyung Hee University, Seoul, South Korea (Y.W.); School of Electronic Engineering, University of Electronic Science and Technology of China, Chengdu, China (S.W.); and Department of Neurology, Yale University, New Haven, Conn (D.P.)
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Grabner G, Dal-Bianco A, Hametner S, Lassmann H, Trattnig S. Group specific vein-atlasing: An application for analyzing the venous system under normal and multiple sclerosis conditions. J Magn Reson Imaging 2013; 40:655-61. [DOI: 10.1002/jmri.24393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 08/16/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Günther Grabner
- Medical University of Vienna, MR Centre of Excellence; Department of Biomedical Imaging and Image-Guided Therapy; Vienna Austria
| | | | - Simon Hametner
- Medical University of Vienna; Center for Brain Research; Vienna Austria
| | - Hans Lassmann
- Medical University of Vienna; Center for Brain Research; Vienna Austria
| | - Siegfried Trattnig
- Medical University of Vienna, MR Centre of Excellence; Department of Biomedical Imaging and Image-Guided Therapy; Vienna Austria
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