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Rjeily NB, Solomon AJ. Misdiagnosis of Multiple Sclerosis: Past, Present, and Future. Curr Neurol Neurosci Rep 2024; 24:547-557. [PMID: 39243340 DOI: 10.1007/s11910-024-01371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE OF REVIEW Misdiagnosis of multiple sclerosis (MS) is a prevalent worldwide problem. This review discusses how MS misdiagnosis has evolved over time and focuses on contemporary challenges and potential strategies for its prevention. RECENT FINDINGS Recent studies report cohorts with a range of misdiagnosis between 5 and 18%. Common disorders are frequently misdiagnosed as MS. Overreliance on MRI findings and misapplication of MS diagnostic criteria are often associated with misdiagnosis. Emerging imaging biomarkers, including the central vein sign and paramagnetic rim lesions, may aid diagnostic accuracy when evaluating patients for suspected MS. MS misdiagnosis can have harmful consequences for patients and healthcare systems. Further research is needed to better understand its causes. Concerted and novel educational efforts to ensure accurate and widespread implementation of MS diagnostic criteria remain an unmet need. The incorporation of diagnostic biomarkers highly specific for MS in the future may prevent misdiagnosis.
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Affiliation(s)
- Nicole Bou Rjeily
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, 1 South Prospect St., Burlington, VT, 05477, USA.
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2
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Bagnato F, Sati P, Hemond CC, Elliott C, Gauthier SA, Harrison DM, Mainero C, Oh J, Pitt D, Shinohara RT, Smith SA, Trapp B, Azevedo CJ, Calabresi PA, Henry RG, Laule C, Ontaneda D, Rooney WD, Sicotte NL, Reich DS, Absinta M. Imaging chronic active lesions in multiple sclerosis: a consensus statement. Brain 2024; 147:2913-2933. [PMID: 38226694 PMCID: PMC11370808 DOI: 10.1093/brain/awae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/17/2024] Open
Abstract
Chronic active lesions (CAL) are an important manifestation of chronic inflammation in multiple sclerosis and have implications for non-relapsing biological progression. In recent years, the discovery of innovative MRI and PET-derived biomarkers has made it possible to detect CAL, and to some extent quantify them, in the brain of persons with multiple sclerosis, in vivo. Paramagnetic rim lesions on susceptibility-sensitive MRI sequences, MRI-defined slowly expanding lesions on T1-weighted and T2-weighted scans, and 18-kDa translocator protein-positive lesions on PET are promising candidate biomarkers of CAL. While partially overlapping, these biomarkers do not have equivalent sensitivity and specificity to histopathological CAL. Standardization in the use of available imaging measures for CAL identification, quantification and monitoring is lacking. To fast-forward clinical translation of CAL, the North American Imaging in Multiple Sclerosis Cooperative developed a consensus statement, which provides guidance for the radiological definition and measurement of CAL. The proposed manuscript presents this consensus statement, summarizes the multistep process leading to it, and identifies the remaining major gaps in knowledge.
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Affiliation(s)
- Francesca Bagnato
- Neuroimaging Unit, Neuroimmunology Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
- Department of Neurology, Nashville VA Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA
| | - Pascal Sati
- Neuroimaging Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Christopher C Hemond
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | | | - Susan A Gauthier
- Department of Neurology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Department of Neurology, Baltimore VA Medical Center, VA Maryland Healthcare System, Baltimore, MD 21201, USA
| | - Caterina Mainero
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jiwon Oh
- Division of Neurology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5S, Canada
| | - David Pitt
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Endeavor, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Seth A Smith
- Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Bruce Trapp
- Department on Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90007, USA
| | - Peter A Calabresi
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Cornelia Laule
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH 44195, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR 97239, USA
| | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Martina Absinta
- Departments of Neurology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Translational Neuropathology Unit, Division of Neuroscience, Institute of Experimental Neurology, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, 20132, Italy
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Hemond CC, Gaitán MI, Absinta M, Reich DS. New Imaging Markers in Multiple Sclerosis and Related Disorders: Smoldering Inflammation and the Central Vein Sign. Neuroimaging Clin N Am 2024; 34:359-373. [PMID: 38942521 PMCID: PMC11213979 DOI: 10.1016/j.nic.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Concepts of multiple sclerosis (MS) biology continue to evolve, with observations such as "progression independent of disease activity" challenging traditional phenotypic categorization. Iron-sensitive, susceptibility-based imaging techniques are emerging as highly translatable MR imaging sequences that allow for visualization of at least 2 clinically useful biomarkers: the central vein sign and the paramagnetic rim lesion (PRL). Both biomarkers demonstrate high specificity in the discrimination of MS from other mimics and can be seen at 1.5 T and 3 T field strengths. Additionally, PRLs represent a subset of chronic active lesions engaged in "smoldering" compartmentalized inflammation behind an intact blood-brain barrier.
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Affiliation(s)
- Christopher C Hemond
- Department of Neurology, University of Massachusetts Memorial Medical Center and University of Massachusetts Chan Medical School, Worcester, MA, USA; National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - María I Gaitán
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Martina Absinta
- Translational Neuropathology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Reeves JA, Mohebbi M, Zivadinov R, Bergsland N, Dwyer MG, Salman F, Schweser F, Jakimovski D. Reliability of paramagnetic rim lesion classification on quantitative susceptibility mapping (QSM) in people with multiple sclerosis: Single-site experience and systematic review. Mult Scler Relat Disord 2023; 79:104968. [PMID: 37716210 PMCID: PMC11092095 DOI: 10.1016/j.msard.2023.104968] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Recent developments in iron-sensitive MRI techniques have enabled visualization of chronic active lesions as paramagnetic rim lesions (PRLs) in vivo. Although PRLs have potential as a diagnostic and prognostic tool for multiple sclerosis (MS), limited studies have reported the reliability of PRL assessment. Further evaluation of PRL reliability, through original investigations and review of PRL literature, are warranted. METHODS A single-center cohort study was conducted to evaluate the inter-rater reliability of PRL identification on quantitative susceptibiltiy mapping (QSM) in 10 people with MS, 5 people with clinically isolated syndrome, and 5 healthy controls. An additional systematic literature search was then conducted of published PRL reliability data, and these results were synthesized. RESULTS In the single-center study, both inter-rater and intra-rater reliability of per-subject PRL number were at an "Excellent" (intraclass correlation coefficient (ICC) of 0.901 for both) level with only 2-years lesion classification experience. Across the reported literature values, reliability of per-lesion rim presence was on average "Near perfect" (for intra-rater; Cohen's κ = 0.833) and "Substantial" (for inter-rater; Cohens κ = 0.687), whereas inter-rater reliability of per-subject PRL number was "Good" (ICC = 0.874). Only 4/22 studies reported complete information on rater experience, rater level of training, detailed PRL classification criteria, and reliability cohort size and disease subtypes. CONCLUSION PRLs can be reliably detected both at per-lesion and per-subject level. We recommend that future PRL studies report detailed reliability results, including rater experience level, and use a standardized set of reliability metrics (Cohen's κ or ICC) for improved comparability between studies.
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Affiliation(s)
- Jack A Reeves
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | - Maryam Mohebbi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | - Fahad Salman
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Dejan Jakimovski
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA.
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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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Hemond CC, Reich DS, Dundamadappa SK. Paramagnetic Rim Lesions in Multiple Sclerosis: Comparison of Visualization at 1.5-T and 3-T MRI. AJR Am J Roentgenol 2022; 219:120-131. [PMID: 34851712 PMCID: PMC9416872 DOI: 10.2214/ajr.21.26777] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Multiple sclerosis (MS) is characterized by both acute and chronic intrathecal inflammation. A subset of MS lesions show paramagnetic rims on susceptibility-weighted MRI sequences, reflecting iron accumulation in microglia. These para-magnetic rim lesions have been proposed as a marker of compartmentalized smoldering disease. Paramagnetic rim lesions have been shown at 7 T and, more recently, at 3 T. As susceptibility effects are weaker at lower field strength, it remains unclear if paramagnetic rim lesions are visible at 1.5 T. OBJECTIVE. The purpose of our study was to compare visualization of paramagnetic rim lesions using susceptibility-weighted imaging at 1.5-T and 3-T MRI in patients with MS. METHODS. This retrospective study included nine patients (five women, four men; mean age, 46.8 years) with MS who underwent both 1.5-T and 3-T MRI using a comparable susceptibility-weighted angiography (SWAN) sequence from the same manufacturer. Lesions measuring greater than 3 mm were annotated. Two reviewers independently assessed images at each field strength in separate sessions and classified the annotated lesions as isointense, diffusely paramagnetic, or paramagnetic rim lesions. Discrepancies were discussed at consensus sessions including a third reviewer. Agreement was assessed using kappa coefficients. RESULTS. Based on the 3-T consensus readings, 115 of 140 annotated lesions (82%) were isointense lesions, 16 (11%) were diffusely paramagnetic lesions, and nine (6%) were paramagnetic rim lesions; based on the 1.5-T consensus readings, 115 (82%) were isointense lesions, 14 (10%) were diffusely paramagnetic lesions, and 11 (8%) were para-magnetic rim lesions. The mean lesion diameter was 11.9 mm for paramagnetic rim lesions versus 6.4 mm for diffusely paramagnetic lesions (p = .006) and 7.8 mm for iso-intense lesions (p = .003). Interrater agreement for lesion classification as a paramagnetic rim lesion was substantial at 1.5 T (κ = 0.65) and 3 T (κ = 0.70). Agreement for paramagnetic rim lesions was also substantial between the consensus readings at the two field strengths (κ = 0.79). CONCLUSION. We show comparable identification of paramagnetic rim lesions at 1.5-T and 3-T MRI with substantial interrater agreement at both field strengths and substantial consensus agreement between the field strengths. CLINICAL IMPACT. Paramagnetic rim lesions may be an emerging marker of chronic neuroinflammation in MS. Their visibility at 1.5 T supports the translational potential of paramagnetic rim lesion identification to more widespread clinical settings, where 1.5-T scanners are prevalent.
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Affiliation(s)
- Christopher C Hemond
- Department of Neurology, University of Massachusetts Medical Center, 55 Lake Ave N, Worcester, MA 01655
| | - Daniel S Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
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Zhang H, Nguyen TD, Zhang J, Marcille M, Spincemaille P, Wang Y, Gauthier SA, Sweeney EM. QSMRim-Net: Imbalance-aware learning for identification of chronic active multiple sclerosis lesions on quantitative susceptibility maps. Neuroimage Clin 2022; 34:102979. [PMID: 35247730 PMCID: PMC8892132 DOI: 10.1016/j.nicl.2022.102979] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Chronic active multiple sclerosis (MS) lesions are characterized by a paramagnetic rim at the edge of the lesion and are associated with increased disability in patients. Quantitative susceptibility mapping (QSM) is an MRI technique that is sensitive to chronic active lesions, termed rim + lesions on the QSM. We present QSMRim-Net, a data imbalance-aware deep neural network that fuses lesion-level radiomic and convolutional image features for automated identification of rim + lesions on QSM. METHODS QSM and T2-weighted-Fluid-Attenuated Inversion Recovery (T2-FLAIR) MRI of the brain were collected at 3 T for 172 MS patients. Rim + lesions were manually annotated by two human experts, followed by consensus from a third expert, for a total of 177 rim + and 3986 rim negative (rim-) lesions. Our automated rim + detection algorithm, QSMRim-Net, consists of a two-branch feature extraction network and a synthetic minority oversampling network to classify rim + lesions. The first network branch is for image feature extraction from the QSM and T2-FLAIR, and the second network branch is a fully connected network for QSM lesion-level radiomic feature extraction. The oversampling network is designed to increase classification performance with imbalanced data. RESULTS On a lesion-level, in a five-fold cross validation framework, the proposed QSMRim-Net detected rim + lesions with a partial area under the receiver operating characteristic curve (pROC AUC) of 0.760, where clinically relevant false positive rates of less than 0.1 were considered. The method attained an area under the precision recall curve (PR AUC) of 0.704. QSMRim-Net out-performed other state-of-the-art methods applied to the QSM on both pROC AUC and PR AUC. On a subject-level, comparing the predicted rim + lesion count and the human expert annotated count, QSMRim-Net achieved the lowest mean square error of 0.98 and the highest correlation of 0.89 (95% CI: 0.86, 0.92). CONCLUSION This study develops a novel automated deep neural network for rim + MS lesion identification using T2-FLAIR and QSM images.
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Affiliation(s)
- Hang Zhang
- Department of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA; Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jinwei Zhang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Melanie Marcille
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Yi Wang
- Department of Electrical and Computer Engineering, Cornell University, Ithaca, NY, USA; Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Susan A Gauthier
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Department of Neurology, Weill Cornell Medicine, New York, NY, USA; Feil Family Brain and Mind Institute, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth M Sweeney
- Penn Statistics in Imaging and Visualization Endeavor (PennSIVE) Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA.
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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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9
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Haacke EM, Bernitsas E, Subramanian K, Utriainen D, Palutla VK, Yerramsetty K, Kumar P, Sethi SK, Chen Y, Latif Z, Jella P, Gharabaghi S, Wang Y, Zhang X, Comley RA, Beaver J, Luo Y. A Comparison of Magnetic Resonance Imaging Methods to Assess Multiple Sclerosis Lesions: Implications for Patient Characterization and Clinical Trial Design. Diagnostics (Basel) 2021; 12:diagnostics12010077. [PMID: 35054244 PMCID: PMC8775217 DOI: 10.3390/diagnostics12010077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a sensitive imaging modality for identifying inflammatory and/or demyelinating lesions, which is critical for a clinical diagnosis of MS and evaluating drug responses. There are many unique means of probing brain tissue status, including conventional T1 and T2 weighted imaging (T1WI, T2WI), T2 fluid attenuated inversion recovery (FLAIR), magnetization transfer, myelin water fraction, diffusion tensor imaging (DTI), phase-sensitive inversion recovery and susceptibility weighted imaging (SWI), but no study has combined all of these modalities into a single well-controlled investigation. The goals of this study were to: compare different MRI measures for lesion visualization and quantification; evaluate the repeatability of various imaging methods in healthy controls; compare quantitative susceptibility mapping (QSM) with myelin water fraction; measure short-term longitudinal changes in the white matter of MS patients and map out the tissue properties of the white matter hyperintensities using STAGE (strategically acquired gradient echo imaging). Additionally, the outcomes of this study were anticipated to aid in the choice of an efficient imaging protocol reducing redundancy of information and alleviating patient burden. Of all the sequences used, T2 FLAIR and T2WI showed the most lesions. To differentiate the putative demyelinating lesions from inflammatory lesions, the fusion of SWI and T2 FLAIR was used. Our study suggests that a practical and efficient imaging protocol combining T2 FLAIR, T1WI and STAGE (with SWI and QSM) can be used to rapidly image MS patients to both find lesions and study the demyelinating and inflammatory characteristics of the lesions.
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Affiliation(s)
- Ewart Mark Haacke
- The MRI Institute for Biomedical Research, Bingham Farms, MI 48025, USA; (D.U.); (S.K.S.)
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA; (K.S.); (Z.L.); (P.J.); (Y.W.)
- Department of Neurology, Wayne State University, Detroit, MI 48201, USA; (E.B.); (Y.C.)
- SpinTech Inc., Bingham Farms, MI 48025, USA
- MR Innovations Inc., Bingham Farms, MI 48025, USA;
- Correspondence:
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University, Detroit, MI 48201, USA; (E.B.); (Y.C.)
| | - Karthik Subramanian
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA; (K.S.); (Z.L.); (P.J.); (Y.W.)
| | - David Utriainen
- The MRI Institute for Biomedical Research, Bingham Farms, MI 48025, USA; (D.U.); (S.K.S.)
- SpinTech Inc., Bingham Farms, MI 48025, USA
| | - Vinay Kumar Palutla
- MR Medical Imaging Innovations India Pvt. Ltd., Hyderabad 500081, India; (V.K.P.); (K.Y.); (P.K.)
| | - Kiran Yerramsetty
- MR Medical Imaging Innovations India Pvt. Ltd., Hyderabad 500081, India; (V.K.P.); (K.Y.); (P.K.)
| | - Prashanth Kumar
- MR Medical Imaging Innovations India Pvt. Ltd., Hyderabad 500081, India; (V.K.P.); (K.Y.); (P.K.)
| | - Sean K. Sethi
- The MRI Institute for Biomedical Research, Bingham Farms, MI 48025, USA; (D.U.); (S.K.S.)
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA; (K.S.); (Z.L.); (P.J.); (Y.W.)
- SpinTech Inc., Bingham Farms, MI 48025, USA
| | - Yongsheng Chen
- Department of Neurology, Wayne State University, Detroit, MI 48201, USA; (E.B.); (Y.C.)
| | - Zahid Latif
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA; (K.S.); (Z.L.); (P.J.); (Y.W.)
| | - Pavan Jella
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA; (K.S.); (Z.L.); (P.J.); (Y.W.)
| | | | - Ying Wang
- Department of Radiology, Wayne State University, Detroit, MI 48201, USA; (K.S.); (Z.L.); (P.J.); (Y.W.)
- MR Innovations Inc., Bingham Farms, MI 48025, USA;
| | - Xiaomeng Zhang
- AbbVie Inc., North Chicago, IL 60064, USA; (X.Z.); (R.A.C.); (J.B.); (Y.L.)
| | - Robert A. Comley
- AbbVie Inc., North Chicago, IL 60064, USA; (X.Z.); (R.A.C.); (J.B.); (Y.L.)
| | - John Beaver
- AbbVie Inc., North Chicago, IL 60064, USA; (X.Z.); (R.A.C.); (J.B.); (Y.L.)
| | - Yanping Luo
- AbbVie Inc., North Chicago, IL 60064, USA; (X.Z.); (R.A.C.); (J.B.); (Y.L.)
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Oligodendrocyte-Specific Deletion of FGFR1 Reduces Cerebellar Inflammation and Neurodegeneration in MOG 35-55-Induced EAE. Int J Mol Sci 2021; 22:ijms22179495. [PMID: 34502405 PMCID: PMC8431355 DOI: 10.3390/ijms22179495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and degenerative disease of the central nervous system (CNS). MS commonly affects the cerebellum causing acute and chronic symptoms. Cerebellar signs significantly contribute to clinical disability, and symptoms such as tremor, ataxia, and dysarthria are difficult to treat. Fibroblast growth factors (FGFs) and their receptors (FGFRs) are involved in demyelinating pathologies such as MS. In autopsy tissue from patients with MS, increased expression of FGF1, FGF2, FGF9, and FGFR1 was found in lesion areas. Recent research using mouse models has focused on regions such as the spinal cord, and data on the expression of FGF/FGFR in the cerebellum are not available. In recent EAE studies, we detected that oligodendrocyte-specific deletion of FGFRs results in a milder disease course, less cellular infiltrates, and reduced neurodegeneration in the spinal cord. The objective of this study was to characterize the role of FGFR1 in oligodendrocytes in the cerebellum. Conditional deletion of FGFR1 in oligodendrocytes (Fgfr1ind−/−) was achieved by tamoxifen application, EAE was induced using the MOG35-55 peptide. The cerebellum was analyzed by histology, immunohistochemistry, and western blot. At day 62 p.i., Fgfr1ind−/− mice showed less myelin and axonal degeneration compared to FGFR1-competent mice. Infiltration of CD3(+) T cells, Mac3(+) cells, B220(+) B cells and IgG(+) plasma cells in cerebellar white matter lesions (WML) was less in Fgfr1ind−/−mice. There were no effects on the number of OPC or mature oligodendrocytes in white matter lesion (WML). Expression of FGF2 and FGF9 associated with less myelin and axonal degeneration, and of the pro-inflammatory cytokines IL-1β, IL-6, and CD200 was downregulated in Fgfr1ind−/− mice. The FGF/FGFR signaling protein pAkt, BDNF, and TrkB were increased in Fgfr1ind−/− mice. These data suggest that cell-specific deletion of FGFR1 in oligodendrocytes has anti-inflammatory and neuroprotective effects in the cerebellum in the EAE disease model of MS.
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A proposal: How to study pro-myelinating proteins in MS. Autoimmun Rev 2021; 21:102924. [PMID: 34416371 DOI: 10.1016/j.autrev.2021.102924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/14/2021] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory and degenerative disease of the CNS. An unmet need in MS is repair i.e.,promoting endogenous regeneration and remyelination after demyelinating inflammatory injury. Remyelination is critical in neuronal preservation and the prevention of clinical progression. There is a good deal of evidence for histological repair and remyelination in MS patients. Repair is driven by several prominent endogenous pro-myelinating proteinsincluding neural cellular adhesion molecule (N-CAM) and brain derived neurotrophic factor (BDNF) among others. To follow changes during acute re-myelination in vivo in MS subjects, non conventional MRI techniques are necessary such as quantitative susceptibility mapping (QSM) that detects the release of Fe from dying oligodendroglial cells and myelin water imaging (MWI) that detects water captured within newly formed myelin. The best time to monitor changes in pro-myelinating proteins and link those changes to imaging evolution is immediately after the acute inflammatory response in MS lesions (gadolinium enhancement [Gd+]) during an intense period of remyelination. We can monitor MS subjects with new Gd + lesions with periodic imaging along with sampling of blood and CSF and determine if myelin formation is linked with increases in pro-myelinating proteins. This would lead to potential therapeutic manipulation with directly administered proteins to promote CNS re-myelination in animal models and in early clinical trials.
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12
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Sun J, Sha Y, Geng W, Chen J, Xing W. Susceptibility-weighted Imaging for Renal Iron Overload Assessment: A Pilot Study. Magn Reson Med Sci 2021; 21:415-424. [PMID: 33642470 PMCID: PMC9316138 DOI: 10.2463/mrms.mp.2020-0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: To explore the feasibility of susceptibility-weighted imaging (SWI) for evaluating renal iron overload. Methods: Twenty-eight rabbits were randomly assigned into control (n = 14) and iron (n = 14) group. In the 0th week, the study group was injected with iron dextran. Both groups underwent SWI examination at the 0th, 8th, and 12th week. The signal intensity (SI) of cortex and medulla was assessed. Angle radian value (ARV) calculated with phase image was taken as the quantitative value for cortical and medullary iron deposition. After the 12th week, the left kidneys of rabbits were removed for pathology. The difference in the ARV among three groups was analyzed using Kruskal–Wallis test. The difference of the iron content between two groups was analyzed through independent sample t-test. Results: In the iron group: at the 12th week, eight rabbits were found to have decreased SI of only cortex, and the other six rabbits had decreased SI of cortex and medulla by the same degree; the ARV of cortex at the 8th and 12th week was significantly higher than that of the 0th week (P < 0.05); the ARV of the six rabbits’ medulla at the 12th week was significantly higher than that of the 0th week, 8th week, and the other eight rabbits at the 12th week (P < 0.05); at the 12th week, eight rabbits (iron group) were found to have many irons only deposit in the cortex, and the others were found to have many irons deposit in both cortex and medulla; the iron content of cortex and six rabbits’ medulla in the iron group was significantly higher than that of the control (P < 0.05). Conclusion: The ARV of SWI can be used to quantitatively assess the excess iron deposition in the kidneys. Excessive iron deposition mainly occurs in the cortex or medulla and causes their SWI SI to decrease.
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Affiliation(s)
- Jun Sun
- Department of Radiology, The Third Affiliated Hospital of Soochow University
| | - Yuanyuan Sha
- Department of Radiology, The Third Affiliated Hospital of Soochow University
| | - Weiwei Geng
- Department of Radiology, The Third Affiliated Hospital of Soochow University
| | - Jie Chen
- Department of Radiology, The Third Affiliated Hospital of Soochow University
| | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University
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13
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Bahrami M, Rabbani M, Shaygannejad V, Badiei S. Comparison of susceptibility weighted imaging with conventional MRI sequences in multiple sclerosis plaque assessment: A cross-sectional study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:128. [PMID: 35126591 PMCID: PMC8772512 DOI: 10.4103/jrms.jrms_726_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/29/2017] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Abstract
Background: The current study was performed to compare susceptibility-weighted imaging (SWI) with magnetic resonance imaging (MRI) methods of T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) imaging in multiple sclerosis (MS) plaque assessment Materials and Methods: This cross-sectional study was conducted among 50 MS patients referred to Shafa Imaging Center, Isfahan, Iran. Patients who fulfilled McDonald criteria and were diagnosed with MS by a professional neurologist at least 1 year before the study initiation were included in the study. Eligible patients underwent brain scans using SWI, T2W imaging, and FLAIR. Plaques’ number and volume were detected separately for each imaging sequence. Moreover, identified lesions in SWI sequence were evaluated in terms of iron deposition and central veins Results: Totally 50 patients (10 males and 40 females) with a mean age of 28.48 ± 5.25 years were included in the current study. Majority of patients (60%) had a disease duration of >5 years, and mean expanded disability status score was 2.56 ± 1.32. There was no significant difference between different imaging modalities in terms of plaques’ number and volume (P > 0.05). It was also found that there was a high correlation between SWI and conventional imaging techniques of T2W (r = 0.97, 0.91, P < 0.001) and FLAIR (r = 0.99, 0.99, P < 0.001) in the estimation of both the number and volume of plaques (P < 0.001) Conclusion: The results of the present study indicated that SWI and conventional MRI sequences have similar efficiency for plaque assessment in MS patients.
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14
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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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15
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Absinta M, Sati P, Masuzzo F, Nair G, Sethi V, Kolb H, Ohayon J, Wu T, Cortese ICM, Reich DS. Association of Chronic Active Multiple Sclerosis Lesions With Disability In Vivo. JAMA Neurol 2020; 76:1474-1483. [PMID: 31403674 DOI: 10.1001/jamaneurol.2019.2399] [Citation(s) in RCA: 296] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance In multiple sclerosis (MS), chronic active lesions, which previously could only be detected at autopsy, can now be identified on susceptibility-based magnetic resonance imaging (MRI) in vivo as non-gadolinium-enhancing lesions with paramagnetic rims. Pathologically, they feature smoldering inflammatory demyelination at the edge, remyelination failure, and axonal degeneration. To our knowledge, the prospect of long-term in vivo monitoring makes it possible for the first time to determine their contribution to disability and value as a treatment target. Objective To assess whether rim lesions are associated with patient disability and long-term lesion outcomes. Design, Setting, Participants We performed 3 studies at the National Institutes of Health Clinical Center: (1) a prospective clinical/radiological cohort of 209 patients with MS (diagnosis according to the 2010 McDonald revised MS criteria, age ≥18 years, with 7-T or 3-T susceptibility-based brain MRI results) who were enrolled from January 2012 to March 2018 (of 209, 17 patients [8%] were excluded because of uninterpretable MRI scans); (2) a radiological/pathological analysis of expanding lesions featuring rims; and (3) a retrospective longitudinal radiological study assessing long-term lesion evolution in 23 patients with MS with yearly MRI scans for 10 years or more (earliest scan, 1992). Main Outcomes and Measures (1) Identification of chronic rim lesions on 7-T or 3-T susceptibility-based brain MRI in 192 patients with MS and the association of rim counts with clinical disability (primary analysis) and brain volume changes (exploratory analysis). (2) Pathological characterization of 10 expanding lesions from an adult with progressive MS who came to autopsy after 7 years of receiving serial in vivo MRI scans. (3) Evaluation of annual lesion volume change (primary analysis) and T1 times (exploratory analysis) in 27 rim lesions vs 27 rimless lesions. Results Of 209 participants, 104 (50%) were women and 32 (15%) were African American. One hundred seventeen patients (56%) had at least 1 rim lesion regardless of prior or ongoing treatment. Further, 84 patients (40%) had no rims (mean [SD] age, 47 [14] years), 66 (32%) had 1 to 3 rims (mean [SD] age, 47 [11] years), and 42 (20%) had 4 rims or more (mean [SD] age, 44 [11] years). Individuals with 4 rim lesions or more reached motor and cognitive disability at an earlier age. Normalized volumes of brain, white matter, and basal ganglia were lower in those with rim lesions. Whereas rimless lesions shrank over time (-3.6%/year), rim lesions were stable in size or expanded (2.2%/year; P < .001). Rim lesions had longer T1 times, suggesting more tissue destruction, than rimless lesions. On histopathological analysis, all 10 rim lesions that expanded in vivo had chronic active inflammation. Conclusions and Relevance Chronic active lesions are common, are associated with more aggressive disease, exert ongoing tissue damage, and occur even in individuals treated with effective disease-modifying therapies. These results prompt the planning of MRI-based clinical trials aimed at treating perilesional chronic inflammation in MS.
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Affiliation(s)
- Martina Absinta
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Pascal Sati
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Federica Masuzzo
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Govind Nair
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Varun Sethi
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Hadar Kolb
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Joan Ohayon
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Tianxia Wu
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Irene C M Cortese
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Daniel S Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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Barquero G, La Rosa F, Kebiri H, Lu PJ, Rahmanzadeh R, Weigel M, Fartaria MJ, Kober T, Théaudin M, Du Pasquier R, Sati P, Reich DS, Absinta M, Granziera C, Maggi P, Bach Cuadra M. RimNet: A deep 3D multimodal MRI architecture for paramagnetic rim lesion assessment in multiple sclerosis. NEUROIMAGE-CLINICAL 2020; 28:102412. [PMID: 32961401 PMCID: PMC7509077 DOI: 10.1016/j.nicl.2020.102412] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES In multiple sclerosis (MS), the presence of a paramagnetic rim at the edge of non-gadolinium-enhancing lesions indicates perilesional chronic inflammation. Patients featuring a higher paramagnetic rim lesion burden tend to have more aggressive disease. The objective of this study was to develop and evaluate a convolutional neural network (CNN) architecture (RimNet) for automated detection of paramagnetic rim lesions in MS employing multiple magnetic resonance (MR) imaging contrasts. MATERIALS AND METHODS Imaging data were acquired at 3 Tesla on three different scanners from two different centers, totaling 124 MS patients, and studied retrospectively. Paramagnetic rim lesion detection was independently assessed by two expert raters on T2*-phase images, yielding 462 rim-positive (rim+) and 4857 rim-negative (rim-) lesions. RimNet was designed using 3D patches centered on candidate lesions in 3D-EPI phase and 3D FLAIR as input to two network branches. The interconnection of branches at both the first network blocks and the last fully connected layers favors the extraction of low and high-level multimodal features, respectively. RimNet's performance was quantitatively evaluated against experts' evaluation from both lesion-wise and patient-wise perspectives. For the latter, patients were categorized based on a clinically relevant threshold of 4 rim+ lesions per patient. The individual prediction capabilities of the images were also explored and compared (DeLong test) by testing a CNN trained with one image as input (unimodal). RESULTS The unimodal exploration showed the superior performance of 3D-EPI phase and 3D-EPI magnitude images in the rim+/- classification task (AUC = 0.913 and 0.901), compared to the 3D FLAIR (AUC = 0.855, Ps < 0.0001). The proposed multimodal RimNet prototype clearly outperformed the best unimodal approach (AUC = 0.943, P < 0.0001). The sensitivity and specificity achieved by RimNet (70.6% and 94.9%, respectively) are comparable to those of experts at the lesion level. In the patient-wise analysis, RimNet performed with an accuracy of 89.5% and a Dice coefficient (or F1 score) of 83.5%. CONCLUSIONS The proposed prototype showed promising performance, supporting the usage of RimNet for speeding up and standardizing the paramagnetic rim lesions analysis in MS.
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Affiliation(s)
- Germán Barquero
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Switzerland; Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), University of Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Francesco La Rosa
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Switzerland; Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), University of Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Hamza Kebiri
- Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), University of Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Po-Jui Lu
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Reza Rahmanzadeh
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Mário João Fartaria
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Tobias Kober
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Marie Théaudin
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Renaud Du Pasquier
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland; Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Pietro Maggi
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Meritxell Bach Cuadra
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne, Switzerland; Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), University of Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland.
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Hnilicová P, Štrbák O, Kolisek M, Kurča E, Zeleňák K, Sivák Š, Kantorová E. Current Methods of Magnetic Resonance for Noninvasive Assessment of Molecular Aspects of Pathoetiology in Multiple Sclerosis. Int J Mol Sci 2020; 21:E6117. [PMID: 32854318 PMCID: PMC7504207 DOI: 10.3390/ijms21176117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease with expanding axonal and neuronal degeneration in the central nervous system leading to motoric dysfunctions, psychical disability, and cognitive impairment during MS progression. The exact cascade of pathological processes (inflammation, demyelination, excitotoxicity, diffuse neuro-axonal degeneration, oxidative and metabolic stress, etc.) causing MS onset is still not fully understood, although several accompanying biomarkers are particularly suitable for the detection of early subclinical changes. Magnetic resonance (MR) methods are generally considered to be the most sensitive diagnostic tools. Their advantages include their noninvasive nature and their ability to image tissue in vivo. In particular, MR spectroscopy (proton 1H and phosphorus 31P MRS) is a powerful analytical tool for the detection and analysis of biomedically relevant metabolites, amino acids, and bioelements, and thus for providing information about neuro-axonal degradation, demyelination, reactive gliosis, mitochondrial and neurotransmitter failure, cellular energetic and membrane alternation, and the imbalance of magnesium homeostasis in specific tissues. Furthermore, the MR relaxometry-based detection of accumulated biogenic iron in the brain tissue is useful in disease evaluation. The early description and understanding of the developing pathological process might be critical for establishing clinically effective MS-modifying therapies.
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Affiliation(s)
- Petra Hnilicová
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Oliver Štrbák
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Martin Kolisek
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia;
| | - Štefan Sivák
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Ema Kantorová
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
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18
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Lee NJ, Ha SK, Sati P, Absinta M, Nair G, Luciano NJ, Leibovitch EC, Yen CC, Rouault TA, Silva AC, Jacobson S, Reich DS. Potential role of iron in repair of inflammatory demyelinating lesions. J Clin Invest 2020; 129:4365-4376. [PMID: 31498148 DOI: 10.1172/jci126809] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Inflammatory destruction of iron-rich myelin is characteristic of multiple sclerosis (MS). Although iron is needed for oligodendrocytes to produce myelin during development, its deposition has also been linked to neurodegeneration and inflammation, including in MS. We report perivascular iron deposition in multiple sclerosis lesions that was mirrored in 72 lesions from 13 marmosets with experimental autoimmune encephalomyelitis. Iron accumulated mainly inside microglia/macrophages from 6 weeks after demyelination. Consistently, expression of transferrin receptor, the brain's main iron-influx protein, increased as lesions aged. Iron was uncorrelated with inflammation and postdated initial demyelination, suggesting that iron is not directly pathogenic. Iron homeostasis was at least partially restored in remyelinated, but not persistently demyelinated, lesions. Taken together, our results suggest that iron accumulation in the weeks after inflammatory demyelination may contribute to lesion repair rather than inflammatory demyelination per se.
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Affiliation(s)
- Nathanael J Lee
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.,Department of Neuroscience, Georgetown University Medical Center, Georgetown University, Washington, District of Columbia, USA
| | - Seung-Kwon Ha
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Govind Nair
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicholas J Luciano
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Emily C Leibovitch
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Cecil C Yen
- Cerebral Microcirculation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Tracey A Rouault
- Section on Human Iron Metabolism, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Afonso C Silva
- Cerebral Microcirculation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven Jacobson
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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19
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Clarke MA, Pareto D, Pessini-Ferreira L, Arrambide G, Alberich M, Crescenzo F, Cappelle S, Tintoré M, Sastre-Garriga J, Auger C, Montalban X, Evangelou N, Rovira À. Value of 3T Susceptibility-Weighted Imaging in the Diagnosis of Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:1001-1008. [PMID: 32439639 DOI: 10.3174/ajnr.a6547] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that the central vein sign and iron rims are specific features of MS lesions. Using 3T SWI, we aimed to compare the frequency of lesions with central veins and iron rims in patients with clinically isolated syndrome and MS-mimicking disorders and test their diagnostic value in predicting conversion from clinically isolated syndrome to MS. MATERIALS AND METHODS For each patient, we calculated the number of brain lesions with central veins and iron rims. We then identified a simple rule involving an absolute number of lesions with central veins and iron rims to predict conversion from clinically isolated syndrome to MS. Additionally, we tested the diagnostic performance of central veins and iron rims when combined with evidence of dissemination in space. RESULTS We included 112 patients with clinically isolated syndrome and 35 patients with MS-mimicking conditions. At follow-up, 94 patients with clinically isolated syndrome developed MS according to the 2017 McDonald criteria. Patients with clinically isolated syndrome had a median of 2 central veins (range, 0-19), while the non-MS group had a median of 1 central vein (range, 0-6). Fifty-six percent of patients who developed MS had ≥1 iron rim, and none of the patients without MS had iron rims. The sensitivity and specificity of finding ≥3 central veins and/or ≥1 iron rim were 70% and 86%, respectively. In combination with evidence of dissemination in space, the 2 imaging markers had higher specificity than dissemination in space and positive findings of oligoclonal bands currently used to support the diagnosis of MS. CONCLUSIONS A single 3T SWI scan offers valuable diagnostic information, which has the potential to prevent MS misdiagnosis.
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Affiliation(s)
- M A Clarke
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - D Pareto
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Pessini-Ferreira
- Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - G Arrambide
- Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Alberich
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain
| | - F Crescenzo
- Department of Neurosciences, Biomedicine and Movement Sciences (F.C.), University of Verona, Verona, Italy
| | - S Cappelle
- Division of Radiology (S.C.), University Hospital Leuven, Leuven, Belgium
| | - M Tintoré
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Sastre-Garriga
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Auger
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain.,Department of Neurology-Neuroimmunology (G.A., M.T., J.S.-G., X.M.), Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Division of Neurology (X.M.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - N Evangelou
- Division of Clinical Neuroscience (N.E.), University of Nottingham, Nottingham, UK
| | - À Rovira
- From the Vall d'Hebron Research Institute (M.A.C., D.P., M.A., M.T., J.S.-G., C.A., X.M., A.R.), Barcelona, Spain .,Section of Neuroradiology, Department of Radiology (D.P., L.P.-F., C.A., A.R.), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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20
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Blindenbacher N, Brunner E, Asseyer S, Scheel M, Siebert N, Rasche L, Bellmann-Strobl J, Brandt A, Ruprecht K, Meier D, Wuerfel J, Paul F, Sinnecker T. Evaluation of the 'ring sign' and the 'core sign' as a magnetic resonance imaging marker of disease activity and progression in clinically isolated syndrome and early multiple sclerosis. Mult Scler J Exp Transl Clin 2020; 6:2055217320915480. [PMID: 32284875 PMCID: PMC7132556 DOI: 10.1177/2055217320915480] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 02/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background Brain lesions with a hypointense ring or core were described in
multiple sclerosis on susceptibility weighted imaging. Objective The purpose of this study was to study the evolution and prognostic
relevance of susceptibility weighted imaging hypointense lesions
in clinically isolated syndrome and early multiple
sclerosis. Methods Sixty-six early multiple sclerosis and clinically isolated syndrome
patients were followed over a median period of 2.9 years (range
1.6–4.6 years) and underwent 3T magnetic resonance imaging
including 3D susceptibility weighted imaging and T2-weighted
fluid-attenuated inversion recovery. We assessed the presence of
susceptibility weighted imaging hypointense core or ring
lesions, and Expanded Disability Status Scale at baseline and
follow-up. Results Of 611 lesions at baseline, 64 (10.5%) had a susceptibility
weighted imaging hypointense core, and 28 (4.6%) had a
susceptibility weighted imaging hypointense ring. Hypointense
ring lesions were larger (p < 0.001) and
more T1w hypointense (p = 0.002) than others.
During follow-up, hypointense core lesions became susceptibility
weighted imaging isointense (52 lesions, 81%); few developed
into hypointense ring lesions (two lesions, 3%). Hypointense
ring lesions did not shrink on T2-weighted fluid-attenuated
inversion recovery images (p = 0.077, trend
towards more enlargement compared to others), while hypointense
core lesions more often shrunk in comparison to lesions without
a hypointense core (p = 0.002). The number of
susceptibility weighted imaging hypointense ring lesions at
baseline correlated with Expanded Disability Status Scale
progression at follow-up (p = 0.021,
R = 0.289). Conclusion In our cohort of patients with clinically isolated syndrome or
early multiple sclerosis, susceptibility weighted imaging
hypointense ring lesions were only rarely detectable, but did
not shrink and were associated with future disability
progression.
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Affiliation(s)
- Nelly Blindenbacher
- qbig, Department of Biomedical Engineering, University of Basel, Switzerland
| | - Eveline Brunner
- qbig, Department of Biomedical Engineering, University of Basel, Switzerland
| | - Susanna Asseyer
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Germany
| | - Michael Scheel
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Germany
| | - Nadja Siebert
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Germany
| | - Ludwig Rasche
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Germany
| | | | - Alexander Brandt
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
| | - Dominik Meier
- qbig, Department of Biomedical Engineering, University of Basel, Switzerland
| | - Jens Wuerfel
- qbig, Department of Biomedical Engineering, University of Basel, Switzerland
| | - Friedemann Paul
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Germany.,Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, and Berlin Institute of Health and Max Delbrück Center for Molecular Medicine, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
| | - Tim Sinnecker
- qbig, Department of Biomedical Engineering, University of Basel, Switzerland.,Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Germany.,Medical Image Analysis Center AG, Switzerland.,Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital and University of Basel, Switzerland
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21
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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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22
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Mattay RR, Davtyan K, Bilello M, Mamourian AC. Do All Patients with Multiple Sclerosis Benefit from the Use of Contrast on Serial Follow-Up MR Imaging? A Retrospective Analysis. AJNR Am J Neuroradiol 2018; 39:2001-2006. [PMID: 30287455 DOI: 10.3174/ajnr.a5828] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/26/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with multiple sclerosis routinely have MR imaging with contrast every 6-12 months to assess response to medication. Multiple recent studies provide evidence of tissue deposition of MR imaging contrast agents, questioning the long-term safety of these agents. The goal of this retrospective image-analysis study was to determine whether contrast could be reserved for only those patients who show new MS lesions on follow-up examinations. MATERIALS AND METHODS We retrospectively reviewed brain MRIs of 138 patients. To increase our sensitivity, we used a previously described computerized image-comparison software to evaluate the stability or progression of multiple sclerosis white matter lesions in noncontrast FLAIR sequences. We correlated these findings with evidence of contrast-enhancing lesions on the enhanced T1 sequence from the same scan. RESULTS Thirty-three scans showed an increase in white matter lesion burden. Among those 33 patients, 14 examinations also demonstrated enhancing new lesions. While we found a single example of enhancement of a pre-existing white matter lesion that appeared unchanged in size, that same examination showed an overall increase in lesion burden with enhancement of other, new lesions. Thus, we found that all patients with enhancing lesions had evidence of progression on their noncontrast imaging. CONCLUSIONS Because all enhancing lesions were associated with new lesions on unenhanced imaging and progression was only evident in 24% of patients, in patients with relapsing-remitting MS, it is reasonable to consider reserving contrast for only those patients with evidence of progression on noncontrast MR images.
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Affiliation(s)
- R R Mattay
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - K Davtyan
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - M Bilello
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - A C Mamourian
- From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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23
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Yan F, He N, Lin H, Li R. Iron deposition quantification: Applications in the brain and liver. J Magn Reson Imaging 2018; 48:301-317. [PMID: 29897645 DOI: 10.1002/jmri.26161] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/02/2018] [Indexed: 01/01/2023] Open
Abstract
Iron has long been implicated in many neurological and other organ diseases. It is known that over and above the normal increases in iron with age, in certain diseases there is an excessive iron accumulation in the brain and liver. MRI is a noninvasive means by which to image the various structures in the brain in three dimensions and quantify iron over the volume of the object of interest. The quantification of iron can provide information about the severity of iron-related diseases as well as quantify changes in iron for patient follow-up and treatment monitoring. This article provides an overview of current MRI-based methods for iron quantification, specifically for the brain and liver, including: signal intensity ratio, R2 , R2*, R2', phase, susceptibility weighted imaging and quantitative susceptibility mapping (QSM). Although there are numerous approaches to measuring iron, R2 and R2* are currently preferred methods in imaging the liver and QSM has become the preferred approach for imaging iron in the brain. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018. J. MAGN. RESON. IMAGING 2018;48:301-317.
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Affiliation(s)
- Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Lin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruokun Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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24
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Absinta M, Sati P, Fechner A, Schindler MK, Nair G, Reich DS. Identification of Chronic Active Multiple Sclerosis Lesions on 3T MRI. AJNR Am J Neuroradiol 2018; 39:1233-1238. [PMID: 29724768 DOI: 10.3174/ajnr.a5660] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/13/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging-pathologic studies have reported that paramagnetic rims on 7T susceptibility-based MR imaging identify, in vivo, the subset of MS lesions with compartmentalized inflammation at the lesion edge and associated remyelination failure. Here, we assessed the reliability of detecting these rims on high-resolution 3T phase images. MATERIALS AND METHODS High-resolution T2* and phase MR imaging was collected in 20 patients with MS at 3T (3D segmented EPI, 0.65 mm3) and 7T (2D gradient-echo, 0.2 × 0.2 × 1 mm) MR imaging. In each case, 5 discrete chronic (nonenhancing) MS lesions were selected on T2 FLAIR images for rim evaluation. Five raters experienced in MS imaging contributed to the rim assessment, of whom 3 worked independently on 3T data, and 2, on 7T data. Consensus agreement was reached for both 3T and 7T rim evaluations. Discrepancies between 3T and 7T were discussed, and consensus was reached. RESULTS Phase rims were seen in 34 lesions at 7T and in 36 lesions at 3T by consensus. Inter- and intrarater reliability were "substantial/good" both at 3T and 7T analysis (Cohen κ, >0.71). Based on consensus agreement, the reliability of rim visualization at 3T versus 7T was 0.78 (κ) with a pair-wise agreement of 90%. More lesions were judged to be false-positive or false-negative at 3T than at 7T. CONCLUSIONS Nearly all 7T paramagnetic rims can also be seen at 3T. Imaging at 3T opens the possibility of implementing paramagnetic rims as an outcome measure in multicenter, MR imaging-based clinical trials aimed at treating perilesional persistent inflammation and its potential effects on remyelination.
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Affiliation(s)
- M Absinta
- From the Translational Neuroradiology Section (M.A., P.S., A.F., M.K.S., G.N., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - P Sati
- From the Translational Neuroradiology Section (M.A., P.S., A.F., M.K.S., G.N., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - A Fechner
- From the Translational Neuroradiology Section (M.A., P.S., A.F., M.K.S., G.N., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.,Department of Radiology (A.F.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - M K Schindler
- From the Translational Neuroradiology Section (M.A., P.S., A.F., M.K.S., G.N., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - G Nair
- From the Translational Neuroradiology Section (M.A., P.S., A.F., M.K.S., G.N., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D S Reich
- From the Translational Neuroradiology Section (M.A., P.S., A.F., M.K.S., G.N., D.S.R.), Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
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25
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Quantifying iron content in magnetic resonance imaging. Neuroimage 2018; 187:77-92. [PMID: 29702183 DOI: 10.1016/j.neuroimage.2018.04.047] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 01/19/2023] Open
Abstract
Measuring iron content has practical clinical indications in the study of diseases such as Parkinson's disease, Huntington's disease, ferritinopathies and multiple sclerosis as well as in the quantification of iron content in microbleeds and oxygen saturation in veins. In this work, we review the basic concepts behind imaging iron using T2, T2*, T2', phase and quantitative susceptibility mapping in the human brain, liver and heart, followed by the applications of in vivo iron quantification in neurodegenerative diseases, iron tagged cells and ultra-small superparamagnetic iron oxide (USPIO) nanoparticles.
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26
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Sheykhansari S, Kozielski K, Bill J, Sitti M, Gemmati D, Zamboni P, Singh AV. Redox metals homeostasis in multiple sclerosis and amyotrophic lateral sclerosis: a review. Cell Death Dis 2018; 9:348. [PMID: 29497049 PMCID: PMC5832817 DOI: 10.1038/s41419-018-0379-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/13/2017] [Accepted: 12/27/2017] [Indexed: 12/12/2022]
Abstract
The effect of redox metals such as iron and copper on multiple sclerosis and amyotrophic lateral sclerosis has been intensively studied. However, the origin of these disorders remains uncertain. This review article critically describes the physiology of redox metals that produce oxidative stress, which in turn leads to cascades of immunomodulatory alteration of neurons in multiple sclerosis and amyotrophic lateral sclerosis. Iron and copper overload has been well established in motor neurons of these diseases’ lesions. On the other hand, the role of other metals like cadmium participating indirectly in the redox cascade of neurobiological mechanism is less studied. In the second part of this review, we focus on this less conspicuous correlation between cadmium as an inactive-redox metal and multiple sclerosis and amyotrophic lateral sclerosis, providing novel treatment modalities and approaches as future prospects.
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Affiliation(s)
- Sahar Sheykhansari
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Kristen Kozielski
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Joachim Bill
- Institute for Materials Science, University of Stuttgart, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Metin Sitti
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Donato Gemmati
- Hemostasis & Thrombosis Center - Azienda Ospedaliera-Universitaria di Ferrara, Ferrara, Italy
| | - Paolo Zamboni
- Translational Surgery Unit, Azienda Ospedaliera Universitaria di Ferrara, via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Ajay Vikram Singh
- Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany.
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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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Puz P, Lasek-Bal A, Radecka P. Transcranial sonography of subcortical structures in patients with multiple sclerosis. Acta Neurol Scand 2017; 136:24-30. [PMID: 27642106 DOI: 10.1111/ane.12689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcranial sonography may be applied to assess the basal ganglia nuclei and brain atrophy by the measurement of the width of the third ventricle. The aim of this study was to assess usefulness of transcranial sonography (TCS) in patients with multiple sclerosis (MS) by examining the echogenicity of subcortical structures and the width of the third ventricle. METHOD Transcranial sonography evaluation of substantia nigra, brain stem raphe nuclei, diameter of the third ventricle, width of the anterior horn of the lateral ventricle, thalamus, lenticular nucleus, and head of the caudate nucleus in 41 patients with relapsing-remitting MS (RRMS), 23 with secondary progressive MS (SPMS), and 20 healthy controls was compared. A potential link between the patients' age, sex, Expanded Disability Status Scale (EDSS) score, relapse index, and ultrasound parameters was assessed. RESULTS The following were found in patients with MS, as compared to the control group: a greater area of the substantia nigra, a longer diameter of the third ventricle and wider frontal horns of the lateral ventricles, hypo-echogenicity of the brain stem raphe, and hyperechogenicity of the lenticular nucleus. The study group was found to have a significant correlation between the area of the substantia nigra, and the age of patients, the duration of the illness, EDSS score, and the number of relapses. There was a significant correlation between the diameter of the third ventricle and the age of patients and EDSS score. CONCLUSIONS Patients with MS reveal ultrasound features of subcortical structure atrophy. Selected TCS findings show a correlation with disease progression and activity.
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Affiliation(s)
- P. Puz
- Department of Neurology; Clinical Hospital No 7; Medical University of Silesia; Professor Leszek Giec Upper Silesian Medical Centre; Katowice Poland
| | - A. Lasek-Bal
- Department of Neurology; Clinical Hospital No 7; Medical University of Silesia; Professor Leszek Giec Upper Silesian Medical Centre; Katowice Poland
- High School of Science; Medical University of Silesia; Katowice Poland
| | - P. Radecka
- Department of Neurology; Clinical Hospital No 7; Medical University of Silesia; Professor Leszek Giec Upper Silesian Medical Centre; Katowice Poland
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29
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Burgetova A, Dusek P, Vaneckova M, Horakova D, Langkammer C, Krasensky J, Sobisek L, Matras P, Masek M, Seidl Z. Thalamic Iron Differentiates Primary-Progressive and Relapsing-Remitting Multiple Sclerosis. AJNR Am J Neuroradiol 2017; 38:1079-1086. [PMID: 28450431 DOI: 10.3174/ajnr.a5166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 01/26/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Potential differences between primary progressive and relapsing remitting multiple sclerosis are the subject of ongoing controversial discussions. The aim of this work was to determine whether and how primary-progressive and relapsing-remitting multiple sclerosis subtypes differ regarding conventional MR imaging parameters, cerebral iron deposits, and their association with clinical status. MATERIALS AND METHODS We analyzed 24 patients with primary-progressive MS, 80 with relapsing-remitting MS, and 20 healthy controls with 1.5T MR imaging for assessment of the conventional quantitative parameters: T2 lesion load, T1 lesion load, brain parenchymal fraction, and corpus callosum volume. Quantitative susceptibility mapping was performed to estimate iron concentration in the deep gray matter. RESULTS Decreased susceptibility within the thalamus in relapsing-remitting MS compared with primary-progressive MS was the only significant MR imaging difference between these MS subtypes. In the relapsing-remitting MS subgroup, the Expanded Disability Status Scale score was positively associated with conventional parameters reflecting white matter lesions and brain atrophy and with iron in the putamen and caudate nucleus. A positive association with putaminal iron and the Expanded Disability Status Scale score was found in primary-progressive MS. CONCLUSIONS Susceptibility in the thalamus might provide additional support for the differentiation between primary-progressive and relapsing-remitting MS. That the Expanded Disability Status Scale score was associated with conventional MR imaging parameters and iron concentrations in several deep gray matter regions in relapsing-remitting MS, while only a weak association with putaminal iron was observed in primary-progressive MS suggests different driving forces of disability in these MS subtypes.
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Affiliation(s)
- A Burgetova
- From the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
| | - P Dusek
- Neurology (P.D., D.H.), Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
- Institute of Neuroradiology (P.D.), University Medicine Göttingen, Göttingen, Germany
| | - M Vaneckova
- From the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
| | - D Horakova
- Neurology (P.D., D.H.), Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - C Langkammer
- Department of Neurology (C.L.), Medical University of Graz, Graz, Austria
| | - J Krasensky
- From the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
| | - L Sobisek
- Department of Statistics and Probability (L.S.), University of Economics, Prague, Czech Republic
| | - P Matras
- From the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
| | - M Masek
- From the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
| | - Z Seidl
- From the Departments of Radiology (A.B., M.V., J.K., P.M., M.M., Z.S.)
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30
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Robinson SD, Bredies K, Khabipova D, Dymerska B, Marques JP, Schweser F. An illustrated comparison of processing methods for MR phase imaging and QSM: combining array coil signals and phase unwrapping. NMR IN BIOMEDICINE 2017; 30:e3601. [PMID: 27619999 PMCID: PMC5348291 DOI: 10.1002/nbm.3601] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 06/14/2016] [Accepted: 07/18/2016] [Indexed: 05/11/2023]
Abstract
Phase imaging benefits from strong susceptibility effects at very high field and the high signal-to-noise ratio (SNR) afforded by multi-channel coils. Combining the information from coils is not trivial, however, as the phase that originates in local field effects (the source of interesting contrast) is modified by the inhomogeneous sensitivity of each coil. This has historically been addressed by referencing individual coil sensitivities to that of a volume coil, but alternative approaches are required for ultra-high field systems in which no such coil is available. An additional challenge in phase imaging is that the phase that develops up to the echo time is "wrapped" into a range of 2π radians. Phase wraps need to be removed in order to reveal the underlying phase distribution of interest. Beginning with a coil combination using a homogeneous reference volume coil - the Roemer approach - which can be applied at 3 T and lower field strengths, we review alternative methods for combining single-echo and multi-echo phase images where no such reference coil is available. These are applied to high-resolution data acquired at 7 T and their effectiveness assessed via an index of agreement between phase values over channels and the contrast-to-noise ratio in combined images. The virtual receiver coil and COMPOSER approaches were both found to be computationally efficient and effective. The main features of spatial and temporal phase unwrapping methods are reviewed, placing particular emphasis on recent developments in temporal phase unwrapping and Laplacian approaches. The features and performance of these are illustrated in application to simulated and high-resolution in vivo data. Temporal unwrapping was the fastest of the methods tested and the Laplacian the most robust in images with low SNR. © 2016 The Authors. NMR in Biomedicine published by John Wiley & Sons Ltd.
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Affiliation(s)
- Simon Daniel Robinson
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - Kristian Bredies
- Institute of Mathematics and Scientific Computing, University of Graz, Austria
| | - Diana Khabipova
- Laboratory for Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne, Switzerland
- Donders Institute for Brain, Cognition and Behaviou, Radboud University Nijmegen, The Netherlands
| | - Barbara Dymerska
- High Field Magnetic Resonance Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria
| | - José P Marques
- Laboratory for Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne, Switzerland
- Donders Institute for Brain, Cognition and Behaviou, Radboud University Nijmegen, The Netherlands
| | - Ferdinand Schweser
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, New York, USA
- MRI Clinical and Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, New York, USA
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31
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Zhang Y, Gauthier SA, Gupta A, Tu L, Comunale J, Chiang GCY, Chen W, Salustri CA, Zhu W, Wang Y. Magnetic Susceptibility from Quantitative Susceptibility Mapping Can Differentiate New Enhancing from Nonenhancing Multiple Sclerosis Lesions without Gadolinium Injection. AJNR Am J Neuroradiol 2016; 37:1794-1799. [PMID: 27365331 DOI: 10.3174/ajnr.a4856] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/15/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Magnetic susceptibility values of multiple sclerosis lesions increase as they change from gadolinium-enhancing to nonenhancing. Can susceptibility values measured on quantitative susceptibility mapping without gadolinium injection be used to identify the status of lesion enhancement in surveillance MR imaging used to monitor patients with MS? MATERIALS AND METHODS In patients who had prior MR imaging and quantitative susceptibility mapping in a current MR imaging, new T2-weighted lesions were evaluated for enhancement on conventional T1-weighted imaging with gadolinium, and their susceptibility values were measured on quantitative susceptibility mapping. Receiver operating characteristic analysis was used to assess the diagnostic accuracy of using quantitative susceptibility mapping in distinguishing new gadolinium-enhancing from new nonenhancing lesions. A generalized estimating equation was used to assess differences in susceptibility values among lesion types. RESULTS In 54 patients, we identified 86 of 133 new lesions that were gadolinium-enhancing and had relative susceptibility values significantly lower than those of nonenhancing lesions (β = -17.2; 95% CI, -20.2 to -14.2; P < .0001). Using susceptibility values to discriminate enhancing from nonenhancing lesions, we performed receiver operating characteristic analysis and found that the area under the curve was 0.95 (95% CI, 0.92-0.99). Sensitivity was measured at 88.4%, and specificity, at 91.5%, with a cutoff value of 11.2 parts per billion for quantitative susceptibility mapping-measured susceptibility. CONCLUSIONS During routine MR imaging monitoring to detect new MS lesion activity, quantitative susceptibility mapping can be used without gadolinium injection for accurate identification of the BBB leakage status in new T2WI lesions.
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Affiliation(s)
- Y Zhang
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology (Y.Z., C.A.S., Y.W.), Weill Cornell Medical College, New York, New York
| | | | - A Gupta
- Radiology (A.G., J.C., G.C.-Y.C.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - L Tu
- School of Applied and Engineering Physics (L.T.)
| | - J Comunale
- Radiology (A.G., J.C., G.C.-Y.C.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - G C-Y Chiang
- Radiology (A.G., J.C., G.C.-Y.C.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - W Chen
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - C A Salustri
- Department of Radiology (Y.Z., C.A.S., Y.W.), Weill Cornell Medical College, New York, New York.,Department of Biomedical Engineering (Y.W.), Cornell University, Ithaca, New York
| | - W Zhu
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y Wang
- Department of Radiology (Y.Z., C.A.S., Y.W.), Weill Cornell Medical College, New York, New York .,Department of Biomedical Engineering (Y.W.), Cornell University, Ithaca, New York
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32
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Zivadinov R, Ramasamy DP, Benedict RRH, Polak P, Hagemeier J, Magnano C, Dwyer MG, Bergsland N, Bertolino N, Weinstock-Guttman B, Kolb C, Hojnacki D, Utriainen D, Haacke EM, Schweser F. Cerebral Microbleeds in Multiple Sclerosis Evaluated on Susceptibility-weighted Images and Quantitative Susceptibility Maps: A Case-Control Study. Radiology 2016; 281:884-895. [PMID: 27308776 DOI: 10.1148/radiol.2016160060] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose To assess cerebral microbleed (CMB) prevalence in patients with multiple sclerosis (MS) and clinically isolated syndrome (CIS) and associations with clinical outcomes. Materials and Methods CMBs are associated with aging and neurodegenerative disorders. The prevalence of CMBs has not previously been well established. In this study, 445 patients with MS (266 with relapsing-remitting MS, 138 with secondary progressive MS, and 41 with primary progressive MS), 45 patients with CIS, 51 patients with other neurological diseases, and 177 healthy control subjects (HCs) underwent 3-T magnetic resonance (MR) imaging and clinical examinations. A subset of 168 patients with MS and 50 HCs underwent neuropsychological testing. Number of CMBs was assessed on susceptibility-weighted minimum intensity projections by using the Microbleed Anatomic Rating Scale; volume was calculated by using quantitative susceptibility maps. Differences between groups were analyzed with the χ2 test, Fisher exact test, Student t test, and analysis of variance; associations of CMBs with clinical and other MR imaging outcomes were explored with correlation and regression analyses. Because CMB frequency increases with age, prevalence was investigated in participants at least 50 years of age and younger than 50 years. Results Significantly more patients with MS than HCs had CMBs (19.8% vs 7.4%, respectively; P = .01) in the group at least 50 years old. A trend toward greater presence of CMBs was found in patients with MS (P = .016) and patients with CIS who were younger than 50 years (P = .039) compared with HCs. In regression analysis adjusted for age, hypertension, and normalized brain volume, increased number of CMBs was significantly associated with increased physical disability in the MS population (R2 = 0.23, P < .0001). In correlation analysis, increased number of CMBs was significantly associated with deteriorated auditory and verbal learning and memory (P = .006) and visual information processing speed trends (P = .049) in patients with MS. Conclusion Monitoring CMBs may be relevant in patients with MS and CIS at higher risk for developing cognitive and physical disability. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Robert Zivadinov
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Deepa P Ramasamy
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Ralph R H Benedict
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Paul Polak
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Jesper Hagemeier
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Christopher Magnano
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Michael G Dwyer
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Niels Bergsland
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Nicola Bertolino
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Bianca Weinstock-Guttman
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Channa Kolb
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - David Hojnacki
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - David Utriainen
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - E Mark Haacke
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
| | - Ferdinand Schweser
- From the Buffalo Neuroimaging Analysis Ctr, Dept of Neurology (R.Z., D.P.R., P.P., J.H., C.M., M.G.D., N. Bergsland, N. Bertolino, F.S.), MR Imaging Clinical and Translational Research Ctr (R.Z., C.M., F.S.), and Jacobs Multiple Sclerosis Ctr, Dept of Neurology (R.R.H.B., B.W.G., C.K., D.H.), Jacobs School of Medicine and Biomedical Sciences, Univ at Buffalo, The State Univ of New York, 100 High St, Buffalo, NY 14203; GE Healthcare, Waukesha, Wis (C.M.); Magnetic Resonance Laboratory, IRCCS Don Gnocchi Foundation, Milan, Italy (N. Bergsland); Magnetic Resonance Innovations, Detroit, Mich (D.U.); Dept of Radiology, Wayne State Univ, Detroit, Mich (E.M.H.); School of Biomedical Engineering, McMaster Univ, Hamilton, Ontario, Canada (E.M.H.); and Shanghai Key Laboratory of Magnetic Resonance, East China Normal Univ, Shanghai, China (E.M.H.)
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Absinta M, Sati P, Schindler M, Leibovitch EC, Ohayon J, Wu T, Meani A, Filippi M, Jacobson S, Cortese ICM, Reich DS. Persistent 7-tesla phase rim predicts poor outcome in new multiple sclerosis patient lesions. J Clin Invest 2016; 126:2597-609. [PMID: 27270171 DOI: 10.1172/jci86198] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/12/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In some active multiple sclerosis (MS) lesions, a strong immune reaction at the lesion edge may contain growth and thereby isolate the lesion from the surrounding parenchyma. Our previous studies suggest that this process involves opening of the blood-brain barrier in capillaries at the lesion edge, seen on MRI as centripetal contrast enhancement and a colocalized phase rim. We hypothesized that using these features to characterize early lesion evolution will allow in vivo tracking of tissue degeneration and/or repair, thus improving the evaluation of potential therapies for chronic active lesions. METHODS Centripetally and centrifugally enhancing lesions were studied in 17 patients with MS using 7-tesla MRI. High-resolution, susceptibility-weighted, T1-weighted (before/after gadolinium), and dynamic contrast-enhanced scans were acquired at baseline and months 1, 3, 6, and 12. For each lesion, time evolution of the phase rim, lesion volume, and T1 hypointensity were assessed. In autopsies of 3 progressive MS cases, the histopathology of the phase rim was determined. RESULTS In centripetal lesions, a phase rim colocalized with initial contrast enhancement. In 12 of 22, this phase rim persisted after enhancement resolved. Compared with centripetal lesions with transient rim, those with persistent rim had less volume shrinkage and became more T1 hypointense between months 3 and 12. No centrifugal lesions developed phase rims at any time point. Pathologically, persistent rims corresponded to an iron-laden inflammatory myeloid cell population at the edge of chronic demyelinated lesions. CONCLUSION In early lesion evolution, a persistent phase rim in lesions that shrink least and become more T1 hypointense over time suggests that the rim might mark failure of early lesion repair and/or irreversible tissue damage. In later stages of MS, phase rim lesions continue to smolder, exerting detrimental effects on affected brain tissue. TRIAL REGISTRATION NCT00001248. FUNDING The Intramural Research Program of NINDS supported this study.
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Zhang Y, Gauthier SA, Gupta A, Chen W, Comunale J, Chiang GCY, Zhou D, Askin G, Zhu W, Pitt D, Wang Y. Quantitative Susceptibility Mapping and R2* Measured Changes during White Matter Lesion Development in Multiple Sclerosis: Myelin Breakdown, Myelin Debris Degradation and Removal, and Iron Accumulation. AJNR Am J Neuroradiol 2016; 37:1629-35. [PMID: 27256856 DOI: 10.3174/ajnr.a4825] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/18/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative susceptibility mapping and R2* are sensitive to myelin and iron changes in multiple sclerosis lesions. This study was designed to characterize lesion changes on quantitative susceptibility mapping and R2* at various gadolinium-enhancement stages. MATERIALS AND METHODS This study included 64 patients with MS with different enhancing patterns in white matter lesions: nodular, shell-like, nonenhancing < 1 year old, and nonenhancing 1-3 years old. These represent acute, late acute, early chronic, and late chronic lesions, respectively. Susceptibility values measured on quantitative susceptibility mapping and R2* values were compared among the 4 lesion types. Their differences were assessed with a generalized estimating equation, controlling for Expanded Disability Status Scale score, age, and disease duration. RESULTS We analyzed 203 lesions: 80 were nodular-enhancing, of which 77 (96.2%) were isointense on quantitative susceptibility mapping; 33 were shell-enhancing, of which 30 (90.9%) were hyperintense on quantitative susceptibility mapping; and 49 were nonenhancing lesions < 1 year old and 41 were nonenhancing lesions 1-3 years old, all of which were hyperintense on quantitative susceptibility mapping. Their relative susceptibility/R2* values were 0.5 ± 4.4 parts per billion/-5.6 ± 2.9 Hz, 10.2 ± 5.4 parts per billion/-8.0 ± 2.6 Hz, 20.2 ± 7.8 parts per billion/-3.1 ± 2.3 Hz, and 33.2 ± 8.2 parts per billion/-2.0 ± 2.6 Hz, respectively, and were significantly different (P < .005). CONCLUSIONS Early active MS lesions with nodular enhancement show R2* decrease but no quantitative susceptibility mapping change, reflecting myelin breakdown; late active lesions with peripheral enhancement show R2* decrease and quantitative susceptibility mapping increase in the lesion center, reflecting further degradation and removal of myelin debris; and early or late chronic nonenhancing lesions show both quantitative susceptibility mapping and R2* increase, reflecting iron accumulation.
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Affiliation(s)
- Y Zhang
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Departments of Radiology (Y.Z., A.G., J.C., G.C.-Y.C., D.Z., Y.W.)
| | | | - A Gupta
- Departments of Radiology (Y.Z., A.G., J.C., G.C.-Y.C., D.Z., Y.W.)
| | - W Chen
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - J Comunale
- Departments of Radiology (Y.Z., A.G., J.C., G.C.-Y.C., D.Z., Y.W.)
| | - G C-Y Chiang
- Departments of Radiology (Y.Z., A.G., J.C., G.C.-Y.C., D.Z., Y.W.)
| | - D Zhou
- Departments of Radiology (Y.Z., A.G., J.C., G.C.-Y.C., D.Z., Y.W.)
| | - G Askin
- Healthcare Policy and Research (G.A.), Weill Cornell Medical College, New York, New York
| | - W Zhu
- From the Department of Radiology (Y.Z., W.C., W.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - D Pitt
- Department of Neurology (D.P.), School of Medicine, Yale University, New Haven, Connecticut
| | - Y Wang
- Departments of Radiology (Y.Z., A.G., J.C., G.C.-Y.C., D.Z., Y.W.) Department of Biomedical Engineering (Y.W.), Cornell University, Ithaca, New York.
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Investigation of cerebral microbleeds in multiple sclerosis as a potential marker of blood-brain barrier dysfunction. Mult Scler Relat Disord 2016; 7:61-4. [DOI: 10.1016/j.msard.2016.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 03/16/2016] [Accepted: 03/20/2016] [Indexed: 11/22/2022]
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Abstract
Over the past few decades, MRI-based visualization of demyelinated CNS lesions has become pivotal to the diagnosis and monitoring of multiple sclerosis (MS). In this Review, we outline current efforts to correlate imaging findings with the pathology of lesion development in MS, and the pitfalls that are being encountered in this research. Multimodal imaging at high and ultra-high magnetic field strengths is yielding biologically relevant insights into the pathophysiology of blood-brain barrier dynamics and both active and chronic inflammation, as well as mechanisms of lesion healing and remyelination. Here, we parallel the results in humans with advances in imaging of a primate model of MS - experimental autoimmune encephalomyelitis (EAE) in the common marmoset - in which demyelinated lesions resemble their human counterparts far more closely than do EAE lesions in the rodent. This approach holds promise for the identification of innovative biological markers, and for next-generation clinical trials that will focus more on tissue protection and repair.
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Spring cleaning: time to rethink imaging research lines in MS? J Neurol 2016; 263:1893-902. [PMID: 26886204 DOI: 10.1007/s00415-016-8060-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 12/15/2022]
Abstract
Together with recently advanced MRI technological capability, new needs and updated questions are emerging in imaging research in multiple sclerosis (MS), especially with respect to the identification of novel in vivo biomarkers of MS-relevant pathological processes. Expected benefits will involve approaches to diagnosis and clinical classification. In detail, three main points of discussion are addressed in this review: (1) new imaging biomarkers (centrifugal/centripetal lesion enhancement, central vein, paramagnetic rims at the lesion edge, subpial cortical demyelination); (2) thinking about high-resolution MR from a pathological perspective (from postmortem to in vivo staging); and (3) the clinical utility of quantitative MRI. In this context, research efforts should increasingly be focused on the direct in vivo visualization of "hidden" inflammation, beyond what can be detected with conventional gadolinium-based methods, as well as remyelination and repair, since these are likely to represent critical pathological processes and potential therapeutic targets. Concluding remarks concern the limitations, challenges, and ultimately clinical role of non-conventional MRI techniques.
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Zhang Y, Gauthier SA, Gupta A, Comunale J, Chia-Yi Chiang G, Zhou D, Chen W, Giambrone AE, Zhu W, Wang Y. Longitudinal change in magnetic susceptibility of new enhanced multiple sclerosis (MS) lesions measured on serial quantitative susceptibility mapping (QSM). J Magn Reson Imaging 2016; 44:426-32. [PMID: 26800367 DOI: 10.1002/jmri.25144] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/16/2015] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To measure the longitudinal change in multiple sclerosis (MS) lesion susceptibility using quantitative susceptibility mapping (QSM). MATERIALS AND METHODS The study was approved by our Institutional Review Board. Longitudinal changes in quantitative susceptibility values of new enhanced-with-Gd MS lesions were measured at baseline magnetic resonance imaging (MRI) and on a follow-up MRI in 29 patients within 2 years using a 3D multiple echo gradient echo sequence on a 3T scanner. Paired t-test and the generalized estimating equations (GEE) model was used to analyze the longitudinal change. RESULTS Lesion susceptibility values relative to normal-appearing white matter (NAWM) changed from 3.61 ± 6.11 ppb when enhanced-with-Gd at the baseline MRI to 20.42 ± 10.23 ppb when not-enhanced-with-Gd at the follow-up MRI (P < 0.001). CONCLUSION MS lesion susceptibility value increases significantly as the lesion evolves from enhanced-with-Gd to not-enhanced-with-Gd, serving as a disease biomarker. J. Magn. Reson. Imaging 2016;44:426-432.
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Affiliation(s)
- Yan Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Susan A Gauthier
- Department of Neurology, Weill Cornell Medical College, New York, New York, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Joseph Comunale
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | | | - Dong Zhou
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Weiwei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Ashley E Giambrone
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.,Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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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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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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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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Eskreis-Winkler S, Deh K, Gupta A, Liu T, Wisnieff C, Jin M, Gauthier SA, Wang Y, Spincemaille P. Multiple sclerosis lesion geometry in quantitative susceptibility mapping (QSM) and phase imaging. J Magn Reson Imaging 2015; 42:224-9. [PMID: 25174493 PMCID: PMC4733654 DOI: 10.1002/jmri.24745] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/14/2014] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To demonstrate the phase and quantitative susceptibility mapping (QSM) patterns created by solid and shell spatial distributions of magnetic susceptibility in multiple sclerosis (MS) lesions. MATERIALS AND METHODS Numerical simulations and experimental phantoms of solid- and shell-shaped magnetic susceptibility sources were used to generate magnitude, phase, and QSM images. Imaging of 20 consecutive MS patients was also reviewed for this Institutional Review Board (IRB)-approved MRI study to identify the appearance of solid and shell lesions on phase and QSM images. RESULTS Solid and shell susceptibility sources were correctly reconstructed in QSM images, while the corresponding phase images depicted both geometries with shell-like patterns, making the underlying susceptibility distribution difficult to determine using phase alone. In MS patients, of the 60 largest lesions identified on T2 , 30 lesions were detected on both QSM and phase, of which 83% were solid and 17% were shells on QSM, and of which 30% were solid and 70% were shell on phase. Of the 21 shell-like lesions on phase, 76% appeared solid on QSM, 24% appeared shell on QSM. Of the five shell-like lesions on QSM, all were shell-like on phase. CONCLUSION QSM accurately depicts both solid and shell patterns of magnetic susceptibility, while phase imaging fails to distinguish them.
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Affiliation(s)
| | - Kofi Deh
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
| | - Ajay Gupta
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
| | - Tian Liu
- Medimagemetric, LLC, New York, NY, USA
| | - Cynthia Wisnieff
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
- Bioengineering Department, Cornell University, Ithaca, NY
| | - Moonsoo Jin
- Bioengineering Department, Cornell University, Ithaca, NY
| | - Susan A. Gauthier
- Neurology Department, Weill Cornell Medical College, New York, NY, USA
| | - Yi Wang
- Radiology Department, Weill Cornell Medical College, New York, NY, USA
- Bioengineering Department, Cornell University, Ithaca, NY
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Dwyer MG, Zivadinov R, Markovic-Plese S, Bergsland N, Heininen-Brown M, Carl E, Kennedy C, Weinstock-Guttman B, Hayward B, Dangond F. Associations between changes in ferritin levels and susceptibility-weighted imaging filtered phase in patients with relapsing–remitting multiple sclerosis over 24weeks of therapy with subcutaneous interferon beta-1a three times weekly. J Neuroimmunol 2015; 281:44-50. [DOI: 10.1016/j.jneuroim.2015.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/24/2015] [Accepted: 03/02/2015] [Indexed: 02/01/2023]
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Zivadinov R, Dwyer M, Markovic-Plese S, Hayward B, Bergsland N, Heininen-Brown M, Carl E, Kennedy C, Dangond F, Weinstock-Guttman B. A pilot, longitudinal, 24-week study to evaluate the effect of interferon beta-1a subcutaneous on changes in susceptibility-weighted imaging-filtered phase assessment of lesions and subcortical deep-gray matter in relapsing-remitting multiple sclerosis. Ther Adv Neurol Disord 2015; 8:59-70. [PMID: 25941537 PMCID: PMC4356661 DOI: 10.1177/1756285615572953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Studies have shown a relationship between increased iron content and clinical progression, cognitive impairment, and brain atrophy in patients with multiple sclerosis. Altered phase, as determined by susceptibility-weighted imaging (SWI), can potentially capture iron content changes. OBJECTIVE The objective of this study was to investigate phase changes in white matter (WM) lesions and subcortical deep-gray matter (SDGM) of patients with relapsing-remitting (RR) MS treated with interferon beta-1a administered subcutaneously versus untreated healthy controls (HCs). METHODS We conducted a 24-week, nonrandomized, open-label pilot study of 23 patients with RRMS receiving interferon beta-1a administered subcutaneously and 15 HCs. Patients were imaged on a 3T scanner at baseline, 12, and 24 weeks; changes in phase behavior in WM lesions and regional SDGM [mean phase of low-phase voxels (MP-LPV)], and in SDGM volumes, were measured. Between- and within-group changes were tested using nonparametric statistics adjusted for multiple comparisons. RESULTS The number (p = 0.003) and volume (p < 0.001) of phase WM lesions both significantly decreased among RRMS patients over 24 weeks. At baseline, MP-LPV was lower (suggestive of greater iron content) in total SDGM among RRMS patients versus HCs (p = 0.002). Week 24 MP-LPV changes from baseline were not significantly different between groups in total SDGM or any region except the putamen (-0.0025 radians in RRMS patients versus 0.0035 radians in HCs; p = 0.041). CONCLUSIONS Over 24 weeks, phase lesions were reduced significantly in the RRMS group. These preliminary results suggest that SWI-filtered phase may become a useful tool for monitoring RRMS disease activity.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, MRI Imaging Clinical Translational Research Center, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | - Michael Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, MRI Imaging Clinical Translational Research Center, University at Buffalo, State University of New York, 100 High Street, Buffalo, NY 14203, USA
| | - Silva Markovic-Plese
- Department of Neurology, Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Mari Heininen-Brown
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ellen Carl
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Cheryl Kennedy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | | | - Bianca Weinstock-Guttman
- Baird MS Center, Department of Neurology, State University of New York at Buffalo, Buffalo, NY, USA
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Wang Y, Liu T. Quantitative susceptibility mapping (QSM): Decoding MRI data for a tissue magnetic biomarker. Magn Reson Med 2015; 73:82-101. [PMID: 25044035 PMCID: PMC4297605 DOI: 10.1002/mrm.25358] [Citation(s) in RCA: 577] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/13/2014] [Accepted: 06/18/2014] [Indexed: 01/03/2023]
Abstract
In MRI, the main magnetic field polarizes the electron cloud of a molecule, generating a chemical shift for observer protons within the molecule and a magnetic susceptibility inhomogeneity field for observer protons outside the molecule. The number of water protons surrounding a molecule for detecting its magnetic susceptibility is vastly greater than the number of protons within the molecule for detecting its chemical shift. However, the study of tissue magnetic susceptibility has been hindered by poor molecular specificities of hitherto used methods based on MRI signal phase and T2* contrast, which depend convolutedly on surrounding susceptibility sources. Deconvolution of the MRI signal phase can determine tissue susceptibility but is challenged by the lack of MRI signal in the background and by the zeroes in the dipole kernel. Recently, physically meaningful regularizations, including the Bayesian approach, have been developed to enable accurate quantitative susceptibility mapping (QSM) for studying iron distribution, metabolic oxygen consumption, blood degradation, calcification, demyelination, and other pathophysiological susceptibility changes, as well as contrast agent biodistribution in MRI. This paper attempts to summarize the basic physical concepts and essential algorithmic steps in QSM, to describe clinical and technical issues under active development, and to provide references, codes, and testing data for readers interested in QSM.
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Affiliation(s)
- Yi Wang
- Radiology, Weill Medical College of Cornell UniversityNew York, New York, USA
- Biomedical Engineering, Cornell UniversityIthaca, New York, USA
- Biomedical Engineering, Kyung Hee UniversitySeoul, South Korea
| | - Tian Liu
- MedImageMetric, LLCNew York, New York, USA
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Bamm VV, Lanthier DK, Stephenson EL, Smith GST, Harauz G. In vitro study of the direct effect of extracellular hemoglobin on myelin components. Biochim Biophys Acta Mol Basis Dis 2014; 1852:92-103. [PMID: 25463632 DOI: 10.1016/j.bbadis.2014.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/26/2014] [Accepted: 10/09/2014] [Indexed: 01/04/2023]
Abstract
There is a relationship between cerebral vasculature and multiple sclerosis (MS) lesions: abnormal accumulations of iron have been found in the walls of dilated veins in MS plaques. The sources of this iron can be varied, but capillary and venous hemorrhages leading to blood extravasation have been recorded, and could result in the release of hemoglobin extracellularly. Extracellular hemoglobin oxidizes quickly and is known to become a reactive molecule that triggers low-density lipoprotein oxidation and plays a pivotal role in atherogenesis. In MS, it could lead to local oxidative stress, inflammation, and tissue damage. Here, we investigated whether extracellular hemoglobin and its breakdown products can cause direct oxidative damage to myelin components in a peroxidative environment such as occurs in inflamed tissue. Oxidation of lipids was assessed by the formation of fluorescent peroxidized lipid-protein covalent adducts, by the increase in conjugated diene and malondialdehyde. Oxidation of proteins was analyzed by the change in protein mass. The results suggest that the globin radical could be a trigger of myelin basic protein oxidative cross-linking, and that heme transferred to the lipids is involved in lipid peroxidation. This study provides new insight into the mechanism by which hemoglobin exerts its pathological oxidative activity towards myelin components. This work supports further research into the vascular pathology in MS, to gain insight into the origin and role of iron deposits in disease pathogenesis, or in stimulation of different comorbidities such as cardiovascular disease.
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Affiliation(s)
- Vladimir V Bamm
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Danielle K Lanthier
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Erin L Stephenson
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - Graham S T Smith
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada
| | - George Harauz
- Department of Molecular and Cellular Biology, University of Guelph, 50 Stone Road East, Guelph, Ontario N1G 2W1, Canada.
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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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Iron and multiple sclerosis. Neurobiol Aging 2014; 35 Suppl 2:S51-8. [DOI: 10.1016/j.neurobiolaging.2014.03.039] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/28/2014] [Accepted: 03/14/2014] [Indexed: 11/23/2022]
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Arrambide G, Sastre-Garriga J. Predictive markers of disease evolution after a CIS in everyday practice. J Neurol Sci 2014; 343:8-14. [DOI: 10.1016/j.jns.2014.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/11/2014] [Accepted: 05/12/2014] [Indexed: 01/04/2023]
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Bamm VV, Harauz G. "Back to the future" or iron in the MS brain - commentary on "perivascular iron deposits are associated with protein nitration in cerebral experimental autoimmune encephalomyelitis". Neurosci Lett 2014; 582:130-2. [PMID: 24942652 DOI: 10.1016/j.neulet.2014.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Vladimir V Bamm
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, N1G 2W1, Canada
| | - George Harauz
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, Ontario, N1G 2W1, Canada.
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