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Voon CC, Wiltgen T, Wiestler B, Schlaeger S, Mühlau M. Quantitative susceptibility mapping in multiple sclerosis: A systematic review and meta-analysis. Neuroimage Clin 2024; 42:103598. [PMID: 38582068 PMCID: PMC11002889 DOI: 10.1016/j.nicl.2024.103598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) is a quantitative measure based on magnetic resonance imaging sensitive to iron and myelin content. This makes QSM a promising non-invasive tool for multiple sclerosis (MS) in research and clinical practice. OBJECTIVE We performed a systematic review and meta-analysis on the use of QSM in MS. METHODS Our review was prospectively registered on PROSPERO (CRD42022309563). We searched five databases for studies published between inception and 30th April 2023. We identified 83 English peer-reviewed studies that applied QSM images on MS cohorts. Fifty-five included studies had at least one of the following outcome measures: deep grey matter QSM values in MS, either compared to healthy controls (HC) (k = 13) or correlated with the score on the Expanded Disability Status Scale (EDSS) (k = 7), QSM lesion characteristics (k = 22) and their clinical correlates (k = 17), longitudinal correlates (k = 11), histological correlates (k = 7), or correlates with other imaging techniques (k = 12). Two meta-analyses on deep grey matter (DGM) susceptibility data were performed, while the remaining findings could only be analyzed descriptively. RESULTS After outlier removal, meta-analyses demonstrated a significant increase in the basal ganglia susceptibility (QSM values) in MS compared to HC, caudate (k = 9, standardized mean difference (SDM) = 0.54, 95 % CI = 0.39-0.70, I2 = 46 %), putamen (k = 9, SDM = 0.38, 95 % CI = 0.19-0.57, I2 = 59 %), and globus pallidus (k = 9, SDM = 0.48, 95 % CI = 0.28-0.67, I2 = 60 %), whereas thalamic QSM values exhibited a significant reduction (k = 12, SDM = -0.39, 95 % CI = -0.66--0.12, I2 = 84 %); these susceptibility differences in MS were independent of age. Further, putamen QSM values positively correlated with EDSS (k = 4, r = 0.36, 95 % CI = 0.16-0.53, I2 = 0 %). Regarding rim lesions, four out of seven studies, representing 73 % of all patients, reported rim lesions to be associated with more severe disability. Moreover, lesion development from initial detection to the inactive stage is paralleled by increasing, plateauing (after about two years), and gradually decreasing QSM values, respectively. Only one longitudinal study provided clinical outcome measures and found no association. Histological data suggest iron content to be the primary source of QSM values in DGM and at the edges of rim lesions; further, when also considering data from myelin water imaging, the decrease of myelin is likely to drive the increase of QSM values within WM lesions. CONCLUSIONS We could provide meta-analytic evidence for DGM susceptibility changes in MS compared to HC; basal ganglia susceptibility is increased and, in the putamen, associated with disability, while thalamic susceptibility is decreased. Beyond these findings, further investigations are necessary to establish the role of QSM in MS for research or even clinical routine.
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Affiliation(s)
- Cui Ci Voon
- Dept. of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Tun Wiltgen
- Dept. of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Benedikt Wiestler
- Dept. of Neuroradiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sarah Schlaeger
- Dept. of Neuroradiology, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Dept. of Neurology, School of Medicine and Health, Technical University of Munich, Munich, Germany; TUM-Neuroimaging Center, School of Medicine and Health, Technical University of Munich, Munich, Germany.
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Zhu Z, Naji N, Esfahani JH, Snyder J, Seres P, Emery DJ, Noga M, Blevins G, Smyth P, Wilman AH. MR Susceptibility Separation for Quantifying Lesion Paramagnetic and Diamagnetic Evolution in Relapsing-Remitting Multiple Sclerosis. J Magn Reson Imaging 2024. [PMID: 38308397 DOI: 10.1002/jmri.29266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) lesion evolution may involve changes in diamagnetic myelin and paramagnetic iron. Conventional quantitative susceptibility mapping (QSM) can provide net susceptibility distribution, but not the discrete paramagnetic and diamagnetic components. PURPOSE To apply susceptibility separation (χ separation) to follow lesion evolution in MS with comparison to R2 */R2 ' /QSM. STUDY TYPE Longitudinal, prospective. SUBJECTS Twenty relapsing-remitting MS subjects (mean age: 42.5 ± 9.4 years, 13 females; mean years of symptoms: 4.3 ± 1.4 years). FIELD STRENGTH/SEQUENCE Three-dimensional multiple echo gradient echo (QSM and R2 * mapping), two-dimensional dual echo fast spin echo (R2 mapping), T2 -weighted fluid attenuated inversion recovery, and T1-weighted magnetization prepared gradient echo sequences at 3 T. ASSESSMENT Data were analyzed from two scans separated by a mean interval of 14.4 ± 2.0 months. White matter lesions on fluid-attenuated inversion recovery were defined by an automatic pipeline, then manually refined (by ZZ/AHW, 3/25 years' experience in MRI), and verified by a radiologist (MN, 25 years' experience in MS). Susceptibility separation yielded the paramagnetic and diamagnetic susceptibility content of each voxel. Lesions were classified into four groups based on the variation of QSM/R2 * or separated into positive/negative components from χ separation. STATISTICAL TESTS Two-sample paired t tests for assessment of longitudinal differences. Spearman correlation coefficients to assess associations between χ separation and R2 */R2 ' /QSM. Significant level: P < 0.005. RESULTS A total of 183 lesions were quantified. Categorizing lesions into groups based on χ separation demonstrated significant annual changes in QSM//R2 */R2 ' . When lesions were grouped based on changes in QSM and R2 *, both changing in unison yielded a significant dominant paramagnetic variation and both opposing yielded a dominant diamagnetic variation. Significant Spearman correlation coefficients were found between susceptibility-sensitive MRI indices and χ separation. DATA CONCLUSION Susceptibility separation changes in MS lesions may distinguish and quantify paramagnetic and diamagnetic evolution, potentially providing additional insight compared to R2 * and QSM alone. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ziyan Zhu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Nashwan Naji
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Javad Hamidi Esfahani
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Jeff Snyder
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Seres
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Derek J Emery
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Noga
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
| | - Gregg Blevins
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Penelope Smyth
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alan H Wilman
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Pfefferbaum A, Zhao Q, Pohl KM, Sassoon SA, Zahr NM, Sullivan EV. Age-Accelerated Increase of White Matter Hyperintensity Volumes Is Exacerbated by Heavy Alcohol Use in People Living With HIV. Biol Psychiatry 2024; 95:231-244. [PMID: 37597798 PMCID: PMC10840832 DOI: 10.1016/j.biopsych.2023.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Antiretroviral treatment has enabled people living with HIV infection to have a near-normal life span. With longevity comes opportunities for engaging in risky behavior, including initiation of excessive drinking. Given that both HIV infection and alcohol use disorder (AUD) can disrupt brain white matter integrity, we questioned whether HIV infection, even if successfully treated, or AUD alone results in signs of accelerated white matter aging and whether HIV+AUD comorbidity further accelerates brain aging. METHODS Longitudinal magnetic resonance imaging-FLAIR data were acquired over a 15-year period from 179 control individuals, 204 participants with AUD, 70 participants with HIV, and 75 participants with comorbid HIV+AUD. White matter hyperintensity (WMH) volumes were quantified and localized, and their functional relevance was examined with cognitive and motor testing. RESULTS The 3 diagnostic groups each had larger WMH volumes than the control group. Although all 4 groups exhibited accelerating volume increases with aging, only the HIV groups showed faster WMH enlargement than control individuals; the comorbid group showed faster acceleration than the HIV-only group. Sex and HIV infection length, but not viral suppression status, moderated acceleration. Correlations emerged between WMH volumes and attention/working memory and executive function scores of the AUD and HIV groups and between WMH volumes and motor skills in the 3 diagnostic groups. CONCLUSIONS Even treated HIV can show accelerated aging, possibly from treatment sequelae or legacy effects, and notably from AUD comorbidity. WMH volumes may be especially relevant for tracking HIV and AUD brain health because each condition is associated with liability for hypertensive processes, for which WMHs are considered a marker.
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Affiliation(s)
- Adolf Pfefferbaum
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Qingyu Zhao
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Kilian M Pohl
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Natalie M Zahr
- Center for Health Sciences, SRI International, Menlo Park, California; Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Edith V Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
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Merenstein JL, Zhao J, Overson DK, Truong TK, Johnson KG, Song AW, Madden DJ. Depth- and curvature-based quantitative susceptibility mapping analyses of cortical iron in Alzheimer's disease. Cereb Cortex 2024; 34:bhad525. [PMID: 38185996 PMCID: PMC10839848 DOI: 10.1093/cercor/bhad525] [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: 09/20/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024] Open
Abstract
In addition to amyloid beta plaques and neurofibrillary tangles, Alzheimer's disease (AD) has been associated with elevated iron in deep gray matter nuclei using quantitative susceptibility mapping (QSM). However, only a few studies have examined cortical iron, using more macroscopic approaches that cannot assess layer-specific differences. Here, we conducted column-based QSM analyses to assess whether AD-related increases in cortical iron vary in relation to layer-specific differences in the type and density of neurons. We obtained global and regional measures of positive (iron) and negative (myelin, protein aggregation) susceptibility from 22 adults with AD and 22 demographically matched healthy controls. Depth-wise analyses indicated that global susceptibility increased from the pial surface to the gray/white matter boundary, with a larger slope for positive susceptibility in the left hemisphere for adults with AD than controls. Curvature-based analyses indicated larger global susceptibility for adults with AD versus controls; the right hemisphere versus left; and gyri versus sulci. Region-of-interest analyses identified similar depth- and curvature-specific group differences, especially for temporo-parietal regions. Finding that iron accumulates in a topographically heterogenous manner across the cortical mantle may help explain the profound cognitive deterioration that differentiates AD from the slowing of general motor processes in healthy aging.
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Affiliation(s)
- Jenna L Merenstein
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
| | - Jiayi Zhao
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
| | - Devon K Overson
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
- Medical Physics Graduate Program, Duke University, Durham, NC 27708, United States
| | - Trong-Kha Truong
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
- Medical Physics Graduate Program, Duke University, Durham, NC 27708, United States
| | - Kim G Johnson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
| | - Allen W Song
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
- Medical Physics Graduate Program, Duke University, Durham, NC 27708, United States
| | - David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Durham, NC 27710, United States
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, United States
- Center for Cognitive Neuroscience, Duke University, Durham, NC 27708, United States
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5
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Khormi I, Al-Iedani O, Alshehri A, Ramadan S, Lechner-Scott J. MR myelin imaging in multiple sclerosis: A scoping review. J Neurol Sci 2023; 455:122807. [PMID: 38035651 DOI: 10.1016/j.jns.2023.122807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/20/2023] [Accepted: 11/19/2023] [Indexed: 12/02/2023]
Abstract
The inability of disease-modifying therapies to stop the progression of multiple sclerosis (MS), has led to the development of a new therapeutic strategy focussing on myelin repair. While conventional MRI lacks sensitivity for quantifying myelin damage, advanced MRI techniques are proving effective. The development of targeted therapeutics requires histological validation of myelin imaging results, alongside the crucial task of establishing correlations between myelin imaging results and clinical assessments, so that the effectiveness of therapeutic interventions can be evaluated. The aims of this scoping review were to identify myelin imaging methods - some of which have been histologically validated, and to determine how these approaches correlate with clinical assessments of people with MS (pwMS), thus allowing for effective therapeutic evaluation. A search of two databases was undertaken for publications relating to studies on adults MS using either MRI/MR-histology of the MS brain in the range 1990-to-2022. The myelin imaging methods specified were relaxometry, magnetization transfer, and quantitative susceptibility. Relaxometry was used most frequently, with myelin water fraction (MWF) being the primary metric. Studies conducted on tissue from various regions of the brain showed that MWF was significantly lower in pwMS than in healthy controls. Magnetization transfer ratio indicated that the macromolecular content of lesions was lower than that of normal-appearing tissue. Higher magnetic susceptibility of lesions were indicative of myelin breakdown and iron accumulation. Several myelin imaging metrics were correlated with disability, disease severity and duration. Many studies showed a good correlation between myelin measured histologically and by MR myelin imaging techniques.
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Affiliation(s)
- Ibrahim Khormi
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; College of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Oun Al-Iedani
- Hunter Medical Research Institute, New Lambton Heights, Australia; School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Abdulaziz Alshehri
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saadallah Ramadan
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, New Lambton Heights, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
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Madden DJ, Merenstein JL. Quantitative susceptibility mapping of brain iron in healthy aging and cognition. Neuroimage 2023; 282:120401. [PMID: 37802405 PMCID: PMC10797559 DOI: 10.1016/j.neuroimage.2023.120401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023] Open
Abstract
Quantitative susceptibility mapping (QSM) is a magnetic resonance imaging (MRI) technique that can assess the magnetic properties of cerebral iron in vivo. Although brain iron is necessary for basic neurobiological functions, excess iron content disrupts homeostasis, leads to oxidative stress, and ultimately contributes to neurodegenerative disease. However, some degree of elevated brain iron is present even among healthy older adults. To better understand the topographical pattern of iron accumulation and its relation to cognitive aging, we conducted an integrative review of 47 QSM studies of healthy aging, with a focus on five distinct themes. The first two themes focused on age-related increases in iron accumulation in deep gray matter nuclei versus the cortex. The overall level of iron is higher in deep gray matter nuclei than in cortical regions. Deep gray matter nuclei vary with regard to age-related effects, which are most prominent in the putamen, and age-related deposition of iron is also observed in frontal, temporal, and parietal cortical regions during healthy aging. The third theme focused on the behavioral relevance of iron content and indicated that higher iron in both deep gray matter and cortical regions was related to decline in fluid (speed-dependent) cognition. A handful of multimodal studies, reviewed in the fourth theme, suggest that iron interacts with imaging measures of brain function, white matter degradation, and the accumulation of neuropathologies. The final theme concerning modifiers of brain iron pointed to potential roles of cardiovascular, dietary, and genetic factors. Although QSM is a relatively recent tool for assessing cerebral iron accumulation, it has significant promise for contributing new insights into healthy neurocognitive aging.
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Affiliation(s)
- David J Madden
- Brain Imaging and Analysis Center, Duke University Medical Center, Box 3918, Durham, NC 27710, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA; Center for Cognitive Neuroscience, Duke University, Durham, NC 27708, USA.
| | - Jenna L Merenstein
- Brain Imaging and Analysis Center, Duke University Medical Center, Box 3918, Durham, NC 27710, USA
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Pietroboni AM, Colombi A, Contarino VE, Russo FML, Conte G, Morabito A, Siggillino S, Carandini T, Fenoglio C, Arighi A, De Riz MA, Arcaro M, Sacchi L, Fumagalli GG, Bianchi AM, Triulzi F, Scarpini E, Galimberti D. Quantitative susceptibility mapping of the normal-appearing white matter as a potential new marker of disability progression in multiple sclerosis. Eur Radiol 2023; 33:5368-5377. [PMID: 36562783 DOI: 10.1007/s00330-022-09338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 10/03/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the normal-appearing white matter (NAWM) susceptibility in a cohort of newly diagnosed multiple sclerosis (MS) patients and to evaluate possible correlations between NAWM susceptibility and disability progression. METHODS Fifty-nine patients with a diagnosis of MS (n = 53) or clinically isolated syndrome (CIS) (n = 6) were recruited and followed up. All participants underwent neurological examination, blood sampling for serum neurofilament light chain (sNfL) level assessment, lumbar puncture for the quantification of cerebrospinal fluid (CSF) β-amyloid1-42 (Aβ) levels, and brain MRI. T2-weighted scans were used to quantify white matter (WM) lesion loads. For each scan, we derived the NAWM volume fraction and the WM lesion volume fraction. Quantitative susceptibility mapping (QSM) of the NAWM was calculated using the susceptibility tensor imaging (STI) suite. Susceptibility maps were computed with the STAR algorithm. RESULTS Primary progressive patients (n = 9) showed a higher mean susceptibility value in the NAWM than relapsing-remitting (n = 44) and CIS (n = 6) (p = 0.01 and p = 0.02). Patients with a higher susceptibility in the NAWM showed increased sNfL concentration (ρ = 0.38, p = 0.004) and lower CSF Aβ levels (ρ = -0.34, p = 0.009). Mean NAWM susceptibility turned out to be a predictor of the expanded disability status scale (EDSS) worsening at follow-up (β = 0.41, t = 2.66, p = 0.01) and of the MS severity scale (MSSS) (β = 0.38, t = 2.43, p = 0.019). CONCLUSIONS QSM in the NAWM seems to predict the EDSS increment over time. This finding might provide evidence on the role of QSM in identifying patients with an increased risk of early disability progression. KEY POINTS • NAWM-QSM is higher in PPMS patients than in RRMS. • NAWM-QSM seems to be a predictor of EDSS worsening over time. • Patients with higher NAWM-QSM show increased sNfL concentration and lower CSF Aβ levels.
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Affiliation(s)
- Anna M Pietroboni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Annalisa Colombi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Valeria E Contarino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Francesco Maria Lo Russo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Giorgio Conte
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- University of Milan, Milan, Italy
| | - Aurelia Morabito
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Silvia Siggillino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Tiziana Carandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | | | - Andrea Arighi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Milena A De Riz
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Marina Arcaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | | | - Giorgio G Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | | | - Fabio Triulzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- University of Milan, Milan, Italy
| | - Elio Scarpini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
- University of Milan, Milan, Italy
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Northall A, Doehler J, Weber M, Vielhaber S, Schreiber S, Kuehn E. Layer-specific vulnerability is a mechanism of topographic map aging. Neurobiol Aging 2023; 128:17-32. [PMID: 37141729 DOI: 10.1016/j.neurobiolaging.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 03/29/2023] [Accepted: 04/02/2023] [Indexed: 05/06/2023]
Abstract
Topographic maps form a critical feature of cortical organization, yet are poorly described with respect to their microstructure in the living aging brain. We acquired quantitative structural and functional 7T-MRI data from younger and older adults to characterize layer-wise topographic maps of the primary motor cortex (M1). Using parcellation-inspired techniques, we show that quantitative T1 and Quantitative Susceptibility Maps values of the hand, face, and foot areas differ significantly, revealing microstructurally distinct cortical fields in M1. We show that these fields are distinct in older adults and that myelin borders between them do not degenerate. We further show that the output layer 5 of M1 shows a particular vulnerability to age-related increased iron, while layer 5 and the superficial layer show increased diamagnetic substance, likely reflecting calcifications. Taken together, we provide a novel 3D model of M1 microstructure, where body parts form distinct structural units, but layers show specific vulnerability toward increased iron and calcium in older adults. Our findings have implications for understanding sensorimotor organization and aging, in addition to topographic disease spread.
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Affiliation(s)
- Alicia Northall
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University Magdeburg, Saxony-Anhalt, Germany.
| | - Juliane Doehler
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University Magdeburg, Saxony-Anhalt, Germany
| | - Miriam Weber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Saxony-Anhalt, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Saxony-Anhalt, Germany
| | - Stefanie Schreiber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Saxony-Anhalt, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Saxony-Anhalt, Germany; Center for Behavioral Brain Sciences (CBBS) Magdeburg, Magdeburg, Saxony-Anhalt, Germany
| | - Esther Kuehn
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University Magdeburg, Saxony-Anhalt, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Saxony-Anhalt, Germany; Center for Behavioral Brain Sciences (CBBS) Magdeburg, Magdeburg, Saxony-Anhalt, Germany; Hertie Institute for Clinical Brain Research, Tübingen, Germany
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9
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Lancione M, Bosco P, Costagli M, Nigri A, Aquino D, Carne I, Ferraro S, Giulietti G, Napolitano A, Palesi F, Pavone L, Pirastru A, Savini G, Tagliavini F, Bruzzone MG, Gandini Wheeler-Kingshott CA, Tosetti M, Biagi L. Multi-centre and multi-vendor reproducibility of a standardized protocol for quantitative susceptibility Mapping of the human brain at 3T. Phys Med 2022; 103:37-45. [DOI: 10.1016/j.ejmp.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
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Rahmanzadeh R, Galbusera R, Lu PJ, Bahn E, Weigel M, Barakovic M, Franz J, Nguyen TD, Spincemaille P, Schiavi S, Daducci A, La Rosa F, Absinta M, Sati P, Cuadra MB, Radue EW, Leppert D, Kuhle J, Kappos L, Brück W, Reich DS, Stadelmann C, Wang Y, Granziera C. A new advanced MRI biomarker for remyelinated lesions in Multiple Sclerosis. Ann Neurol 2022; 92:486-502. [PMID: 35713309 PMCID: PMC9527017 DOI: 10.1002/ana.26441] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022]
Abstract
Objectives Neuropathological studies have shown that multiple sclerosis (MS) lesions are heterogeneous in terms of myelin/axon damage and repair as well as iron content. However, it remains a challenge to identify specific chronic lesion types, especially remyelinated lesions, in vivo in patients with MS. Methods We performed 3 studies: (1) a cross‐sectional study in a prospective cohort of 115 patients with MS and 76 healthy controls, who underwent 3 T magnetic resonance imaging (MRI) for quantitative susceptibility mapping (QSM), myelin water fraction (MWF), and neurite density index (NDI) maps. White matter (WM) lesions in QSM were classified into 5 QSM lesion types (iso‐intense, hypo‐intense, hyperintense, lesions with hypo‐intense rims, and lesions with paramagnetic rim legions [PRLs]); (2) a longitudinal study of 40 patients with MS to study the evolution of lesions over 2 years; (3) a postmortem histopathology‐QSM validation study in 3 brains of patients with MS to assess the accuracy of QSM classification to identify neuropathological lesion types in 63 WM lesions. Results At baseline, hypo‐ and isointense lesions showed higher mean MWF and NDI values compared to other QSM lesion types (p < 0.0001). Further, at 2‐year follow‐up, hypo‐/iso‐intense lesions showed an increase in MWF. Postmortem analyses revealed that QSM highly accurately identifies (1) fully remyelinated areas as hypo‐/iso‐intense (sensitivity = 88.89% and specificity = 100%), (2) chronic inactive lesions as hyperintense (sensitivity = 71.43% and specificity = 92.00%), and (3) chronic active/smoldering lesions as PRLs (sensitivity = 92.86% and specificity = 86.36%). Interpretation These results provide the first evidence that it is possible to distinguish chronic MS lesions in a clinical setting, hereby supporting with new biomarkers to develop and assess remyelinating treatments. ANN NEUROL 2022;92:486–502
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Affiliation(s)
- Reza Rahmanzadeh
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Riccardo Galbusera
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Erik Bahn
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Matthias Weigel
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.,Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center, Göttingen, Germany.,Max Planck Institute for Experimental Medicine, Göttingen, Germany.,Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Pascal Spincemaille
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Simona Schiavi
- Department of Computer Science, University of Verona, Verona, Italy
| | | | - Francesco La Rosa
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Martina Absinta
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and Hospital, Milan, Italy
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive MSC 1400, Building 10 Room 5C103, Bethesda, Maryland, USA.,Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Meritxell Bach Cuadra
- Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Medical Image Analysis Laboratory (MIAL), Center for Biomedical Imaging (CIBM), Lausanne, Switzerland
| | - Ernst-Wilhelm Radue
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Leppert
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive MSC 1400, Building 10 Room 5C103, Bethesda, Maryland, USA
| | | | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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11
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Caruana G, Auger C, Pessini LM, Calderon W, de Barros A, Salerno A, Sastre-Garriga J, Montalban X, Rovira À. SWI as an Alternative to Contrast-Enhanced Imaging to Detect Acute MS Lesions. AJNR Am J Neuroradiol 2022; 43:534-539. [PMID: 35332015 PMCID: PMC8993188 DOI: 10.3174/ajnr.a7474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute inflammatory activity of MS lesions is traditionally assessed through contrast-enhanced T1-weighted MR images. The aim of our study was to determine whether a qualitative evaluation of non-contrast-enhanced SWI of new T2-hyperintense lesions might help distinguish acute and chronic lesions and whether it could be considered a possible alternative to gadolinium-based contrast agents for this purpose. MATERIALS AND METHODS Serial MR imaging studies from 55 patients with MS were reviewed to identify 169 new T2-hyperintense lesions. Two blinded neuroradiologists determined their signal pattern on SWI, considering 5 categories (hypointense rings, marked hypointensity, mild hypointensity, iso-/hyperintensity, indeterminate). Two different blinded neuroradiologists evaluated the presence or absence of enhancement in postcontrast T1-weighted images of the lesions. The Fisher exact test was used to determine whether each category of signal intensity on SWI was associated with gadolinium enhancement. RESULTS The presence of hypointense rings or marked hypointensity showed a strong association with the absence of gadolinium enhancement (P < .001), with a sensitivity of 93.0% and a specificity of 82.9%. The presence of mild hypointensity or isohyperintensity showed a strong association with the presence of gadolinium enhancement (P < .001), with a sensitivity of 68.3% and a specificity of 99.2%. CONCLUSIONS A qualitative analysis of the signal pattern on SWI of new T2-hyperintense MS lesions allows determining the likelihood that the lesions will enhance after administration of a gadolinium contrast agent, with high specificity albeit with a moderate sensitivity. While it cannot substitute for the use of contrast agent, it can be useful in some clinical settings in which the contrast agent cannot be administered.
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Affiliation(s)
- G Caruana
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - C Auger
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - L M Pessini
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - W Calderon
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A de Barros
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A Salerno
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - J Sastre-Garriga
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
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12
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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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13
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Guo Z, Long L, Qiu W, Lu T, Zhang L, Shu Y, Zhang K, Fang L, Chen S. The Distributional Characteristics of Multiple Sclerosis Lesions on Quantitative Susceptibility Mapping and Their Correlation With Clinical Severity. Front Neurol 2021; 12:647519. [PMID: 34305779 PMCID: PMC8299522 DOI: 10.3389/fneur.2021.647519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Multiple sclerosis (MS) patients have a wide spectrum of severity and responses to therapy; the personalization of treatment relies on sensitive and specific biomarkers. Previous studies have suggested that susceptibility contrast in demyelinated plaques is associated with iron-related pathology in multiple sclerosis which may indicate clinical severity. The aims of this study were to characterize the spatial distribution of MS lesions with different iron patterns by using quantitative susceptibility mapping and to explore neuroradiological findings that correlate with poor clinical outcome. Methods: Twenty-six patients with relapsing-remitting MS [14 men, 12 women; mean age, 29 ± 8 (standard deviation) years; age range, 21-52 years] were included in this study. Differences in lesion number, T2 volume, and susceptibility were compared among lesions subcategorized by location and by the presence or absence of a hyperintense rim on quantitative susceptibility mapping. Associations between these imaging features and clinical outcomes including Expanded Disability Status Scale scores and annual relapse rates were investigated. Results: A total of 811 unifocal MS lesions were included, and their QSM patterns were nodular hyperintensity with no rim (rim-, 540, 67%) or with a hyperintense rim on the edge (rim+, 172, 21%) and nodular isointensity (99, 12%). Rim+ lesions had significantly larger volume (115 ± 142 vs. 166 ± 185 mm3, p < 0.001) and lower susceptibility (4 ± 15 vs. 8 ± 16 ppb, p < 0.05) than rim- lesions. More rim+ lesions were found in periventricular areas [median, 45%; interquartile range (IQR), 36%], whereas a larger proportion of rim- lesions were distributed in juxtacortical (median, 32%; IQR, 21%) and deep white matter (median, 38%; IQR, 22%) areas. The annual relapse rate was positively correlated with the proportion of periventricular rim+ lesions (p < 0.001, r = 0.65) and the proportion of subtentorial rim+ lesions (p < 0.05, r = 0.40). Additionally, a significant association was found between the burden of periventricular rim+ lesions (β = 0.64, p < 0.001) and the burden of subtentorial rim- lesions (β = 0.36, p < 0.05). Conclusions: A high number or lesion burden of periventricular rim+ lesions or subtentorial lesions is associated with frequent clinical relapses.
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Affiliation(s)
- Zhuoxin Guo
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liu Long
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tingting Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lina Zhang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Shu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ke Zhang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ling Fang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaoqiong Chen
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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14
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Granziera C, Wuerfel J, Barkhof F, Calabrese M, De Stefano N, Enzinger C, Evangelou N, Filippi M, Geurts JJG, Reich DS, Rocca MA, Ropele S, Rovira À, Sati P, Toosy AT, Vrenken H, Gandini Wheeler-Kingshott CAM, Kappos L. Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis. Brain 2021; 144:1296-1311. [PMID: 33970206 PMCID: PMC8219362 DOI: 10.1093/brain/awab029] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/25/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response.
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Affiliation(s)
- 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 Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
- Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- UCL Institutes of Healthcare Engineering and Neurology, London, UK
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefan Ropele
- Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmed T Toosy
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludwig Kappos
- 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 Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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15
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Gillen KM, Mubarak M, Park C, Ponath G, Zhang S, Dimov A, Levine‐Ritterman M, Toro S, Huang W, Amici S, Kaunzner UW, Gauthier SA, Guerau‐de‐Arellano M, Wang Y, Nguyen TD, Pitt D. QSM is an imaging biomarker for chronic glial activation in multiple sclerosis lesions. Ann Clin Transl Neurol 2021; 8:877-886. [PMID: 33704933 PMCID: PMC8045922 DOI: 10.1002/acn3.51338] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Inflammation in chronic active lesions occurs behind a closed blood-brain barrier and cannot be detected with MRI. Activated microglia are highly enriched for iron and can be visualized with quantitative susceptibility mapping (QSM), an MRI technique used to delineate iron. OBJECTIVE To characterize the histopathological correlates of different QSM hyperintensity patterns in MS lesions. METHODS MS brain slabs were imaged with MRI and QSM, and processed for histology. Immunolabeled cells were quantified in the lesion rim, center, and adjacent normal-appearing white matter (NAWM). Iron+ myeloid cell densities at the rims were correlated with susceptibilities. Human-induced pluripotent stem cell (iPSC)-derived microglia were used to determine the effect of iron on the production of reactive oxygen species (ROS) and pro-inflammatory cytokines. RESULTS QSM hyperintensity at the lesion perimeter correlated with activated iron+ myeloid cells in the rim and NAWM. Lesions with high punctate or homogenous QSM signal contained no or minimally activated iron- myeloid cells. In vitro, iron accumulation was highest in M1-polarized human iPSC-derived microglia, but it did not enhance ROS or cytokine production. CONCLUSION A high QSM signal outlining the lesion rim but not punctate signal in the center is a biomarker for chronic inflammation in white matter lesions.
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Affiliation(s)
- Kelly M. Gillen
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Mayyan Mubarak
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
| | - Calvin Park
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
| | - Gerald Ponath
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
| | - Shun Zhang
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Alexey Dimov
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | | | - Steven Toro
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
| | - Weiyuan Huang
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Stephanie Amici
- Department of NeuroscienceThe Ohio State UniversityColumbusOhioUSA
| | | | - Susan A. Gauthier
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA,Department of NeurologyWeill Cornell MedicineNew YorkNew YorkUSA
| | | | - Yi Wang
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Thanh D. Nguyen
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - David Pitt
- Department of NeurologyYale School of MedicineNew HavenConnecticutUSA
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16
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Thaler C, Kyselyova AA, Faizy TD, Nawka MT, Jespersen S, Hansen B, Stellmann JP, Heesen C, Stürner KH, Stark M, Fiehler J, Bester M, Gellißen S. Heterogeneity of multiple sclerosis lesions in fast diffusional kurtosis imaging. PLoS One 2021; 16:e0245844. [PMID: 33539364 PMCID: PMC7861404 DOI: 10.1371/journal.pone.0245844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background Mean kurtosis (MK), one of the parameters derived from diffusion kurtosis imaging (DKI), has shown increased sensitivity to tissue microstructure damage in several neurological disorders. Methods Thirty-seven patients with relapsing-remitting MS and eleven healthy controls (HC) received brain imaging on a 3T MR scanner, including a fast DKI sequence. MK and mean diffusivity (MD) were measured in the white matter of HC, normal-appearing white matter (NAWM) of MS patients, contrast-enhancing lesions (CE-L), FLAIR lesions (FLAIR-L) and black holes (BH). Results Overall 1529 lesions were analyzed, including 30 CE-L, 832 FLAIR-L and 667 BH. Highest MK values were obtained in the white matter of HC (0.814 ± 0.129), followed by NAWM (0.724 ± 0.137), CE-L (0.619 ± 0.096), FLAIR-L (0.565 ± 0.123) and BH (0.549 ± 0.12). Lowest MD values were obtained in the white matter of HC (0.747 ± 0.068 10−3mm2/sec), followed by NAWM (0.808 ± 0.163 10−3mm2/sec), CE-L (0.853 ± 0.211 10−3mm2/sec), BH (0.957 ± 0.304 10−3mm2/sec) and FLAIR-L (0.976 ± 0.35 10−3mm2/sec). While MK differed significantly between CE-L and non-enhancing lesions, MD did not. Conclusion MK adds predictive value to differentiate between MS lesions and might provide further information about diffuse white matter injury and lesion microstructure.
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Affiliation(s)
- Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Anna A. Kyselyova
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D. Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marie T. Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sune Jespersen
- Department of Clinical Medicine - Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Brian Hansen
- Department of Clinical Medicine - Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jan-Patrick Stellmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hospital de la Timone, CEMEREM, Marseille, France
- Aix Marseille University, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Klarissa H. Stürner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Sweeney EM, Nguyen TD, Kuceyeski A, Ryan SM, Zhang S, Zexter L, Wang Y, Gauthier SA. Estimation of Multiple Sclerosis lesion age on magnetic resonance imaging. Neuroimage 2020; 225:117451. [PMID: 33069865 PMCID: PMC7805079 DOI: 10.1016/j.neuroimage.2020.117451] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 01/17/2023] Open
Abstract
We introduce the first-ever statistical framework for estimating the age of Multiple Sclerosis (MS) lesions from magnetic resonance imaging (MRI). Estimating lesion age is an important step when studying the longitudinal behavior of MS lesions and can be used in applications such as studying the temporal dynamics of chronic active MS lesions. Our lesion age estimation models use first order radiomic features over a lesion derived from conventional T1 (T1w) and T2 weighted (T2w) and fluid attenuated inversion recovery (FLAIR), T1w with gadolinium contrast (T1w+c), and Quantitative Susceptibility Mapping (QSM) MRI sequences as well as demographic information. For this analysis, we have a total of 32 patients with 53 new lesions observed at 244 time points. A one or two step random forest model for lesion age is fit on a training set using a lesion volume cutoff of 15 mm3 or 50 mm3 . We explore the performance of nine different modeling scenarios that included various combinations of the MRI sequences and demographic information and a one or two step random forest models, as well as simpler models that only uses the mean radiomic feature from each MRI sequence. The best performing model on a validation set is a model that uses a two-step random forest model on the radiomic features from all of the MRI sequences with demographic information using a lesion volume cutoff of 50 mm3 . This model has a mean absolute error of 7.23 months (95% CI: [6.98, 13.43]) and a median absolute error of 5.98 months (95% CI: [5.26, 13.25]) in the validation set. For this model, the predicted age and actual age have a statistically significant association (p-value <0.001) in the validation set.
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Affiliation(s)
- Elizabeth M Sweeney
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States.
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States; Brain and Mind Institute, Weill Cornell Medical College, New York, NY, United States
| | - Sarah M Ryan
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, United States
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Wuhan, China
| | - Lily Zexter
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Susan A Gauthier
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States; Brain and Mind Institute, Weill Cornell Medical College, New York, NY, United States; Department of Neurology, Weill Cornell Medical College, New York, NY, United States
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18
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Piredda GF, Hilbert T, Thiran JP, Kober T. Probing myelin content of the human brain with MRI: A review. Magn Reson Med 2020; 85:627-652. [PMID: 32936494 DOI: 10.1002/mrm.28509] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022]
Abstract
Rapid and efficient transmission of electric signals among neurons of vertebrates is ensured by myelin-insulating sheaths surrounding axons. Human cognition, sensation, and motor functions rely on the integrity of these layers, and demyelinating diseases often entail serious cognitive and physical impairments. Magnetic resonance imaging radically transformed the way these disorders are monitored, offering an irreplaceable tool to noninvasively examine the brain structure. Several advanced techniques based on MRI have been developed to provide myelin-specific contrasts and a quantitative estimation of myelin density in vivo. Here, the vast offer of acquisition strategies developed to date for this task is reviewed. Advantages and pitfalls of the different approaches are compared and discussed.
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Affiliation(s)
- Gian Franco Piredda
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,LTS5, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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19
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Elliott C, Arnold DL, Chen H, Ke C, Zhu L, Chang I, Cahir-McFarland E, Fisher E, Zhu B, Gheuens S, Scaramozza M, Beynon V, Franchimont N, Bradley DP, Belachew S. Patterning Chronic Active Demyelination in Slowly Expanding/Evolving White Matter MS Lesions. AJNR Am J Neuroradiol 2020; 41:1584-1591. [PMID: 32819894 DOI: 10.3174/ajnr.a6742] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/31/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Slowly expanding/evolving lesions measured by conventional T1-weighted/T2-weighted brain MR imaging may contribute to progressive disability accumulation in MS. We evaluated the longitudinal change in myelin and axonal tissue integrity in white matter slowly expanding/evolving lesions by means of the magnetization transfer ratio and DTI radial diffusivity. MATERIALS AND METHODS Slowly expanding/evolving lesions were detected within the Study to Assess the Efficacy, Safety, Tolerability, and Pharmacokinetics of BIIB033 in Participants With Relapsing Forms of Multiple Sclerosis When Used Concurrently With Avonex (SYNERGY) Phase 2 clinical trial dataset (NCT01864148), comprising patients with relapsing-remitting and secondary-progressive MS (n = 299) with T1-weighted/T2-weighted MR imaging at all trial time points (baseline to week 72). RESULTS Compared with non-slowly expanding/evolving lesions (areas not classified as slowly expanding/evolving lesion) of baseline nonenhancing T2 lesions, slowly expanding/evolving lesions had a lower normalized magnetization transfer ratio and greater DTI radial diffusivity, both in patients with relapsing-remitting MS (n = 242) and secondary-progressive MS (n = 57, P < .001 for all). Although the changes with time in both the normalized magnetization transfer ratio and DTI radial diffusivity between slowly expanding/evolving lesions and non-slowly expanding/evolving lesions were positively correlated (P < .001), a decrease in the normalized magnetization transfer ratio and a greater increase in DTI radial diffusivity were observed in slowly expanding/evolving lesions versus non-slowly expanding/evolving lesions from baseline to week 72 in relapsing-remitting MS and secondary-progressive MS (P < .001 for all). CONCLUSIONS Patterns of longitudinal change in the normalized magnetization transfer ratio and DTI radial diffusivity in slowly expanding/evolving lesions were consistent with progressive demyelination and tissue loss, as seen in smoldering white matter MS plaques.
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Affiliation(s)
- C Elliott
- From the NeuroRx Research (C.E., D.L.A.) Montreal, Quebec, Canada
| | - D L Arnold
- From the NeuroRx Research (C.E., D.L.A.) Montreal, Quebec, Canada.,McGill University (D.L.A.) Montreal, Quebec, Canada
| | - H Chen
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - C Ke
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - L Zhu
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - I Chang
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - E Cahir-McFarland
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - E Fisher
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - B Zhu
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - S Gheuens
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - M Scaramozza
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - V Beynon
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - N Franchimont
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - D P Bradley
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
| | - S Belachew
- Biogen (H.C., C.K., L.Z., I.C., E.C.-M., E.F., B.Z., S.G., M.S., V.B., N.F., D.P.B., S.B.), Cambridge, Massachusetts
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20
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Semi-automatic detection of increased susceptibility in multiple sclerosis white matter lesions imaged with 1.5T MRI. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Zhang L, Ellor S, Sun JM, Liu C, Kurtzburg J, Song AW. DTI Tract-Based Quantitative Susceptibility Mapping: An Initial Feasibility Study to Investigate the Potential Role of Myelination in Brain Connectivity Change in Cerebral Palsy Patients During Autologous Cord Blood Cell Therapy Using a Rotationally-Invariant Quantitative Measure. J Magn Reson Imaging 2020; 53:251-258. [PMID: 32677156 DOI: 10.1002/jmri.27286] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous studies using diffusion tensor imaging (DTI)-based connectome analysis revealed improved connectivity in cerebral palsy (CP) patients who underwent autologous umbilical cord blood (UCB) stem-cell therapy. However, the potential mechanism for the connectivity increase remains unclear and needs to be further elucidated. PURPOSE To develop a technique with improved accuracy for quantitative susceptibility mapping (QSM) with unique sensitivity to myelin, and demonstrate its use in elucidating the underlying mechanism of the observed motor function improvement and brain connectivity increase in CP patients who received autologous UCB stem-cell therapy. STUDY TYPE Prospective. POPULATION A cohort of eight pediatric CP patients (2.6 ± 0.6 years of age) with intact corticospinal tracts (CST) from a randomized, placebo-controlled trial of autologous UCB stem-cell therapy in CP children was included in this study. FIELD STRENGTH/SEQUENCE DTI and 3D spoiled gradient recalled (SPGR) QSM at 3.0T. ASSESSMENT Pre- and posttreatment magnetic susceptibility (χ) and the rotationally-invariant magnetic susceptibility anisotropy (MSA) along the CST were derived. Behavioral changes were assessed using the 66-item Gross Motor Function Measurement. Changes in χ and MSA were compared between patients with and without substantial behavioral improvements. STATISTICAL TESTS Two-sample t-tests were performed to assess the differences in the changes of measurements of interest (Δχ, ΔMSA, and ΔFA) between patients who significantly improved and those who did not. RESULTS Patients who demonstrated posttreatment motor improvements exceeding expectations showed significantly more diamagnetic Δχ in the periventricular region along the CST (P = 0.003). Further analysis on the ΔMSA of this region was significantly increased (P = 0.006) for high responders, along with concurrent FA increase. DATA CONCLUSION These initial findings suggest that the DTI tract-based QSM method has the potential to characterize white matter changes associated with behavioral improvements in CP children who underwent cord blood stem-cell therapy. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Lijia Zhang
- Brain Imaging and Analysis Center, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - Susan Ellor
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Jessica M Sun
- The Robertson Clinical and Translational Cell Therapy Program, Duke University, Durham, North California, USA
| | - Chunlei Liu
- Department of Electrical Engineering and Computer Sciences, University of California Berkeley, Berkeley, California, USA.,Helen Wills Neuroscience Institute, University of California, Berkeley, Berkeley, California, USA
| | - Joanne Kurtzburg
- The Robertson Clinical and Translational Cell Therapy Program, Duke University, Durham, North California, USA
| | - Allen W Song
- Brain Imaging and Analysis Center, Duke University Medical Center, Duke University, Durham, North Carolina, USA
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22
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Elliott C, Belachew S, Wolinsky JS, Hauser SL, Kappos L, Barkhof F, Bernasconi C, Fecker J, Model F, Wei W, Arnold DL. Chronic white matter lesion activity predicts clinical progression in primary progressive multiple sclerosis. Brain 2020; 142:2787-2799. [PMID: 31497864 PMCID: PMC6736181 DOI: 10.1093/brain/awz212] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 12/18/2022] Open
Abstract
Chronic active and slowly expanding lesions with smouldering inflammation are neuropathological correlates of progressive multiple sclerosis pathology. T1 hypointense volume and signal intensity on T1-weighted MRI reflect brain tissue damage that may develop within newly formed acute focal inflammatory lesions or in chronic pre-existing lesions without signs of acute inflammation. Using a recently developed method to identify slowly expanding/evolving lesions in vivo from longitudinal conventional T2- and T1-weighted brain MRI scans, we measured the relative amount of chronic lesion activity as measured by change in T1 volume and intensity within slowly expanding/evolving lesions and non-slowly expanding/evolving lesion areas of baseline pre-existing T2 lesions, and assessed the effect of ocrelizumab on this outcome in patients with primary progressive multiple sclerosis participating in the phase III, randomized, placebo-controlled, double-blind ORATORIO study (n = 732, NCT01194570). We also assessed the predictive value of T1-weighted measures of chronic lesion activity for clinical multiple sclerosis progression as reflected by a composite disability measure including the Expanded Disability Status Scale, Timed 25-Foot Walk and 9-Hole Peg Test. We observed in this clinical trial population that most of total brain non-enhancing T1 hypointense lesion volume accumulation was derived from chronic lesion activity within pre-existing T2 lesions rather than new T2 lesion formation. There was a larger decrease in mean normalized T1 signal intensity and greater relative accumulation of T1 hypointense volume in slowly expanding/evolving lesions compared with non-slowly expanding/evolving lesions. Chronic white matter lesion activity measured by longitudinal T1 hypointense lesion volume accumulation in slowly expanding/evolving lesions and in non-slowly expanding/evolving lesion areas of pre-existing lesions predicted subsequent composite disability progression with consistent trends on all components of the composite. In contrast, whole brain volume loss and acute lesion activity measured by longitudinal T1 hypointense lesion volume accumulation in new focal T2 lesions did not predict subsequent composite disability progression in this trial at the population level. Ocrelizumab reduced longitudinal measures of chronic lesion activity such as T1 hypointense lesion volume accumulation and mean normalized T1 signal intensity decrease both within regions of pre-existing T2 lesions identified as slowly expanding/evolving and in non-slowly expanding/evolving lesions. Using conventional brain MRI, T1-weighted intensity-based measures of chronic white matter lesion activity predict clinical progression in primary progressive multiple sclerosis and may qualify as a longitudinal in vivo neuroimaging correlate of smouldering demyelination and axonal loss in chronic active lesions due to CNS-resident inflammation and/or secondary neurodegeneration across the multiple sclerosis disease continuum.
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Affiliation(s)
| | | | - Jerry S Wolinsky
- McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | | | - Ludwig Kappos
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- VU University Medical Centre, Amsterdam, The Netherlands.,UCL Institutes of Biomedical Engineering and Neurology, London, UK
| | | | | | | | - Wei Wei
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada.,McGill University, Montreal, QC, Canada
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23
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Xie F, Weihua L, Lirong O, Wang X, Xing W. Quantitative susceptibility mapping in spinocerebellar ataxia type 3/Machado-Joseph disease (SCA3/MJD). Acta Radiol 2020; 61:520-527. [PMID: 31450947 DOI: 10.1177/0284185119868906] [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] [Indexed: 12/18/2022]
Abstract
Background The deep nuclei, brainstem, and anterior central gyrus are important sites of spinocerebellar ataxia type3/Machado–Joseph Disease (SCA3/MJD) involvement. These locations were the common iron deposition areas. We hypothesized that iron deposition changes occur in SCA3/MJD patients and are associated with disease progression. Purpose Quantitative susceptibility mapping was used to quantitatively analyze changes in iron levels in SCA3/MJD patients. Material and Methods Eighteen symptomatic SCA3/MJD patients and 18 age-matched normal controls (group 1; NC1), and 12 asymptomatic mutation carriers (pre-SCA3/MJD) and 16 age-matched normal controls (group 2; NC2) were examined by enhanced gradient echo T2*-weighted angiography. Data were processed to obtain the quantitative susceptibility mapping values. Independent sample t-tests were conducted to compare the differences in the quantitative susceptibility mapping values. Results In the red nuclei and substantia nigra, the quantitative susceptibility mapping values of the symptomatic SCA3/MJD group were significantly higher than those of NC1 ( P < 0.05). The quantitative susceptibility mapping values of the symptomatic SCA3/MJD group were higher than those of NC1 in the globus pallidus, but it was not statistically significant ( P = 0.056). No significant difference in quantitative susceptibility mapping values was found between the pre-SCA3/MJD and NC2. No significant correlation was found between the International Cooperative Ataxia Rating Scale and the Scale for the Assessment and Rating of Ataxia and the quantitative susceptibility mapping values. Conclusion The results clearly demonstrated the quantitative susceptibility mapping value increase in the globus pallidus, red nuclei, and substantia nigra of the symptomatic SCA3/MJD group, indicating iron overload in these nuclei, suggesting that iron deposition is associated with disease onset.
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Affiliation(s)
- Fangfang Xie
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Liao Weihua
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Ouyang Lirong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Xiaoyi Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, PR China
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24
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Jang J, Nam Y, Choi Y, Shin NY, An JY, Ahn KJ, Kim BS, Lee KS, Kim W. Paramagnetic Rims in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder: A Quantitative Susceptibility Mapping Study with 3-T MRI. J Clin Neurol 2020; 16:562-572. [PMID: 33029961 PMCID: PMC7542003 DOI: 10.3988/jcn.2020.16.4.562] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 02/07/2023] Open
Abstract
Background and Purpose Iron retained by activated microglia and macrophages in multiple sclerosis (MS) lesions may serve as a marker of innate immune system activation. Among several magnetic resonance imaging (MRI) methods, there has been recent interest in using quantitative susceptibility mapping (QSM) as a potential tool for assessing iron levels in the human brain. This study examined QSM findings in MS and neuromyelitis optica spectrum disorder (NMOSD) lesions obtained with 3-T MRI to assess imaging characteristics related to paramagnetic rims around brain lesions in MS and NMOSD. Methods This study included 32 MS and 21 seropositive NMOSD patients. MRI images were obtained using two 3-T MRI devices (Ingenia, Philips Healthcare; and Magnetom Verio, Siemens Healthineers) during routine diagnosis and treatment procedures. Multi and single echo gradient echo magnitude and phase images were obtained for QSM reconstruction. QSM images were used to characterize the detected lesions, and the findings were compared between MS and NMOSD. Results Totals of 71 and 35 MRI scans were performed during the study period in MS and NMOSD patients, respectively. In QSM images, paramagnetic rims were found in 26 (81.2%) MS patients and 1 (4.8%) NMOSD patient. Eight of the 22 MS patients and only 1 of the 10 NMOSD patients who underwent follow-up MRI showed new paramagnetic rims. The paramagnetic rim lesions appeared after enhancement or in new T2-weighted lesions without enhancement. Conclusions Paramagnetic rims might be a characteristic MRI finding for MS, and therefore they have potential as an imaging marker for differentially diagnosing MS from NMOSD using 3-T MRI.
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Affiliation(s)
- Jinhee Jang
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoonho Nam
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Division of Biomedical Engineering, Hankuk University of Foreign Studies, Yongin, Korea
| | - Yangsean Choi
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Na Young Shin
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Young An
- Department of Neurology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kook Jin Ahn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bum Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang Soo Lee
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woojun Kim
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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25
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Bisulca J, De Lury A, Coyle PK, Syritsyna O, Peyster R, Bangiyev L, Duong TQ. MRI features associated with high likelihood of conversion of radiologically isolated syndrome to multiple sclerosis. Mult Scler Relat Disord 2019; 36:101381. [PMID: 31518773 DOI: 10.1016/j.msard.2019.101381] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 10/26/2022]
Abstract
Radiologically isolated syndrome (RIS) is the asymptomatic precursor to clinically isolated syndrome, relapsing-remitting multiple sclerosis (MS) or primary progressive MS. RIS is frequently diagnosed when an individual gets an MRI for an unrelated medical issue, such as headache or trauma. Treating RIS patients is controversial, but physicians may be inclined to offer prophylactic treatment for high-risk RIS patients. Identifying imaging and clinical features associated with high likelihood of early clinical conversion may prove helpful to identify a high-risk subset for potential MS therapy. The goal of this paper is to review current literatures to identify imaging and clinical features that predict early (within 5 years) conversion from RIS to MS.
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Affiliation(s)
- Joseph Bisulca
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Amy De Lury
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Patricia K Coyle
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Olga Syritsyna
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Robert Peyster
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Lev Bangiyev
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA
| | - Tim Q Duong
- Departments of Radiology and Neurology, Stony Brook Medicine, 101 Nicolls Rd, Stony Brook, NY 11794, USA.
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26
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Zhang S, Nguyen TD, Hurtado Rúa SM, Kaunzner UW, Pandya S, Kovanlikaya I, Spincemaille P, Wang Y, Gauthier SA. Quantitative Susceptibility Mapping of Time-Dependent Susceptibility Changes in Multiple Sclerosis Lesions. AJNR. AMERICAN JOURNAL OF NEURORADIOLOGY 2019; 40:987-993. [PMID: 31097429 DOI: 10.3174/ajnr.a6071] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/17/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging studies have demonstrated that magnetic susceptibility in multiple sclerosis lesions is dependent on lesion age. The objective of this study was to use quantitative susceptibility mapping to determine whether lesions with a hyperintense rim, indicative of iron-laden inflammatory cells (rim+), follow a unique time-dependent trajectory of susceptibility change compared with those without (rim-). MATERIALS AND METHODS We studied patients with MS with at least 1 new gadolinium-enhancing lesion and at least 3 longitudinal quantitative susceptibility mapping scans obtained between 1.1 and 6.1 years. Lesions were classified as rim+ if a hyperintense rim appeared on quantitative susceptibility mapping at any time. A multilevel growth curve model compared longitudinal susceptibility among rim+ and rim- lesions. RESULTS Thirty-two new gadolinium-enhancing lesions from 19 patients with MS were included, and 16 lesions (50%) were identified as rim+. Quantitative susceptibility mapping rim+ lesions were larger than rim- lesions with gadolinium enhancement (P < .001). Among all lesions, susceptibility increased sharply after enhancement to a peak between 1 and 2 years followed by a decrease. The overall susceptibility curve height for rim- lesions was 4.27 parts per billion lower than that for rim+ lesions (P = .01). Rim- lesions demonstrated a higher linear slope relative to rim+ lesions (P = .023) but faster cubic decay relative to rim+ lesions (P = .005). Rim- lesions started decaying approximately 2 years earlier compared with rim+ lesions. CONCLUSIONS There was a marked difference in the susceptibility temporal trajectory between rim+ and rim- lesions during the first 6 years of lesion formation. Most rim+ lesions retain iron for years after the initial lesion appearance.
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Affiliation(s)
- S Zhang
- From the Departments of Radiology (S.Z., T.D.N., S.P., I.K., P.S., Y.W., S.A.G.).,Department of Radiology (S.Z.), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - T D Nguyen
- From the Departments of Radiology (S.Z., T.D.N., S.P., I.K., P.S., Y.W., S.A.G.)
| | - S M Hurtado Rúa
- Department of Mathematics and Statistics (S.M.H.R.), College of Science and Health Professions, Cleveland State University, Cleveland, Ohio
| | | | - S Pandya
- From the Departments of Radiology (S.Z., T.D.N., S.P., I.K., P.S., Y.W., S.A.G.)
| | - I Kovanlikaya
- From the Departments of Radiology (S.Z., T.D.N., S.P., I.K., P.S., Y.W., S.A.G.)
| | - P Spincemaille
- From the Departments of Radiology (S.Z., T.D.N., S.P., I.K., P.S., Y.W., S.A.G.)
| | - Y Wang
- From the Departments of Radiology (S.Z., T.D.N., S.P., I.K., P.S., Y.W., S.A.G.).,Department of Biomedical Engineering (Y.W.), Cornell University, Ithaca, New York
| | - S A Gauthier
- From the Departments of Radiology (S.Z., T.D.N., S.P., I.K., P.S., Y.W., S.A.G.) .,Neurology (U.W.K., S.A.G.).,Feil Family Brain and Mind Research Institute (S.A.G.), Weill Cornell Medicine, New York, New York
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27
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Zhang S, Liu Z, Nguyen TD, Yao Y, Gillen KM, Spincemaille P, Kovanlikaya I, Gupta A, Wang Y. Clinical feasibility of brain quantitative susceptibility mapping. Magn Reson Imaging 2019; 60:44-51. [PMID: 30954651 DOI: 10.1016/j.mri.2019.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/31/2019] [Accepted: 04/02/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the quality of brain quantitative susceptibility mapping (QSM) that is fully automatically reconstructed in clinical MRI of various neurological diseases. METHODS 393 consecutive patients in one month were recruited for this evaluation study. QSM was reconstructed using Morphology Enabled Dipole Inversion without zero reference regularization (MEDI) and using MEDI with cerebrospinal fluid automatic zero-reference regularization to generate susceptibility values (MEDI+0). Two neuroradiologists independently assessed the image quality of MEDI+0 and MEDI and image concordance between them. Lesion susceptibility values were measured in 20 cases of glioma, 21 cases of ischemic stroke and 43 multiple sclerosis (MS) cases on both MEDI+0 and MEDI images. RESULTS The two neuroradiologists rated the MEDI+0 image qualities of the 393 cases as 351 (89.3%) and 362 (92.1%) excellent, 29 (7.4%) and 24 (6.1%) diagnostic, and 13 (3.3%) and 7 (1.8%) poor, and scored the concordances between MEDI+0 and MEDI as 364 (92.6%) and 351 (89.3%) excellent, 13 (3.3%) and 31 (7.9%) good, 14 (3.6%) and 9 (2.3%) intermediate, 2 (0.5%) and 2 (0.5%) poor, and 0 (0%) and 0 (0%) none. There was good correlation between MEDI+0 and MEDI in lesion susceptibility contrast of glioma, ischemic stroke, and MS cases (all p < 0.05). The MS lesion susceptibility time course from this patient cohort was found to be similar to the reported pattern: isointense initially for acute enhancing lesions, and hyperintense over the following years for active chronic lesions. CONCLUSION Brain QSM images of various neurological diseases have reliable diagnostic quality in clinical MRI, with MEDI+0 providing susceptibility values automatically referenced to CSF in longitudinal and cross-center studies.
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Affiliation(s)
- Shun Zhang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhe Liu
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Yihao Yao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kelly M Gillen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA; Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA.
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28
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Elliott C, Wolinsky JS, Hauser SL, Kappos L, Barkhof F, Bernasconi C, Wei W, Belachew S, Arnold DL. Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions. Mult Scler 2018; 25:1915-1925. [PMID: 30566027 PMCID: PMC6876256 DOI: 10.1177/1352458518814117] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Chronic lesion activity driven by smoldering inflammation is a pathological hallmark of progressive forms of multiple sclerosis (MS). Objective: To develop a method for automatic detection of slowly expanding/evolving lesions (SELs) on conventional brain magnetic resonance imaging (MRI) and characterize such SELs in primary progressive MS (PPMS) and relapsing MS (RMS) populations. Methods: We defined SELs as contiguous regions of existing T2 lesions showing local expansion assessed by the Jacobian determinant of the deformation between reference and follow-up scans. SEL candidates were assigned a heuristic score based on concentricity and constancy of change in T2- and T1-weighted MRIs. SELs were examined in 1334 RMS patients and 555 PPMS patients. Results: Compared with RMS patients, PPMS patients had higher numbers of SELs (p = 0.002) and higher T2 volumes of SELs (p < 0.001). SELs were devoid of gadolinium enhancement. Compared with areas of T2 lesions not classified as SEL, SELs had significantly lower T1 intensity at baseline and larger decrease in T1 intensity over time. Conclusion: We suggest that SELs reflect chronic tissue loss in the absence of ongoing acute inflammation. SELs may represent a conventional brain MRI correlate of chronic active MS lesions and a candidate biomarker for smoldering inflammation in MS.
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Affiliation(s)
| | - Jerry S Wolinsky
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Stephen L Hauser
- Department of Neurology, University of California-San Francisco, San Francisco, CA, USA
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands/Institutes of Biomedical Engineering and Neurology, University College London (UCL), London, UK
| | | | - Wei Wei
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Douglas L Arnold
- NeuroRx Research, Montreal, QC, Canada/Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
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29
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Lin F, Prince MR, Spincemaille P, Wang Y. Patents on Quantitative Susceptibility Mapping (QSM) of Tissue Magnetism. Recent Pat Biotechnol 2018; 13:90-113. [PMID: 30556508 DOI: 10.2174/1872208313666181217112745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Quantitative susceptibility mapping (QSM) depicts biodistributions of tissue magnetic susceptibility sources, including endogenous iron and calcifications, as well as exogenous paramagnetic contrast agents and probes. When comparing QSM with simple susceptibility weighted MRI, QSM eliminates blooming artifacts and shows reproducible tissue susceptibility maps independent of field strength and scanner manufacturer over a broad range of image acquisition parameters. For patient care, QSM promises to inform diagnosis, guide surgery, gauge medication, and monitor drug delivery. The Bayesian framework using MRI phase data and structural prior knowledge has made QSM sufficiently robust and accurate for routine clinical practice. OBJECTIVE To address the lack of a summary of US patents that is valuable for QSM product development and dissemination into the MRI community. METHOD We searched the USPTO Full-Text and Image Database for patents relevant to QSM technology innovation. We analyzed the claims of each patent to characterize the main invented method and we investigated data on clinical utility. RESULTS We identified 17 QSM patents; 13 were implemented clinically, covering various aspects of QSM technology, including the Bayesian framework, background field removal, numerical optimization solver, zero filling, and zero-TE phase. CONCLUSION Our patent search identified patents that enable QSM technology for imaging the brain and other tissues. QSM can be applied to study a wide range of diseases including neurological diseases, liver iron disorders, tissue ischemia, and osteoporosis. MRI manufacturers can develop QSM products for more seamless integration into existing MRI scanners to improve medical care.
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Affiliation(s)
- Feng Lin
- School of Law, City University of Hong Kong, Hong Kong, China
| | - Martin R Prince
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
| | - Pascal Spincemaille
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States
| | - Yi Wang
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, United States.,Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, United States
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