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Kummari S, Burra KG, Reddy VRK, Das S, Anilkumar C. Determination of Efficiency of 3D Fluid-Attenuated Inversion Recovery (FLAIR) in the Imaging of Multiple Sclerosis in Comparison With 2D FLAIR at 3-Tesla MRI. Cureus 2023; 15:e48136. [PMID: 38046735 PMCID: PMC10693390 DOI: 10.7759/cureus.48136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND A fluid-attenuated inversion recovery (FLAIR) method eliminates the cerebrospinal fluid (CSF) signal, enhancing white matter lesion detection by enhancing the contrast between the lesion and CSF. Three-dimensional (3D) volume acquisition has the advantage of multiplanar reformation of contiguous slices yielding improved signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs). To our knowledge, there are only three studies comparing 3D- and 2D-FLAIR sequences with respect to multiple sclerosis (MS) lesions at 3 tesla. AIMS AND OBJECTIVES This study aimed to determine the efficiency of 3D-FLAIR in the detection of lesions of multiple sclerosis in terms of spatial and contrast resolutions in comparison with 2D-FLAIR sequences. METHODOLOGY A total of 75 patients with MS undergoing magnetic resonance imaging (MRI) brain at the Department of Radiology, Krishna Institute of Medical Sciences (KIMS), Secunderabad, Telangana, India. This is an observational comparative study. Independent-samples t-tests were performed in the present study to compare the number of lesions detected. The measured CNR and SNR values were subjected to Mann-Whitney U test. RESULTS As a result of the 3D-FLAIR, more lesions were found as compared to 2D-FLAIR (p = 0.001). There was a greater CNRs for 3D-FLAIR images than for 2D-FLAIR images (p = 0.001). Lesions, CSF, white matter, and gray matter showed significantly higher SNRs with 3D-FLAIR (p = 0.001). CONCLUSION 3D-FLAIR has exhibited greater sensitivity in detecting lesions associated with MS when contrasted with the 2D-FLAIR sequence. Significantly more lesions and higher SNRs and CNRs were detected with 3D-FLAIR in contrast to 2D-FLAIR. 3D-FLAIR may be considered the sequence of choice for MS imaging in the future.
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Affiliation(s)
| | - Kiran Goud Burra
- Department of Radiology, Government District Hospital, Medak, Medak, IND
| | | | - Saraswata Das
- Department of Radiodiagnosis, College of Medicine and JNM Hospital, Kalyani, IND
| | - Challa Anilkumar
- Department of Radiology, Great Eastern Medical School & Hospital, Srikakulam, IND
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Sundermann B, Billebaut B, Bauer J, Iacoban CG, Alykova O, Schülke C, Gerdes M, Kugel H, Neduvakkattu S, Bösenberg H, Mathys C. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 1-3D Acquisitions, Dixon Techniques and Artefact Reduction. ROFO-FORTSCHR RONTG 2022; 194:1100-1108. [PMID: 35545104 DOI: 10.1055/a-1800-8692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recently introduced MRI techniques offer improved image quality and facilitate examinations of patients even when artefacts are expected. They pave the way for novel diagnostic imaging strategies in neuroradiology. These methods include improved 3D imaging, movement and metal artefact reduction techniques as well as Dixon techniques. METHODS Narrative review with an educational focus based on current literature research and practical experiences of different professions involved (physicians, MRI technologists/radiographers, physics/biomedical engineering). Different hardware manufacturers are considered. RESULTS AND CONCLUSIONS 3D FLAIR is an example of a versatile 3D Turbo Spin Echo sequence with broad applicability in routine brain protocols. It facilitates detection of smaller lesions and more precise measurements for follow-up imaging. It also offers high sensitivity for extracerebral lesions. 3D techniques are increasingly adopted for imaging arterial vessel walls, cerebrospinal fluid spaces and peripheral nerves. Improved hybrid-radial acquisitions are available for movement artefact reduction in a broad application spectrum. Novel susceptibility artefact reduction techniques for targeted application supplement previously established metal artefact reduction sequences. Most of these techniques can be further adapted to achieve the desired diagnostic performances. Dixon techniques allow for homogeneous fat suppression in transition areas and calculation of different image contrasts based on a single acquisition. KEY POINTS · 3D FLAIR can replace 2 D FLAIR for most brain imaging applications and can be a cornerstone of more precise and more widely applicable protocols.. · Further 3D TSE sequences are increasingly replacing 2D TSE sequences for specific applications.. · Improvement of artefact reduction techniques increase the potential for effective diagnostic MRI exams despite movement or near metal implants.. · Dixon techniques facilitate homogeneous fat suppression and simultaneous acquisition of multiple contrasts.. CITATION FORMAT · Sundermann B, Billebaut B, Bauer J et al. Practical Aspects of novel MRI Techniques in Neuroradiology: Part 1-3D Acquisitions, Dixon Techniques and Artefact Reduction. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1800-8692.
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Affiliation(s)
- Benedikt Sundermann
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Clinic for Radiology, University Hospital Münster, Germany
| | - Benoit Billebaut
- Clinic for Radiology, University Hospital Münster, Germany.,School for Radiologic Technologists, University Hospital Münster, Germany
| | - Jochen Bauer
- Clinic for Radiology, University Hospital Münster, Germany
| | - Catalin George Iacoban
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Olga Alykova
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | | | - Maike Gerdes
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Harald Kugel
- Clinic for Radiology, University Hospital Münster, Germany
| | | | - Holger Bösenberg
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany
| | - Christian Mathys
- Institute of Radiology and Neuroradiology, Evangelisches Krankenhaus, Medical Campus University of Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Germany.,Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Germany
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Homos MD. Can white matter lesion burden predict involvement of normal appearing thalami in multiple sclerosis? Study using 3D FLAIR and DTI. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multiple sclerosis is a chronic demyelinating disease that affects the white and grey matter. The thalamus is responsible for many neurological functions, and it is liable to damage in multiple sclerosis in the absence of MRI-detectable thalamic lesions. Standardized imaging protocol for multiple sclerosis includes 3D FLAIR sequence that is highly sensitive in detecting white matter lesions. Owing to the thalamic functional importance, we aim in this study to show to what extent the standardized imaging protocol (3D FLAIR) can predict microscopic damage of normal appearing thalami, depending on DTI metrics (ADC and FA) as indicators of the microscopic damage.
Results
We examined 42 multiple sclerosis patients, 16 males and 26 females, with mean age 29 ± 6 years using 3D FLAIR sequence to delineate the white matter lesions and calculate their total areas and using DTI to calculate the average ADC and FA values of the thalami. Spearman’s correlation coefficient (r) was used to correlate between the white matter lesion burden and the thalamic diffusivity (ADC and FA).
Moderate correlation was found between average ADC values of the thalami and the total white matter lesion areas (r = 0.5, p = 0.03).
Very weak correlation was found between average FA values of the thalami and the total white matter lesion areas (r = − 0.1, p = 0.6)
Conclusion
White matter lesion burden detected using the highly sensitive 3D FLAIR sequence does not always correlate with the microstructural damage in normal appearing thalami. DTI needs to be added to the examination protocol if damage of normal appearing thalami is of concern.
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Tzanetakos D, Tzartos JS, Vakrakou AG, Breza M, Velonakis G, Stathopoulos P, Pantou E, Markakis I, Papadimitriou D, Karavasilis E, Toulas P, Evangelopoulos ΜE, Koutsis G, Anagnostouli M, Stefanis L, Kilidireas C. Cortical involvement and leptomeningeal inflammation in myelin oligodendrocyte glycoprotein antibody disease: A three-dimensional fluid-attenuated inversion recovery MRI study. Mult Scler 2021; 28:718-729. [PMID: 34410179 DOI: 10.1177/13524585211034362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cortical demyelination and meningeal inflammation have been detected neuropathologically in multiple sclerosis (MS) and recently in myelin oligodendrocyte glycoprotein antibody disease (MOGAD). OBJECTIVES To assess in vivo cortical and leptomeningeal involvement in MOGAD. METHODS We prospectively evaluated 11 MOGAD and 12 relapsing-remitting MS (RRMS) patients combining three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and 3D-T1-weighted (3D-T1w) sequences at 3-Tesla magnetic resonance imaging (MRI). Leptomeningeal contrast enhancement (LMCE) was assessed on 3D-FLAIR post-gadolinium (3D-FLAIRGd). Cerebral cortical lesions (CCLs) were classified as either intracortical-subpial (IC-SP) or leukocortical (LC). RESULTS CCLs were present in 8/11 MOGAD and 12/12 RRMS patients, with the number of CCLs being significantly lower in MOGAD (median (interquartile range (IQR)) 3 (0.5-4) vs 12 (4.75-19), p = 0.0032). In MOGAD, IC-SP lesions were slightly more prevalent than LC lesions (2 (0-2.5) vs 1 (0-2), p = 0.6579); whereas in RRMS, IC-SP lesions were less prevalent than LC lesions (3.5 (2.75-5.5) vs 9 (2-12.75), p = 0.27). LMCE was observed in 3/11 MOGAD and 1/12 RRMS patients; MOGAD with LMCE showed an increased median number of CCLs compared with MOGAD without LMCE (8 (4-9) vs 2.5 (0.75-3.25), p = 0.34). No correlation was observed between MOGAD MRI findings and (a) MOGAD duration, (b) serum MOG-immunoglobulin G1 titers, and (c) oligoclonal band presence. CONCLUSION We described cortical lesion topography and detected for the first time LMCE using 3D-FLAIRGd sequences in MOGAD patients.
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Affiliation(s)
- Dimitrios Tzanetakos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - John S Tzartos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece/2nd Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece/Tzartos NeuroDiagnostics, Athens, Greece
| | - Aigli G Vakrakou
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panos Stathopoulos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Pantou
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Markakis
- Department of Neurology, General Hospital of Nikaia, Piraeus, Greece
| | | | - Efstratios Karavasilis
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Toulas
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Μaria-Eleptheria Evangelopoulos
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Koutsis
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anagnostouli
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Costantinos Kilidireas
- Multiple Sclerosis & Demyelinating Diseases Unit, 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Kamran S, Khan A, Salam A, Akhtar N, Petropoulos I, Ponirakis G, Babu B, George P, Shuaib A, Malik RA. Cornea: A Window to White Matter Changes in Stroke; Corneal Confocal Microscopy a Surrogate Marker for the Presence and Severity of White Matter Hyperintensities in Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104543. [PMID: 31902645 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104543] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/14/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The presence of white matter hyperintensities (WMH) on MRI imaging confers an increased risk of stroke, dementia, and death. Corneal confocal microscopy (CCM) can detect nerve injury non-invasively and may be a useful surrogate marker for WMH. The objective is to determine whether corneal nerve pathology identified using CCM is associated with the presence of WMH in patients with acute ischemic stroke. METHODS This is a cross-sectional study where 196 consecutive individuals with acute ischemic stroke were enrolled and underwent neurological examination, MRI brain imaging and CCM. Participants underwent blinded quantification of WMH and corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD) and corneal nerve fiber length (CNFL). RESULTS The prevalence of hypertension [P = .013] was significantly higher and CNFD [P = .031] was significantly lower in patients with WMH compared to those without WMH. CNFD and CNFL were significantly lower in patients with DM without WMH [P = .008, P = .019] and in patients with DM and WMH [P = .042, P = .024] compared to patients without DM or WMH, respectively. In a multivariate model, a 1-unit decrease in the CNFD increased the risk of WMH by 6%, after adjusting for age, DM, gender, dyslipidemia, metabolic syndrome, smoking, and HbA1c. DM was associated with a decrease in all CCM parameters but was not a significant independent factor associated with WMH. CONCLUSIONS CCM demonstrates corneal nerve pathology, which is associated with the presence of WMH in participants with acute ischemic stroke. CCM may be a useful surrogate imaging marker for the presence and severity of WMHs.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.
| | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Abdul Salam
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Naveed Akhtar
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar; Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Blessy Babu
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Pooja George
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad General Hospital, Doha, Qatar
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
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Optimizing 3D FLAIR to detect MS lesions: pushing past factory settings for precise results. J Neurol 2019; 266:2786-2795. [PMID: 31372735 DOI: 10.1007/s00415-019-09490-y] [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: 05/13/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND To assess the diagnostic value of three 3D FLAIR sequences with differing repetition-times (TR) at 3-Tesla when detecting multiple sclerosis (MS) lesions. METHODS In this prospective study, approved by the institutional review board, 27 patients with confirmed MS were prospectively included. One radiologist performed manual segmentations of all high-signal intensity lesions using three 3D FLAIR data sets with different TR of 4800 ms ("FLAIR4800"), 8000 ms ("FLAIR8000") and 10,000 ms ("FLAIR10,000") and two radiologists double-checked it. The main judgment criterion was the overall number of lesions; secondary objectives were the assessment of lesion location, as well as measuring contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). A non-parametric Wilcoxon's test was used to compare the differing FLAIR. RESULTS The FLAIR8000 and FLAIR10,000 detected significantly more overall lesions per patient as compared with the FLAIR4800 [116.1 (± 61.7) (p = 0.02) and 115.8 (± 56.3) (p = 0.03) versus 99.2 (± 66.9), respectively]. The FLAIR8000 and FLAIR10,000 detected four and eight times more cortical or juxta-cortical lesions per patient as compared with FLAIR4800 [1.6 (± 2.2) (p = 0.001) and 4.1 (± 5.9) (p = 6 × 10-5) versus 0.4 (± 1.1), respectively]. CNR was significantly correlated to the TR value. It was significantly higher with FLAIR10,000 than it was with FLAIR8000 and FLAIR4800 [16.3 (± 3.5) versus 15 (± 2.4) (p = 0.01) and 12 (± 2.2) (p = 2 × 10-6), respectively] CONCLUSION: An optimized 3D FLAIR with a long TR significantly improved both overall lesion detection and CNR in MS patients as compared to a 3D FLAIR with factory settings.
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Lecler A, El Sanharawi I, El Methni J, Gout O, Koskas P, Savatovsky J. Improving Detection of Multiple Sclerosis Lesions in the Posterior Fossa Using an Optimized 3D-FLAIR Sequence at 3T. AJNR Am J Neuroradiol 2019; 40:1170-1176. [PMID: 31248862 DOI: 10.3174/ajnr.a6107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/14/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is no consensus regarding the best MR imaging sequence for detecting MS lesions. The aim of our study was to assess the diagnostic value of optimized 3D-FLAIR in the detection of infratentorial MS lesions compared with an axial T2-weighted imaging, a 3D-FLAIR with factory settings, and a 3D double inversion recovery sequence. MATERIALS AND METHODS In this prospective study, 27 patients with confirmed MS were included. Two radiologists blinded to clinical data independently read the following sequences: axial T2WI, 3D double inversion recovery, standard 3D-FLAIR with factory settings, and optimized 3D-FLAIR. The main judgment criterion was the overall number of high-signal-intensity lesions in the posterior fossa; secondary objectives were the assessment of the reading confidence and the measurement of the contrast. A nonparametric Wilcoxon test was used to compare the MR images. RESULTS Twenty-two patients had at least 1 lesion in the posterior fossa. The optimized FLAIR sequence detected significantly more posterior fossa lesions than any other sequence: 7.5 versus 5.8, 4.8, and 4.1 (P values of .04, .03, and .03) with the T2WI, the double inversion recovery, and the standard FLAIR, respectively. The reading confidence index was significantly higher with the optimized FLAIR, and the contrast was significantly higher with the optimized FLAIR than with the standard FLAIR and the double inversion recovery. CONCLUSIONS An optimized 3D-FLAIR sequence improved posterior fossa lesion detection in patients with MS.
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Affiliation(s)
- A Lecler
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
| | - I El Sanharawi
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
| | - J El Methni
- Department of Biostatistics (J.E.M.), MAP5 Laboratory, Unité Mixte de Recherche Centre National de la Recherche Scientifique 8145, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - O Gout
- Neurology (O.G.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - P Koskas
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
| | - J Savatovsky
- From the Departments of Neuroradiology (A.L., I.E.S., P.K., J.S.)
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Zivadinov R, Bergsland N, Carl E, Ramasamy DP, Hagemeier J, Dwyer MG, Lizarraga AA, Kolb C, Hojnacki D, Weinstock-Guttman B. Effect of Teriflunomide and Dimethyl Fumarate on Cortical Atrophy and Leptomeningeal Inflammation in Multiple Sclerosis: A Retrospective, Observational, Case-Control Pilot Study. J Clin Med 2019; 8:jcm8030344. [PMID: 30870983 PMCID: PMC6463015 DOI: 10.3390/jcm8030344] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 02/08/2023] Open
Abstract
Background: Pathologic changes in cortical gray matter (GM) and leptomeninges contribute to disability worsening in patients with multiple sclerosis (MS), but there is little evidence whether disease-modifying treatments can slow down cortical pathology in MS. Objectives: To investigate the effect of teriflunomide (TFM) and dimethyl fumarate (DMF) in reducing cortical pathology, as determined by percentage cortical volume change (PCVC) and leptomeningeal contrast enhancement (LMCE) on MRI. Methods: This was a retrospective, single-center, observational study that selected 60 TFM- and 60 DMF-treated MS patients over 24 months. Results: TFM had a lower rate of PCVC compared to DMF over 24 months (−0.2% vs. −2.94%, p = 0.004). Similar results were observed for percentage GM volume change over 0–12 (p = 0.044) and 0–24 (−0.44% vs. −3.12%, p = 0.015) months. No significant differences were found between the TFM and DMF groups in the frequency and number of LMCE foci over the follow-up. TFM showed a numerically lower rate of whole brain atrophy over 24 months (p = 0.077), compared to DMF. No significant clinical or MRI lesion differences between TFM and DMF were detected over follow-up. Conclusions: These findings suggest that TFM has a superior effect on the preservation of cortical GM volume, compared to DMF.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Ellen Carl
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Michael G Dwyer
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
- Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Alexis A Lizarraga
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Channa Kolb
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY 14203, USA.
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Comparing lesion detection of infratentorial multiple sclerosis lesions between T2-weighted spin-echo, 2D-FLAIR, and 3D-FLAIR sequences. Clin Imaging 2018; 51:229-234. [PMID: 29879598 DOI: 10.1016/j.clinimag.2018.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/14/2018] [Accepted: 05/24/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Infratentorial lesions in patients with multiple sclerosis are associated with long-term disability. Two-dimensional fluid-attenuated inversion recovery demonstrates poor infratentorial lesion detection when compared to T2-weighted spin echo. Evidence of improved detection with 3D fluid-attenuated inversion recovery has been conflicting. This study compares the infratentorial lesion detection performance, observer performance, and signal and contrast properties between T2-weighted spin echo, 2D, and 3D fluid-attenuated inversion recovery. METHODS Two board-certified radiologists independently reviewed and counted infratentorial lesions from 85 brain MRIs in patients with clinically definite multiple sclerosis and concurrent 3D, 2D fluid-attenuated inversion recovery, and T2-weighted spin echo sequences. Contrast-to-noise and signal-to-noise ratios were measured for 25 MRIs. Wilcoxon signed-rank test was used for pairwise comparisons of the combined average infratentorial lesion count, contrast-to-noise, and signal-to-noise ratios, and was adjusted for three pairwise comparisons using Bonferroni correction. A corrected p value < 0.05 was considered statistically significant. RESULTS The number of lesions on 3D fluid-attenuated inversion recovery was significantly higher than those on 2D (p < 0.001) and T2-weighted spin echo (p < 0.001). Results of contrast-to-noise and signal-to-noise ratios were overall mixed and predominantly not concordant with lesion count findings, with T2-weighted spin echo demonstrating the highest signal-to-noise ratios and contrast-to-noise ratio of lesion compared with white matter but the lowest contrast-to-noise ratio of lesion compared with gray matter. CONCLUSION The 3D fluid-attenuated inversion recovery sequence addresses the disadvantage of poor infratentorial lesion detection on 2D, while still maintaining the advantage over T2-weighted spin echo in the detection of lesions adjacent to the cerebrospinal fluid.
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Zivadinov R, Ramasamy DP, Hagemeier J, Kolb C, Bergsland N, Schweser F, Dwyer MG, Weinstock-Guttman B, Hojnacki D. Evaluation of Leptomeningeal Contrast Enhancement Using Pre-and Postcontrast Subtraction 3D-FLAIR Imaging in Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:642-647. [PMID: 29439125 DOI: 10.3174/ajnr.a5541] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/28/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Leptomeningeal contrast enhancement is found in patients with multiple sclerosis, though reported rates have varied. The use of 3D-fluid-attenuated inversion recovery pre- and postcontrast subtraction imaging may more accurately determine the frequency of leptomeningeal contrast enhancement. The purpose of this study was to investigate the frequency of leptomeningeal contrast enhancement using the pre- and postcontrast subtraction approach and to evaluate 3 different methods of assessing the presence of leptomeningeal contrast enhancement. MATERIALS AND METHODS We enrolled 258 consecutive patients with MS (212 with relapsing-remitting MS, 32 with secondary-progressive MS, and 14 with clinically isolated syndrome) who underwent both pre- and 10-minute postcontrast 3D-FLAIR sequences after a single dose of gadolinium injection on 3T MR imaging. The analysis included leptomeningeal contrast-enhancement evaluation on 3D-FLAIR postcontrast images in native space (method A), on pre- and postcontrast 3D-FLAIR images in native space (method B), and on pre-/postcontrast 3D-FLAIR coregistered and subtracted images (method C, used as the criterion standard). RESULTS In total, 51 (19.7%) patients with MS showed the presence of leptomeningeal contrast enhancement using method A; 39 (15.1%), using method B; and 39 (15.1%), using method C (P = .002). Compared with method C as the criterion standard, method A showed 89.8% sensitivity and 92.7% specificity, while method B showed 84.6% sensitivity and 97.3% specificity (P < .001) at the patient level. Reproducibility was the highest using method C (κ agreement, r = 088, P < .001). The mean time to analyze the 3D-FLAIR images was significantly lower with method C compared with methods A and B (P < .001). CONCLUSIONS 3D-FLAIR postcontrast imaging offers a sensitive method for detecting leptomeningeal contrast enhancement in patients with MS. However, the use of subtraction imaging helped avoid false-positive cases, decreased reading time, and increased the accuracy of leptomeningeal contrast-enhancement foci detection in a clinical routine.
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Affiliation(s)
- R Zivadinov
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
- Department of Neurology (R.Z., C.K., D.H.), Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - D P Ramasamy
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - J Hagemeier
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - C Kolb
- Department of Neurology (R.Z., C.K., D.H.), Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, New York
| | - N Bergsland
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - F Schweser
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - M G Dwyer
- From the Department of Neurology (R.Z., D.P.R., J.H., N.B., F.S., M.G.D.), Buffalo Neuroimaging Analysis Center, Jacobs School of Medicine and Biomedical Sciences
| | - B Weinstock-Guttman
- Translational Imaging Center at Clinical Translational Science Institute (B.W.-G.)
| | - D Hojnacki
- Department of Neurology (R.Z., C.K., D.H.), Jacobs Comprehensive MS Treatment and Research Center, University at Buffalo, State University of New York, Buffalo, New York
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Gabr RE, Pednekar AS, Govindarajan KA, Sun X, Riascos RF, Ramírez MG, Hasan KM, Lincoln JA, Nelson F, Wolinsky JS, Narayana PA. Patient-specific 3D FLAIR for enhanced visualization of brain white matter lesions in multiple sclerosis. J Magn Reson Imaging 2016; 46:557-564. [PMID: 27869333 DOI: 10.1002/jmri.25557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/01/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To improve the conspicuity of white matter lesions (WMLs) in multiple sclerosis (MS) using patient-specific optimization of single-slab 3D fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI). MATERIALS AND METHODS Sixteen MS patients were enrolled in a prospective 3.0T MRI study. FLAIR inversion time and echo time were automatically optimized for each patient during the same scan session based on measurements of the relative proton density and relaxation times of the brain tissues. The optimization criterion was to maximize the contrast between gray matter (GM) and white matter (WM), while suppressing cerebrospinal fluid. This criterion also helps increase the contrast between WMLs and WM. The performance of the patient-specific 3D FLAIR protocol relative to the fixed-parameter protocol was assessed both qualitatively and quantitatively. RESULTS Patient-specific optimization achieved a statistically significant 41% increase in the GM-WM contrast ratio (P < 0.05) and 32% increase in the WML-WM contrast ratio (P < 0.01) compared with fixed-parameter FLAIR. The increase in WML-WM contrast ratio correlated strongly with echo time (P < 10-11 ). Two experienced neuroradiologists indicated substantially higher lesion conspicuity on the patient-specific FLAIR images over conventional FLAIR in 3-4 cases (intrarater correlation coefficient ICC = 0.72). In no case was the image quality of patient-specific FLAIR considered inferior to conventional FLAIR by any of the raters (ICC = 0.32). CONCLUSION Changes in proton density and relaxation times render fixed-parameter FLAIR suboptimal in terms of lesion contrast. Patient-specific optimization of 3D FLAIR increases lesion conspicuity without scan time penalty, and has potential to enhance the detection of subtle and small lesions in MS. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2017;46:557-564.
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Affiliation(s)
- Refaat E Gabr
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | | | - Koushik A Govindarajan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Xiaojun Sun
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Roy F Riascos
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - María G Ramírez
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Khader M Hasan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - John A Lincoln
- Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Flavia Nelson
- Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Jerry S Wolinsky
- Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Ponnada A Narayana
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
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12
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Zivadinov R, Ramasamy DP, Vaneckova M, Gandhi S, Chandra A, Hagemeier J, Bergsland N, Polak P, Benedict RHB, Hojnacki D, Weinstock-Guttman B. Leptomeningeal contrast enhancement is associated with progression of cortical atrophy in MS: A retrospective, pilot, observational longitudinal study. Mult Scler 2016; 23:1336-1345. [DOI: 10.1177/1352458516678083] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Leptomeningeal contrast enhancement (LM CE) has been recently described in multiple sclerosis (MS) patients as a potential in vivo marker of cortical pathology. Objectives: To investigate the association of LM CE and development of cortical atrophy in 50 MS patients (27 relapsing-remitting (RR) and 23 secondary-progressive (SP)) followed for 5 years. Methods: The presence and number of LM CE foci were assessed only at the 5-year follow-up using three-dimensional (3D) fluid-attenuated inversion recovery magnetic resonance imaging (MRI) sequence obtained 10 minutes after single dose of gadolinium injection on 3T scanner. The percentage change in whole brain, cortical and deep gray matter (GM) volumes, and lesion volume (LV) was measured between baseline and the 5-year follow-up. Results: In total, 25 (50%) of MS patients had LM CE at the 5-year follow-up. Significantly more SPMS patients (12, 85.7%) had multiple LM CE foci, compared to those with RRMS (2, 18.2%) ( p = 0.001). MS patients with LM CE showed significantly greater percentage decrease in total GM (−3.6% vs −2%, d = 0.80, p = 0.006) and cortical (−3.4% vs −1.8%, d = 0.84, p = 0.007) volumes and greater percentage increase in ventricular cerebrospinal fluid (vCSF) volume (22.8% vs 9.9%, d = 0.90, p = 0.003) over the follow-up, compared to those without. Conclusion: In this retrospective, pilot, observational longitudinal study, the presence of LM CE was associated with progression of cortical atrophy over 5 years.
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Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA/MR Imaging Clinical Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - Deepa P Ramasamy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Sirin Gandhi
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - Avinash Chandra
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - Jesper Hagemeier
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA/IRCCS “S. Maria Nascente,” Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Paul Polak
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - Ralph HB Benedict
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - David Hojnacki
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
| | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo—The State University of New York, Buffalo, NY, USA
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GRAPE: a graphical pipeline environment for image analysis in adaptive magnetic resonance imaging. Int J Comput Assist Radiol Surg 2016; 12:449-457. [PMID: 27796790 DOI: 10.1007/s11548-016-1495-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We present a platform, GRAphical Pipeline Environment (GRAPE), to facilitate the development of patient-adaptive magnetic resonance imaging (MRI) protocols. METHODS GRAPE is an open-source project implemented in the Qt C++ framework to enable graphical creation, execution, and debugging of real-time image analysis algorithms integrated with the MRI scanner. The platform provides the tools and infrastructure to design new algorithms, and build and execute an array of image analysis routines, and provides a mechanism to include existing analysis libraries, all within a graphical environment. The application of GRAPE is demonstrated in multiple MRI applications, and the software is described in detail for both the user and the developer. RESULTS GRAPE was successfully used to implement and execute three applications in MRI of the brain, performed on a 3.0-T MRI scanner: (i) a multi-parametric pipeline for segmenting the brain tissue and detecting lesions in multiple sclerosis (MS), (ii) patient-specific optimization of the 3D fluid-attenuated inversion recovery MRI scan parameters to enhance the contrast of brain lesions in MS, and (iii) an algebraic image method for combining two MR images for improved lesion contrast. CONCLUSIONS GRAPE allows graphical development and execution of image analysis algorithms for inline, real-time, and adaptive MRI applications.
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14
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De Guio F, Jouvent E, Biessels GJ, Black SE, Brayne C, Chen C, Cordonnier C, De Leeuw FE, Dichgans M, Doubal F, Duering M, Dufouil C, Duzel E, Fazekas F, Hachinski V, Ikram MA, Linn J, Matthews PM, Mazoyer B, Mok V, Norrving B, O'Brien JT, Pantoni L, Ropele S, Sachdev P, Schmidt R, Seshadri S, Smith EE, Sposato LA, Stephan B, Swartz RH, Tzourio C, van Buchem M, van der Lugt A, van Oostenbrugge R, Vernooij MW, Viswanathan A, Werring D, Wollenweber F, Wardlaw JM, Chabriat H. Reproducibility and variability of quantitative magnetic resonance imaging markers in cerebral small vessel disease. J Cereb Blood Flow Metab 2016; 36:1319-37. [PMID: 27170700 PMCID: PMC4976752 DOI: 10.1177/0271678x16647396] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/20/2016] [Indexed: 12/11/2022]
Abstract
Brain imaging is essential for the diagnosis and characterization of cerebral small vessel disease. Several magnetic resonance imaging markers have therefore emerged, providing new information on the diagnosis, progression, and mechanisms of small vessel disease. Yet, the reproducibility of these small vessel disease markers has received little attention despite being widely used in cross-sectional and longitudinal studies. This review focuses on the main small vessel disease-related markers on magnetic resonance imaging including: white matter hyperintensities, lacunes, dilated perivascular spaces, microbleeds, and brain volume. The aim is to summarize, for each marker, what is currently known about: (1) its reproducibility in studies with a scan-rescan procedure either in single or multicenter settings; (2) the acquisition-related sources of variability; and, (3) the techniques used to minimize this variability. Based on the results, we discuss technical and other challenges that need to be overcome in order for these markers to be reliably used as outcome measures in future clinical trials. We also highlight the key points that need to be considered when designing multicenter magnetic resonance imaging studies of small vessel disease.
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Affiliation(s)
- François De Guio
- University Paris Diderot, Sorbonne Paris Cité, UMRS 1161 INSERM, Paris, France DHU NeuroVasc, Sorbonne Paris Cité, Paris, France
| | - Eric Jouvent
- University Paris Diderot, Sorbonne Paris Cité, UMRS 1161 INSERM, Paris, France DHU NeuroVasc, Sorbonne Paris Cité, Paris, France Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Christopher Chen
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Frank-Eric De Leeuw
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Department of Neurology, Nijmegen, The Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian-University (LMU), Munich, Germany Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Fergus Doubal
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian-University (LMU), Munich, Germany
| | | | - Emrah Duzel
- Department of Cognitive Neurology and Dementia Research, University of Magdeburg, Magdeburg, Germany
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
| | - M Arfan Ikram
- Department of Radiology and Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jennifer Linn
- Department of Neuroradiology, University Hospital Munich, Munich, Germany
| | - Paul M Matthews
- Department of Medicine, Division of Brain Sciences, Imperial College London, London, UK
| | | | - Vincent Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Sudha Seshadri
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Eric E Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada
| | - Blossom Stephan
- Institute of Health and Society, Newcastle University Institute of Ageing, Newcastle University, Newcastle, UK
| | - Richard H Swartz
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - Mark van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Meike W Vernooij
- Department of Radiology and Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anand Viswanathan
- Department of Neurology, J. Philip Kistler Stroke Research Center, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - David Werring
- Department of Brain Repair and Rehabilitation, Stroke Research Group, UCL, London, UK
| | - Frank Wollenweber
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Joanna M Wardlaw
- Department of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), University of Edinburgh, Edinburgh, UK
| | - Hugues Chabriat
- University Paris Diderot, Sorbonne Paris Cité, UMRS 1161 INSERM, Paris, France DHU NeuroVasc, Sorbonne Paris Cité, Paris, France Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
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15
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Multi-parametric quantitative MRI of normal appearing white matter in multiple sclerosis, and the effect of disease activity on T2. Brain Imaging Behav 2016; 11:744-753. [DOI: 10.1007/s11682-016-9550-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Gabr RE, Hasan KM, Haque ME, Nelson FM, Wolinsky JS, Narayana PA. Optimal combination of FLAIR and T2-weighted MRI for improved lesion contrast in multiple sclerosis. J Magn Reson Imaging 2016; 44:1293-1300. [PMID: 27126898 DOI: 10.1002/jmri.25281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Postacquisition combination of three-dimensional T2-weighted (T2w) and fluid-attenuated inversion recovery (FLAIR) images can improve the visualization of brain lesions in multiple sclerosis (MS). However, an optimal way to combine these images has not been described so far. The main objective of this study is to investigate an optimal combination of T2w and FLAIR to improve the conspicuity of MS lesions. MATERIALS AND METHODS We determined the parameters for a generalized multiplicative image combination which maximize the contrast-to-noise ratio (CNR) between lesions and normal-appearing brain tissue through simulations and verified experimentally. MRI data from 11 MS patients acquired at 3 Tesla were retrospectively analyzed using the proposed approach and compared with conventional FLAIR, and to images obtained by direct multiplication of T2w and FLAIR (FLAIR2 ). Image quality was assessed by region-of-interest analysis. In addition, to evaluate the degree of cerebrospinal fluid (CSF) suppression, CSF-to-gray matter (CSF/GM) ratio was calculated. Reduction in global image contrast was assessed by computing the reduction in the contrast of mid-level intensity values. RESULTS An optimal combination was found to be the third order expression: FLAIR3 = FLAIR1.55 × T2w1.45 . Compared with FLAIR, the lesion CNR was significantly increased by 1.9× (P < 0.005) and 2.5× (P < 0.001) using FLAIR2 and FLAIR3 , respectively. CSF/GM ratio was increased by 1.7× in FLAIR2 (P < 0.001) compared with FLAIR, while it was reduced to 0.7× on FLAIR3 (P < 0.05). The mid-intensity contrast was preserved on FLAIR2 (P = 0.2), and decreased by 29% on FLAIR3 (P < 0.001). CONCLUSION These results show that the optimized combination of FLAIR and T2w can improve MS lesion conspicuity. J. Magn. Reson. Imaging 2016;44:1293-1300.
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Affiliation(s)
- Refaat E Gabr
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA.
| | - Khader M Hasan
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Muhammad E Haque
- Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Flavia M Nelson
- Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Jerry S Wolinsky
- Department of Neurology, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Ponnada A Narayana
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
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Harlow DE, Honce JM, Miravalle AA. Remyelination Therapy in Multiple Sclerosis. Front Neurol 2015; 6:257. [PMID: 26696956 PMCID: PMC4674562 DOI: 10.3389/fneur.2015.00257] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/23/2015] [Indexed: 01/10/2023] Open
Abstract
Multiple sclerosis (MS) is an immune-mediated disorder of the central nervous system that results in destruction of the myelin sheath that surrounds axons and eventual neurodegeneration. Current treatments approved for the treatment of relapsing forms of MS target the aberrant immune response and successfully reduce the severity of attacks and frequency of relapses. Therapies are still needed that can repair damage particularly for the treatment of progressive forms of MS for which current therapies are relatively ineffective. Remyelination can restore neuronal function and prevent further neuronal loss and clinical disability. Recent advancements in our understanding of the molecular and cellular mechanisms regulating myelination, as well as the development of high-throughput screens to identify agents that enhance myelination, have lead to the identification of many potential remyelination therapies currently in preclinical and early clinical development. One problem that has plagued the development of treatments to promote remyelination is the difficulty in assessing remyelination in patients with current imaging techniques. Powerful new imaging technologies are making it easier to discern remyelination in patients, which is critical for the assessment of these new therapeutic strategies during clinical trials. This review will summarize what is currently known about remyelination failure in MS, strategies to overcome this failure, new therapeutic treatments in the pipeline for promoting remyelination in MS patients, and new imaging technologies for measuring remyelination in patients.
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Affiliation(s)
- Danielle E Harlow
- Department of Cell and Developmental Biology, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Justin M Honce
- Department of Radiology, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
| | - Augusto A Miravalle
- Department of Neurology, University of Colorado Anschutz Medical Campus , Aurora, CO , USA
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18
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Gramsch C, Nensa F, Kastrup O, Maderwald S, Deuschl C, Ringelstein A, Schelhorn J, Forsting M, Schlamann M. Diagnostic value of 3D fluid attenuated inversion recovery sequence in multiple sclerosis. Acta Radiol 2015; 56:622-7. [PMID: 24867222 DOI: 10.1177/0284185114534413] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/15/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is an indispensable tool in the diagnostic work-up of multiple sclerosis (MS). To date, guidelines suggest MRI protocols containing axial dual-echo, unenhanced and post-contrast T1-weighted sequences. Especially the usage of dual-echo sequences has markedly improved the ability of MRI to detect cortical and infratentorial lesions. Newer 3D FLAIR sequences are supposed to provide even more positive imaging features such as improved detection of white matter lesions and a better resolution due to smaller slice thickness. PURPOSE To evaluate the diagnostic impact of 3D FLAIR sequences in comparison to conventional T2 and PD sequences. MATERIAL AND METHODS Examinations of 20 MS patients (10 women, 10 men) were reviewed retrospectively. All patients received MRI standard protocol containing PD and T2 sequences and a mid-sagittal T2 sequence. Additionally an isotropic 3D FLAIR sequence was performed. Whole-brain lesion load and number of lesions in juxtacortical, infratentorial, and midcallosal localizations were assessed by two observers independently and compared. RESULTS Whole lesion load and the count of detectable lesions at the 3D FLAIR sequence were significantly higher in the juxtacortical and infratentorial regions compared to the PD/T2 sequence. Detection rate of midcallosal lesions did not differ significantly in sagittal T2 and 3D FLAIR sequence. CONCLUSION 3D FLAIR sequences can improve the detection of brain lesions in patients with MS and are even more sensitive in depicting lesions in cortical and infratentorial locations than current dual-echo sequences. The sequence can replace both PD/T2 sequences and mid-sagittal T2 sequences of the corpus callosum.
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Affiliation(s)
- Carolin Gramsch
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Oliver Kastrup
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Stefan Maderwald
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Adrian Ringelstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Juliane Schelhorn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Naganawa S. The Technical and Clinical Features of 3D-FLAIR in Neuroimaging. Magn Reson Med Sci 2015; 14:93-106. [PMID: 25833275 DOI: 10.2463/mrms.2014-0132] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In clinical MR neuroimaging, 3D fluid-attenuated inversion recovery (3D-FLAIR) with a variable-flip-angle turbo spin echo sequence is becoming popular. There are more than 100 reports regarding 3D-FLAIR in the PubMed database. In this article, the technical and clinical features of 3D-FLAIR for neuroimaging are reviewed and summarized. 3D-FLAIR allows thinner slices with multi-planar reformation capability, a higher flow sensitivity, high sensitivity to subtle T1 changes in fluid, images without cerebrospinal fluid (CSF) inflow artifacts, and a 3D dataset compatible with computer-aided analysis. In addition, 3D-FLAIR can be obtained within a clinically reasonable scan time. It is important for radiologists to be familiar with the features of 3D-FLAIR and to provide useful information for patients.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
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A historical overview of magnetic resonance imaging, focusing on technological innovations. Invest Radiol 2013; 47:725-41. [PMID: 23070095 DOI: 10.1097/rli.0b013e318272d29f] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Magnetic resonance imaging (MRI) has now been used clinically for more than 30 years. Today, MRI serves as the primary diagnostic modality for many clinical problems. In this article, historical developments in the field of MRI will be discussed with a focus on technological innovations. Topics include the initial discoveries in nuclear magnetic resonance that allowed for the advent of MRI as well as the development of whole-body, high field strength, and open MRI systems. Dedicated imaging coils, basic pulse sequences, contrast-enhanced, and functional imaging techniques will also be discussed in a historical context. This article describes important technological innovations in the field of MRI, together with their clinical applicability today, providing critical insights into future developments.
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