1
|
Dziadkowiak E, Koszewicz M, Podgórski P, Wieczorek M, Budrewicz S, Zimny A. Central nervous system involvement in chronic inflammatory demyelinating polyradiculoneuropathy-MRS and DTI study. Front Neurol 2024; 15:1301405. [PMID: 38333607 PMCID: PMC10850251 DOI: 10.3389/fneur.2024.1301405] [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: 09/24/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Objective The current research aimed to analyze the alterations within the motor cortex and pyramidal pathways and their association with the degree of damage within the peripheral nerve fibers in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). To achieve that goal, we investigated the microstructural changes within the pyramidal white matter tracts using diffusion tensor imaging (DTI) parameters, evaluated metabolic alterations in both precentral gyri using magnetic resonance spectroscopy (MRS) ratios, and correlated them with the neurographic findings in patients with CIDP. Methods The spectroscopic ratios of NAA/Cr, Cho/Cr, and mI/Cr from both precentral gyri and the values of fractional anisotropy (FA), axial diffusivity (AD), and mean diffusivity (MD) from both of the corticospinal tracts were correlated with the results of neurological and neurographic findings. The comparison of DTI parameters between the patients and controls was performed using Student's t-test or the Mann-Whitney U test. Due to the lack of normal distribution of most variables, Spearman's Rho rank coefficient was used to test all correlations. All analyses were performed at a significant level of alpha = 0.05 using STATISTICA 13.3. Results Compared to the control group (CG), the patient group showed significantly lower ratios of NAA/Cr (1.66 ± 0.11 vs. 1.61 ± 0.15; p = 0.022), higher ratios of ml/Cr in the right precentral gyrus (0.57 ± 0.15 vs. 0.61 ± 0.08; p = 0.005), and higher levels of Cho/Cr within the left precentral gyrus (0.83 ± 0.09 vs. 0.88 ± 0.14, p = 0.012). The DTI parameters of MD from the right CST and AD from the right and left CSTs showed a strong positive correlation (0.52-0.53) with the sural sensory nerve action potential (SNAP) latency of the right sural nerve. There were no other significant correlations between other DTI and MRS parameters and neurographic results. Significance In our study, significant metabolic alterations were found in the precentral gyri in patients with CIDP without clinical symptoms of central nervous system involvement. The revealed changes reflected neuronal loss or dysfunction, myelin degradation, and increased gliosis. Our results suggest coexisting CNS damage in these patients and may provide a new insight into the still unknown pathomechanism of CIDP.
Collapse
Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Przemysław Podgórski
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Małgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Uniwersytecki, Wrocław, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska, Wrocław, Poland
| |
Collapse
|
2
|
Su X, Kong X, Kong X, Zhu Q, Lu Z, Zheng C. Multisequence magnetic resonance neurography of brachial and lumbosacral plexus in chronic inflammatory demyelinating polyneuropathy: correlations with electrophysiological parameters and clinical features. Ther Adv Neurol Disord 2023; 16:17562864221150540. [PMID: 36762318 PMCID: PMC9905022 DOI: 10.1177/17562864221150540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/23/2022] [Indexed: 02/10/2023] Open
Abstract
Background Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare and challenging demyelinating disorder. It is necessary to increase our understanding of potential connections between imaging, electromyography, and clinical characteristics. Objective The aim of this study was to evaluate the relationships between multisequence magnetic resonance neurography (MRN) findings, electrophysiological parameters, and clinical characteristics in CIDP patients. Design A cross-sectional study. Methods Overall, 51 CIDP patients underwent MRN of the brachial and lumbosacral plexus, and nerve conduction studies. The inflammatory Rasch-built overall disability scale (I-RODS) questionnaire, CIDP disease activity status (CADS) scale, and muscle strength scores were evaluated by two neurologists. Electrophysiological parameters, clinical information, and multiparameter-MRN were analyzed for correlations. Multiparameter-MRN includes diameter, nerve-to-muscle T2 signal intensity ratio (nT2), contrast-enhanced ratio (CR), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of bilateral plexus nerve roots. Results Electrophysiological parameters that were not elicited were significantly higher in the lower extremities than in the upper extremities, and those were higher in sensory nerve conduction than in motor. There were moderate correlations between motor nerve conduction velocity and distal motor latency in nerve diameter, nT2, FA, and ADC, respectively (|r|, 0.45-0.64, p < 0.05). The correlations between CR and sensory nerve conduction velocity and peak latency were moderate, and ADC had a positive correlation with compound motor action potential amplitude (|r|, 0.45-0.63). FA correlated negatively with the course (r = -0.62) and cerebrospinal fluid (CSF) protein (r = -0.41), whereas ADC had correlated positively with CSF protein (r = 0.34). Only CR had a moderately negative correlation with CADS (r's = -0.57). Muscle strength in all extremities was positively correlated with FA (r's range, 0.41-0.49). There was no significant correlation between I-RODS scores and multiparameter-MR. Conclusion MRN-derived multiparameter [nerve size, nT2, and diffusion tensor imaging (DTI) parameters] could serve as quantitative biomarkers of myelin sheath integrity in CIDP. DTI parameters and CR correlated with clinical characteristics better than morphological parameters-MR for CIDP patients.
Collapse
Affiliation(s)
| | - Xiangquan Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Zhu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | | |
Collapse
|
3
|
Pušnik L, Serša I, Umek N, Cvetko E, Snoj Ž. Correlation between diffusion tensor indices and fascicular morphometric parameters of peripheral nerve. Front Physiol 2023; 14:1070227. [PMID: 36909220 PMCID: PMC9995878 DOI: 10.3389/fphys.2023.1070227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/03/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction: Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique that measures the anisotropy of water diffusion. Clinical magnetic resonance imaging scanners enable visualization of the structural integrity of larger axonal bundles in the central nervous system and smaller structures like peripheral nerves; however, their resolution for the depiction of nerve fascicular morphology is limited. Accordingly, high-field strength MRI and strong magnetic field gradients are needed to depict the fascicular pattern. The study aimed to quantify diffusion tensor indices with high-field strength MRI within different anatomical compartments of the median nerve and determine if they correlate with nerve structure at the fascicular level. Methods: Three-dimensional pulsed gradient spin-echo (PGSE) imaging sequence in 19 different gradient directions and b value 1,150 s/mm2 was performed on a 9.4T wide-bore vertical superconducting magnet. Nine-millimeter-long segments of five median nerve samples were obtained from fresh cadavers and acquired in sixteen 0.625 mm thick slices. Each nerve sample had the fascicles, perineurium, and interfascicular epineurium segmented. The diffusion tensor was calculated from the region-average diffusion-weighted signals for all diffusion gradient directions. Subsequently, correlations between diffusion tensor indices of segmentations and nerve structure at the fascicular level (number of fascicles, fascicular ratio, and cross-sectional area of fascicles or nerve) were assessed. The acquired diffusion tensor imaging data was employed for display with trajectories and diffusion ellipsoids. Results: The nerve fascicles proved to be the most anisotropic nerve compartment with fractional anisotropy 0.44 ± 0.05. In the interfascicular epineurium, the diffusion was more prominent in orthogonal directions with fractional anisotropy 0.13 ± 0.02. Diffusion tensor indices within the fascicles and perineurium differed significantly between the subjects (p < 0.0001); however, there were no differences within the interfascicular epineurium (p ≥ 0.37). There were no correlations between diffusion tensor indices and nerve structure at the fascicular level (p ≥ 0.29). Conclusion: High-field strength MRI enabled the depiction of the anisotropic diffusion within the fascicles and perineurium. Diffusion tensor indices of the peripheral nerve did not correlate with nerve structure at the fascicular level. Future studies should investigate the relationship between diffusion tensor indices at the fascicular level and axon- and myelin-related parameters.
Collapse
Affiliation(s)
- Luka Pušnik
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Igor Serša
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - Nejc Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Erika Cvetko
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Žiga Snoj
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
4
|
Visualization of human optic nerve by diffusion tensor mapping and degree of neuropathy. PLoS One 2022; 17:e0278987. [PMID: 36508429 PMCID: PMC9744320 DOI: 10.1371/journal.pone.0278987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging of the human optic nerve and tract is technically difficult because of its small size, the inherent strong signal generated by the surrounding fat and the cerebrospinal fluid, and due to eddy current-induced distortions and subject movement artifacts. The effects of the bone canal through which the optic nerve passes, and the proximity of blood vessels, muscles and tendons are generally unknown. Also, the limited technical capabilities of the scanners and the minimization of acquisition times result in poor quality diffusion-weighted images. It is challenging for current tractography methods to accurately track optic pathway fibers that correspond to known anatomy. Despite these technical limitations and low image resolution, here we show how to visualize the optic nerve and tract and quantify nerve atrophy. Our visualization method based on the analysis of the diffusion tensor shows marked differences between a healthy male subject and a male subject with progressive optic nerve neuropathy. These differences coincide with diffusion scalar metrics and are not visible on standard morphological images. A quantification of the degree of optic nerve atrophy in a systematic way is provided and it is tested on 9 subjects from the Human Connectome Project.
Collapse
|
5
|
Wu F, Ren Y, Wang W, Li C, Wang Y, Yang Y, Shen Y, Wang J, Yang J, Liu H. Microstructural Alteration of Lumbosacral Nerve Roots in Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Insights From DTI and Correlations with Electrophysiological Parameters. Acad Radiol 2022; 29 Suppl 3:S175-S182. [PMID: 34642113 DOI: 10.1016/j.acra.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES To detect the diffusion characteristics of lumbosacral nerve roots in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and further to explore their correlations with electrophysiological parameters of lower extremity nerves. MATERIALS AND METHODS Eighteen CIDP patients and 18 age and sex-matched healthy volunteers were enrolled in this study from August 2019 to August 2020. Axial diffusion tensor imaging (DTI) of lumbosacral plexus was performed in all subjects and fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) of lumbosacral nerve roots were measured. Two-sample t test or Mann-Whitney U test was used to compare the difference of DTI parameters between two groups. Receiver operating characteristic curves were plotted to determine the diagnostic accuracy. All patients also underwent nerve conduction studies. Correlations between DTI parameters of lumbosacral nerve roots and electrophysiological parameters were analyzed with Pearson or Spearman coefficients. RESULTS CIDP patients showed significantly lower FA as well as higher AD, RD, and MD values of lumbosacral nerve roots (FA:0.24±0.054, 0.32±0.044; AD:2.31±0.256, 2.11±0.230 (×10-3mm2/s); RD:1.28±0.189, 1.13±0.106 (×10-3mm2/s); MD:1.68±0.268, 1.45±0.186 (×10-3mm2/s) in CIDP and control group, respectively, all p < 0.05). Receiver operating characteristic analysis showed among all DTI parameters, FA had the best diagnostic accuracy with an area under the curve of 0.914 and optimal cut-off value of 0.27. FA showed a positive correlation while RD showed a negative correlation with a conduction velocity of tibial and common peroneal nerves. RD also correlated positively with F-wave minimal latency of tibial nerves. CONCLUSION DTI can be used to assess the microstructure alterations of lumbosacral nerve roots in CIDP patients. FA and RD may serve as potential markers reflecting the conduction function of tibial and common peroneal nerves.
Collapse
Affiliation(s)
- Fei Wu
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Yan Ren
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Weiwei Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Chong Li
- Department of Radiology, Shijiazhuang People's Hospital, Fangbei Rd, Shijiazhuang, 050000, China
| | - Yin Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Yang Yang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Yiyuan Shen
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Junlong Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Jinming Yang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China
| | - Hanqiu Liu
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai 20040, China.
| |
Collapse
|
6
|
Preisner F, Behnisch R, Schwehr V, Godel T, Schwarz D, Foesleitner O, Bäumer P, Heiland S, Bendszus M, Kronlage M. Quantitative MR-Neurography at 3.0T: Inter-Scanner Reproducibility. Front Neurosci 2022; 16:817316. [PMID: 35250457 PMCID: PMC8888927 DOI: 10.3389/fnins.2022.817316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022] Open
Abstract
Background Quantitative MR-neurography (MRN) is increasingly applied, however, the impact of the MR-scanner on the derived parameters is unknown. Here, we used different 3.0T MR scanners and applied comparable MR-sequences in order to quantify the inter-scanner reproducibility of various MRN parameters of the sciatic nerve. Methods Ten healthy volunteers were prospectively examined at three different 3.0T MR scanners and underwent MRN of their sciatic nerve using comparable imaging protocols including diffusion tensor imaging (DTI) and T2 relaxometry. Subsequently, inter-scanner agreement was assessed for seven different parameters by calculating the intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Results Assessment of inter-scanner reliability revealed good to excellent agreement for T2 (ICC: 0.846) and the quantitative DTI parameters, such as fractional anisotropy (FA) (ICC: 0.876), whereas moderate agreement was observed for proton spin density (PD) (ICC: 0.51). Analysis of variance identified significant inter-scanner differences for several parameters, such as FA (p < 0.001; p = 0.02), T2 (p < 0.01) and PD (p = 0.02; p < 0.01; p = 0.02). Calculated SEM values were mostly within the range of one standard deviation of the absolute mean values, for example 0.033 for FA, 4.12 ms for T2 and 27.8 for PD. Conclusion This study quantifies the measurement imprecision for peripheral nerve DTI and T2 relaxometry, which is associated with the use of different MR scanners. The here presented values may serve as an orientation of the possible scanner-associated fluctuations of MRN biomarkers, which can occur under similar conditions.
Collapse
Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Rouven Behnisch
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Véronique Schwehr
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Godel
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Olivia Foesleitner
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- *Correspondence: Moritz Kronlage,
| |
Collapse
|
7
|
Lichtenstein T, Sprenger A, Weiss K, Große Hokamp N, Maintz D, Schlamann M, Fink GR, Lehmann HC, Henning TD. MRI DTI and PDFF as Biomarkers for Lower Motor Neuron Degeneration in ALS. Front Neurosci 2021; 15:682126. [PMID: 34512239 PMCID: PMC8428530 DOI: 10.3389/fnins.2021.682126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the utility of nerve magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), and muscle MRI multi-echo Dixon for assessing lower motor neuron (LMN) degeneration in amyotrophic lateral sclerosis (ALS). Methods In this prospective observational cohort study, 14 patients with ALS and 13 healthy controls underwent a multiparametric MRI protocol, including DTI of the sciatic nerve and assessment of muscle proton density fat fraction of the biceps femoris and the quadriceps femoris muscles by a multi-echo Dixon sequence. Results In ALS patients, mean fractional anisotropy values of the sciatic nerve were significantly lower than those of healthy controls. The quadriceps femoris, but not the biceps femoris muscle, showed significantly higher intramuscular fat fractions in ALS. Interpretation Our study provides evidence that multiparametric MRI protocols might help estimate structural nerve damage and neurogenic muscle changes in ALS.
Collapse
Affiliation(s)
- Thorsten Lichtenstein
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alina Sprenger
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Kilian Weiss
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Philips Healthcare, Hamburg, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Tobias D Henning
- Department of Neuroradiology, Center Hospital Luxembourg, Luxembourg City, Luxembourg
| |
Collapse
|
8
|
van Rosmalen MHJ, Goedee HS, Derks R, Asselman F, Verhamme C, de Luca A, Hendrikse J, van der Pol WL, Froeling M. Quantitative magnetic resonance imaging of the brachial plexus shows specific changes in nerve architecture in chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and motor neuron disease. Eur J Neurol 2021; 28:2716-2726. [PMID: 33934438 PMCID: PMC8362016 DOI: 10.1111/ene.14896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The immunological pathophysiologies of chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) differ considerably, but neither has been elucidated completely. Quantitative magnetic resonance imaging (MRI) techniques such as diffusion tensor imaging, T2 mapping, and fat fraction analysis may indicate in vivo pathophysiological changes in nerve architecture. Our study aimed to systematically study nerve architecture of the brachial plexus in patients with CIDP, MMN, motor neuron disease (MND) and healthy controls using these quantitative MRI techniques. METHODS We enrolled patients with CIDP (n = 47), MMN (n = 29), MND (n = 40) and healthy controls (n = 10). All patients underwent MRI of the brachial plexus and we obtained diffusion parameters, T2 relaxation times and fat fraction using an automated processing pipeline. We compared these parameters between groups using a univariate general linear model. RESULTS Fractional anisotropy was lower in patients with CIDP compared to healthy controls (p < 0.001), patients with MND (p = 0.010) and MMN (p < 0.001). Radial diffusivity was higher in patients with CIDP compared to healthy controls (p = 0.015) and patients with MND (p = 0.001) and MMN (p < 0.001). T2 relaxation time was elevated in patients with CIDP compared to patients with MND (p = 0.023). Fat fraction was lower in patients with CIDP and MMN compared to patients with MND (both p < 0.001). CONCLUSION Our results show that quantitative MRI parameters differ between CIDP, MMN and MND, which may reflect differences in underlying pathophysiological mechanisms.
Collapse
Affiliation(s)
- Marieke H. J. van Rosmalen
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - H. Stephan Goedee
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Rosina Derks
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Fay‐Lynn Asselman
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Camiel Verhamme
- Department of NeurologyAmsterdam NeuroscienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Alberto de Luca
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - J. Hendrikse
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - W. Ludo van der Pol
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Martijn Froeling
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| |
Collapse
|
9
|
Su X, Kong X, Alwalid O, Wang J, Zhang H, Lu Z, Zheng C. Multisequence Quantitative Magnetic Resonance Neurography of Brachial and Lumbosacral Plexus in Chronic Inflammatory Demyelinating Polyneuropathy. Front Neurosci 2021; 15:649071. [PMID: 34366769 PMCID: PMC8346234 DOI: 10.3389/fnins.2021.649071] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon demyelinating disorder. Although treatable, it is difficult to diagnose. The purpose of this study was to evaluate the diagnostic performance and abnormalities of plexus via quantitative multisequence magnetic resonance neurography (MRN) for CIDP. Methods Brachial and lumbosacral (LS) plexus of 37 CIDP patients and 37 age- and gender-matched controls were examined by using multisequence MRN. Nerve diameter, nerve-to-muscle T2 signal intensity ratio (nT2), contrast-enhanced ratio (CR), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were determined in both plexus, and tractographies were performed. The disease histories and the Inflammatory Rasch-built Overall Disability Scale (I-RODS) questionnaire scores were documented before MRI scans. Results The sizes of nerve roots were larger in CIDP (p < 0.01). CR, nT2, and ADC were significantly higher, while FA was lower in CIDP than in controls (p < 0.01). FA had the highest sensitivity (0.809) and area under the curve (AUC) (0.925), while the highest specificity was 0.961 for CR in single parameters. The combination of FA and CR has the highest sensitivity, specificity, accuracy, and AUC in the LS plexus. CR only had a weak correlation with nT2 (p < 0.05). ADC and diameter had a positive correlation with nT2, and the diameter and nT2 had a negative correlation with FA in CIDP (p < 0.05). FA had a negative correlation with the duration in the CIDP (r’s = −0.404, p < 0.05). There was no significant correlation between the I-RODS scores and MR multiparameters (p < 0.05). Conclusion Multisequence MRN possesses a high diagnostic performance in the LS plexus. Sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE) combined with DTI and contrast enhancement serves as a recommended composite protocol for CIDP.
Collapse
Affiliation(s)
- Xiaoyun Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangquan Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Osamah Alwalid
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Zuneng Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
10
|
Irimia A, Van Horn JD. Mapping the rest of the human connectome: Atlasing the spinal cord and peripheral nervous system. Neuroimage 2021; 225:117478. [PMID: 33160086 PMCID: PMC8485987 DOI: 10.1016/j.neuroimage.2020.117478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
The emergence of diffusion, structural, and functional neuroimaging methods has enabled major multi-site efforts to map the human connectome, which has heretofore been defined as containing all neural connections in the central nervous system (CNS). However, these efforts are not structured to examine the richness and complexity of the peripheral nervous system (PNS), which arguably forms the (neglected) rest of the connectome. Despite increasing interest in an atlas of the spinal cord (SC) and PNS which is simultaneously stereotactic, interactive, electronically dissectible, scalable, population-based and deformable, little attention has thus far been devoted to this task of critical importance. Nevertheless, the atlasing of these complete neural structures is essential for neurosurgical planning, neurological localization, and for mapping those components of the human connectome located outside of the CNS. Here we recommend a modification to the definition of the human connectome to include the SC and PNS, and argue for the creation of an inclusive atlas to complement current efforts to map the brain's human connectome, to enhance clinical education, and to assist progress in neuroscience research. In addition to providing a critical overview of existing neuroimaging techniques, image processing methodologies and algorithmic advances which can be combined for the creation of a full connectome atlas, we outline a blueprint for ultimately mapping the entire human nervous system and, thereby, for filling a critical gap in our scientific knowledge of neural connectivity.
Collapse
Affiliation(s)
- Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles CA 90089, United States; Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, United States.
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, 485 McCormick Road, Gilmer Hall, Room 102, Charlottesville, Virginia 22903, United States; School of Data Science, University of Virginia, Dell 1, Charlottesville, Virginia 22903, United States.
| |
Collapse
|
11
|
Tereshenko V, Pashkunova-Martic I, Manzano-Szalai K, Friske J, Bergmeister KD, Festin C, Aman M, Hruby LA, Klepetko J, Theiner S, Klose MHM, Keppler B, Helbich TH, Aszmann OC. MR Imaging of Peripheral Nerves Using Targeted Application of Contrast Agents: An Experimental Proof-of-Concept Study. Front Med (Lausanne) 2020; 7:613138. [PMID: 33363189 PMCID: PMC7759654 DOI: 10.3389/fmed.2020.613138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Current imaging modalities for peripheral nerves display the nerve's structure but not its function. Based on a nerve's capacity for axonal transport, it may be visualized by targeted application of a contrast agent and assessing the distribution through radiological imaging, thus revealing a nerve's continuity. This concept has not been explored, however, may potentially guide the treatment of peripheral nerve injuries. In this experimental proof-of-concept study, we tested imaging through MRI after administering gadolinium-based contrast agents which were then retrogradely transported. Methods: We synthesized MRI contrast agents consisting of paramagnetic agents and various axonal transport facilitators (HSA-DTPA-Gd, chitosan-DTPA-Gd or PLA/HSA-DTPA-Gd). First, we measured their relaxivity values in vitro to assess their radiological suitability. Subsequently, the sciatic nerve of 24 rats was cut and labeled with one of the contrast agents to achieve retrograde distribution along the nerve. One week after surgery, the spinal cords and sciatic nerves were harvested to visualize the distribution of the respective contrast agent using 7T MRI. In vivo MRI measurements were performed using 9.4 T MRI on the 1st, 3rd, and the 7th day after surgery. Following radiological imaging, the concentration of gadolinium in the harvested samples was analyzed using inductively coupled mass spectrometry (ICP-MS). Results: All contrast agents demonstrated high relaxivity values, varying between 12.1 and 116.0 mM-1s-1. HSA-DTPA-Gd and PLA/HSA-DTPA-Gd application resulted in signal enhancement in the vertebral canal and in the sciatic nerve in ex vivo MRI. In vivo measurements revealed significant signal enhancement in the sciatic nerve on the 3rd and 7th day after HSA-DTPA-Gd and chitosan-DTPA-Gd (p < 0.05) application. Chemical evaluation showed high gadolinium concentration in the sciatic nerve for HSA-DTPA-Gd (5.218 ± 0.860 ng/mg) and chitosan-DTPA-Gd (4.291 ± 1.290 ng/mg). Discussion: In this study a novel imaging approach for the evaluation of a peripheral nerve's integrity was implemented. The findings provide radiological and chemical evidence of successful contrast agent uptake along the sciatic nerve and its distribution within the spinal canal in rats. This novel concept may assist in the diagnostic process of peripheral nerve injuries in the future.
Collapse
Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Irena Pashkunova-Martic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital, Vienna, Austria.,Institute of Inorganic Chemistry, University of Vienna, Vienna, Austria
| | - Krisztina Manzano-Szalai
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Centre for Microbiology and Environmental Systems Science, University of Vienna, Vienna, Austria
| | - Joachim Friske
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital, Vienna, Austria
| | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Martin Aman
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Vienna, Austria.,Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Hospital Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Laura A Hruby
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Johanna Klepetko
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Sarah Theiner
- Institute of Inorganic Chemistry, University of Vienna, Vienna, Austria
| | | | - Bernhard Keppler
- Institute of Inorganic Chemistry, University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
12
|
Hardy PA. Editorial for "Microstructural Integrity of Peripheral Nerves in Charcot-Marie-Tooth (CMT) Disease: An MRI Evaluation Study". J Magn Reson Imaging 2020; 53:445-446. [PMID: 33128410 DOI: 10.1002/jmri.27417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Peter A Hardy
- Department of Radiology, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
13
|
Cheah PL, Krisnan T, Wong JHD, Rozalli FI, Fadzli F, Rahmat K, Shahrizaila N, Tan LK, Nawawi O, Ramli N. Microstructural Integrity of Peripheral Nerves in
Charcot–Marie–Tooth
Disease: An
MRI
Evaluation Study. J Magn Reson Imaging 2020; 53:437-444. [DOI: 10.1002/jmri.27354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Peng Loon Cheah
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Thiagu Krisnan
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Jeannie Hsiu Ding Wong
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Faizatul Izza Rozalli
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Farhana Fadzli
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Kartini Rahmat
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Nortina Shahrizaila
- Division of Neurology, Department of Medicine, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Ouzreiah Nawawi
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| | - Norlisah Ramli
- Department of Biomedical Imaging, Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
- University of Malaya Research Imaging Centre (UMRIC), Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
| |
Collapse
|
14
|
Gersing AS, Cervantes B, Knebel C, Schwaiger BJ, Kirschke JS, Weidlich D, Claudi C, Peeters JM, Pfeiffer D, Rummeny EJ, Karampinos DC, Woertler K. Diffusion tensor imaging and tractography for preoperative assessment of benign peripheral nerve sheath tumors. Eur J Radiol 2020; 129:109110. [PMID: 32559592 DOI: 10.1016/j.ejrad.2020.109110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/14/2020] [Accepted: 05/30/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the diagnostic value of fiber tractography and diffusivity analysis generated from 3D diffusion-weighted (DW) sequences for preoperative assessment of benign peripheral nerve sheath tumors. METHOD MR imaging at 3 T was performed in 22 patients (mean age 41.9 ± 17.1y, 13 women) with histologically confirmed schwannomas (N = 18) and histologically confirmed neurofibromas (N = 11), including a 3D DW turbo spin echo sequence with fat suppression. Diffusion tensor parameters were computed and fiber tracks were determined. Evaluation was performed by two radiologists and one orthopedic surgeon blinded for final diagnosis. Mean diffusivity was computed to allow further assessment of tumor microstructure. Preoperative fascicle visualization was graded, fascicles were categorized regarding anatomical location and amount of fascicles surrounding the tumor. The agreement of imaging findings with intraoperative findings was assessed. RESULTS On 78.3 % of the DTI images, the fascicle visualization was rated as good or very good. Tractography differences were observed in schwannomas and neurofibromas, showing schwannomas to be significantly more often located eccentrically to the nerve (94.8 %) than neurofibromas (0 %, P < 0.01). Fascicles were significantly more often continuous (87.5 %) in schwannomas, while in neurofibromas, none of the tracks was graded to be continuous (0 %, P = 0.014). A substantial agreement between fiber tracking and surgical anatomy was found regarding the fascicle courses surrounding the tumor (κ = 0.78). Mean diffusivity of schwannomas (1.5 ± 0.2 × 10-3 mm2/s) was significantly lower than in neurofibromas (1.8 ± 0.2 × 10-3 mm2/s; P < 0.001). The Youden index showed an optimal cutoff at 1.7 × 10-3 mm2/s (sensitivity, 0.91; specificity, 0.78; J = 0.69). CONCLUSIONS Preoperative diffusion tensor imaging allowed to accurately differentiate between schwannomas and neurofibromas and to describe their location in relation to the nerve fascicles for preoperative planning.
Collapse
Affiliation(s)
- Alexandra S Gersing
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Barbara Cervantes
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Carolin Knebel
- Department of Orthopaedic Surgery, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt J Schwaiger
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Weidlich
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Carolin Claudi
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | | | - Daniela Pfeiffer
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany; Chair for Biomedical Physics, Department of Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst J Rummeny
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| |
Collapse
|
15
|
Edward R, Abdelalim AM, Ashour AS, Afifi L, Al-Athwari A. A study of diffusion tensor imaging of median nerve in diabetic peripheral neuropathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00172-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Objective
To evaluate the role of diffusion tensor imaging (DTI) in the evaluation of diabetic peripheral neuropathy (DPN) compared to clinical scores and nerve conduction studies (NCS).
Patients and methods
We included 30 patients with diabetes mellitus complaining of neuropathy symptoms and 15 healthy volunteers. All subjects underwent evaluation using 1.5-T DTI of median nerves and NCS. Patients underwent clinical evaluation using the Neuropathy Deficit Score (NDS), Neuropathy Impairment Score in the Lower Limbs (NIS-LL), and Diabetic Neuropathy Examination (DNE) score.
Results
We found statistically significant differences between healthy volunteers and patients in fractional anisotropy (FA) of the distal segment (P = 0.016) and whole median nerve (P = 0.024), apparent diffusion coefficient (ADC) of proximal (P = 0.027) and distal (P < 0.001) segments, and whole median nerve (P = 0.019). Distal segment FA was significantly correlated with NDS (P = 0.003), DNEs (P = 0.003), sensory amplitude (P = 0.048), and motor CV (P = 0.020). Distal segment ADC was significantly correlated with NDS (P = 0.007), NIS-LL (P = 0.003), DNEs (P = 0.01), and sensory amplitude (P = 0.032). The best cut-off value of distal segment for FA was 0.45 (87% sensitivity, 80% specificity) and of distal segment ADC was 1.217 (80% sensitivity and specificity).
Conclusions
Our results suggest that 1.5-T DTI examination of the median nerve can provide useful non-invasive information in patients with DPN.
Trial registration
ClinicalTrials.gov, NCT03934970. Registered on May 1, 2019
Collapse
|
16
|
Preisner F, Bäumer P, Wehrstein M, Friedmann-Bette B, Hackbusch M, Heiland S, Bendszus M, Kronlage M. Peripheral Nerve Diffusion Tensor Imaging : Interreader and Test-retest Reliability as Quantified by the Standard Error of Measurement. Clin Neuroradiol 2019; 30:679-689. [PMID: 31807812 DOI: 10.1007/s00062-019-00859-0] [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: 09/26/2019] [Accepted: 11/16/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Diffusion tensor imaging (DTI) is increasingly being used in magnetic resonance neurography (MRN). The purpose of this study was to determine the interreader and test-retest reliability of peripheral nerve DTI in MRN with focus on the sciatic nerve. METHODS In this prospective study 27 healthy volunteers each underwent 3 scans of a short DTI protocol on separate days consisting of a T2-weighted turbo spin-echo and single-shot DTI sequence of the sciatic nerve of the dominant leg. The DTI parameters fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were obtained after manual nerve segmentation by two independent readers. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), and Bland-Altman plots were calculated as measures for both interreader and test-retest agreement for all readout parameters. RESULTS The mean ± standard deviation was 0.507 ± 0.05 for FA, 1308.5 ± 162.4 × 10-6 mm2/s for MD, 905.6 ± 145.4 ×10-6 mm2/s for RD and 2114.1 ± 219.2 × 10-6 mm2/s for AD. The SEM for FA was 0.02 for interreader and test-retest agreement, the SEM for MD, RD, and AD ranged between 46.2 × 10-6 mm2/s (RD) and 70.1 × 10-6 mm2/s (AD) for interreader reliability and between 45.9 × 10-6 mm2/s (RD) and 70.1 × 10-6 mm2/s (AD) for test-retest reliability. The ICC for interreader reliability of DTI parameters ranged between 0.81 and 0.92 and ICC for test-retest reliability between 0.76 and 0.91. CONCLUSION Peripheral nerve DTI of the sciatic nerve is reliable and reproducible. The measures presented here may serve as first orientation values of measurement accuracy when interpreting parameters of sciatic nerve DTI.
Collapse
Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Philipp Bäumer
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Center for Radiology Dia.log, Vinzenz-von-Paul Str. 8, 84503, Altötting, Germany
| | - Michaela Wehrstein
- Department of Sports Medicine (Internal Medicine VII), Medical Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Birgit Friedmann-Bette
- Department of Sports Medicine (Internal Medicine VII), Medical Clinic, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Matthes Hackbusch
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| |
Collapse
|
17
|
Krishnamurthy R, Wang DJJ, Cervantes B, McAllister A, Nelson E, Karampinos DC, Hu HH. Recent Advances in Pediatric Brain, Spine, and Neuromuscular Magnetic Resonance Imaging Techniques. Pediatr Neurol 2019; 96:7-23. [PMID: 31023603 DOI: 10.1016/j.pediatrneurol.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 12/21/2022]
Abstract
Magnetic resonance imaging (MRI) is a powerful radiologic tool with the ability to generate a variety of proton-based signal contrast from tissues. Owing to this immense flexibility in signal generation, new MRI techniques are constantly being developed, tested, and optimized for clinical utility. In addition, the safe and nonionizing nature of MRI makes it a suitable modality for imaging in children. In this review article, we summarize a few of the most popular advances in MRI techniques in recent years. In particular, we highlight how these new developments have affected brain, spine, and neuromuscular imaging and focus on their applications in pediatric patients. In the first part of the review, we discuss new approaches such as multiphase and multidelay arterial spin labeling for quantitative perfusion and angiography of the brain, amide proton transfer MRI of the brain, MRI of brachial plexus and lumbar plexus nerves (i.e., neurography), and T2 mapping and fat characterization in neuromuscular diseases. In the second part of the review, we focus on describing new data acquisition strategies in accelerated MRI aimed collectively at reducing the scan time, including simultaneous multislice imaging, compressed sensing, synthetic MRI, and magnetic resonance fingerprinting. In discussing the aforementioned, the review also summarizes the advantages and disadvantages of each method and their current state of commercial availability from MRI vendors.
Collapse
Affiliation(s)
| | - Danny J J Wang
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Barbara Cervantes
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | | | - Eric Nelson
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | | |
Collapse
|
18
|
Martín Noguerol T, Barousse R, Gómez Cabrera M, Socolovsky M, Bencardino JT, Luna A. Functional MR Neurography in Evaluation of Peripheral Nerve Trauma and Postsurgical Assessment. Radiographics 2019; 39:427-446. [DOI: 10.1148/rg.2019180112] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
19
|
Cao J, He B, Wang S, Zhou Z, Gao F, Xiao L, Luo X, Wu C, Gong T, Chen W, Wang G. Diffusion Tensor Imaging of Tibial and Common Peroneal Nerves in Patients With Guillain-Barre Syndrome: A Feasibility Study. J Magn Reson Imaging 2018; 49:1356-1364. [PMID: 30252994 DOI: 10.1002/jmri.26324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The development of a noninvasive, objective, and accurate method to assess peripheral nerve disorders in Guillain-Barre syndrome (GBS) is of clinical significance. Diffusion tensor imaging (DTI) has been used to evaluate some peripheral nerve disorders. PURPOSE To investigate the feasibility of DTI in evaluating the peripheral nerve disorders in patients with GBS. STUDY TYPE Case control. SUBJECTS Twenty GBS patients and 16 healthy volunteers. FIELD STRENGTH/SEQUENCE 3.0T, T1 WI-SE, T2 WI-SPAIR, DTI; electrophysiology. ASSESSMENT MRI data were analyzed by two radiologists blindly and independently. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusion coefficient (AD), and radial diffusion coefficient (RD) values of tibial nerve (TN) and common peroneal nerve (CPN) were recorded. Motor nerve conduction velocity (MCV) and motor nerve conduction amplitude of TN and CPN were recorded. STATISTICAL TESTS Intraclass correlation coefficient (ICC), t-test, receiver-operating characteristic (ROC), and area under the curve (AUC) analysis, Pearson correlation coefficient. RESULTS The FA and AD values of TN and CPN in the GBS group were significantly lower and the ADC and RD values were higher than those in the controls (P <0.05). The AUC of the FA values (0.970 for TN and 0.927 for CPN) were higher than that of the ADC, AD, and RD values. FA and AD values were positively correlated and ADC, RD values were negatively correlated with MCV and motor nerve conduction amplitude, respectively (P <0.05). The correlations between FA value and electrophysiology parameters were the highest. DATA CONCLUSION DTI quantitative parameters could evaluate the disorders of peripheral nerves in patients with GBS. A moderate correlation was observed between DTI and electrophysiology parameters. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:1356-1364.
Collapse
Affiliation(s)
- Jinfeng Cao
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, P.R. China
| | - Bing He
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, P.R. China
| | - Shanshan Wang
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Zhongmin Zhou
- Department of Nephrology, Zibo Central Hospital, Shandong, P.R. China
| | - Fei Gao
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Lianxiang Xiao
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Xin Luo
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, P.R. China
| | - Chao Wu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Tao Gong
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| | - Weibo Chen
- Philips Healthcare, Shanghai, P.R. China
| | - Guangbin Wang
- Department of MR, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong, P.R. China
| |
Collapse
|
20
|
Cervantes B, Van AT, Weidlich D, Kooijman H, Hock A, Rummeny EJ, Gersing A, Kirschke JS, Karampinos DC. Isotropic resolution diffusion tensor imaging of lumbosacral and sciatic nerves using a phase-corrected diffusion-prepared 3D turbo spin echo. Magn Reson Med 2018; 80:609-618. [PMID: 29380414 PMCID: PMC5947302 DOI: 10.1002/mrm.27072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To perform in vivo isotropic-resolution diffusion tensor imaging (DTI) of lumbosacral and sciatic nerves with a phase-navigated diffusion-prepared (DP) 3D turbo spin echo (TSE) acquisition and modified reconstruction incorporating intershot phase-error correction and to investigate the improvement on image quality and diffusion quantification with the proposed phase correction. METHODS Phase-navigated DP 3D TSE included magnitude stabilizers to minimize motion and eddy-current effects on the signal magnitude. Phase navigation of motion-induced phase errors was introduced before readout in 3D TSE. DTI of lower back nerves was performed in vivo using 3D TSE and single-shot echo planar imaging (ss-EPI) in 13 subjects. Diffusion data were phase-corrected per kz plane with respect to T2 -weighted data. The effects of motion-induced phase errors on DTI quantification was assessed for 3D TSE and compared with ss-EPI. RESULTS Non-phase-corrected 3D TSE resulted in artifacts in diffusion-weighted images and overestimated DTI parameters in the sciatic nerve (mean diffusivity [MD] = 2.06 ± 0.45). Phase correction of 3D TSE DTI data resulted in reductions in all DTI parameters (MD = 1.73 ± 0.26) of statistical significance (P ≤ 0.001) and in closer agreement with ss-EPI DTI parameters (MD = 1.62 ± 0.21). CONCLUSION DP 3D TSE with phase correction allows distortion-free isotropic diffusion imaging of lower back nerves with robustness to motion-induced artifacts and DTI quantification errors. Magn Reson Med 80:609-618, 2018. © 2018 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Collapse
Affiliation(s)
- Barbara Cervantes
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Anh T. Van
- Institute of Medical Engineering (IMETUM)Technical University of MunichGarchingGermany
| | - Dominik Weidlich
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | | | | | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Alexandra Gersing
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Jan S. Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| | - Dimitrios C. Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der IsarTechnical University of MunichMunichGermany
| |
Collapse
|
21
|
Wako Y, Nakamura J, Hagiwara S, Miura M, Eguchi Y, Suzuki T, Orita S, Inage K, Kawarai Y, Sugano M, Nawata K, Yoshino K, Masuda Y, Matsumoto K, Ohtori S. Diffusion tensor imaging of the sciatic and femoral nerves in unilateral osteoarthritis of the hip and osteonecrosis of femoral head: Comparison of the affected and normal sides. Mod Rheumatol 2018; 29:693-699. [PMID: 29862862 DOI: 10.1080/14397595.2018.1484545] [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] [Indexed: 10/14/2022]
Abstract
Objective: The aim was to compare the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the sciatic and femoral nerves in patients with unilateral osteoarthritis of the hip (OA) and osteonecrosis of the femoral head (ONFH) using diffusion tensor imaging (DTI) and to investigate the mechanism of hip pain. Methods: Forty-four patients (22 OA and 22 ONFH) underwent DTI of the sciatic and femoral nerves at the level of the hip joint and the S1 roots to visualize the tractography and quantify the FA and ADC values. Results: The tractography of the femoral and the sciatic nerves on the affected side with OA and ONFH were similar to those on the normal side. The mean FA values of the sciatic and femoral nerves, and the S1 roots were 0.542, 0.551, and 0.316 with OA, 0.568, 0.560, and 0.318 with ONFH on the affected side, and 0.559, 0.560, and 0.315 on the normal side, respectively, and did not show significant differences. The FA values of the sciatic nerve on the affected side with OA decreased with longer pain duration. Conclusion: The FA and ADC values of the sciatic and femoral nerves in patients with unilateral OA and ONFH showed no significant differences between the affected and normal sides.
Collapse
Affiliation(s)
- Yasushi Wako
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Junichi Nakamura
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Shigeo Hagiwara
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Michiaki Miura
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Yawara Eguchi
- b Department of Orthopedic Surgery , National Hospital Organization Shimoshizu National Hospital , Chiba , Japan
| | - Takane Suzuki
- c Department of Bioenvironmentral Medicine, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Sumihisa Orita
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Kazuhide Inage
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Yuya Kawarai
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Masahiko Sugano
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Kento Nawata
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Kensuke Yoshino
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| | - Yoshitada Masuda
- d Department of Radiology , Chiba University Hospital , Chiba , Japan
| | - Koji Matsumoto
- d Department of Radiology , Chiba University Hospital , Chiba , Japan
| | - Seiji Ohtori
- a Department of Orthopedic Surgery, Graduate School of Medicine , Chiba University , Chiba , Japan
| |
Collapse
|
22
|
Oudeman J, Verhamme C, Engbersen MP, Caan MWA, Maas M, Froeling M, Nederveen AJ, Strijkers GJ. Diffusion tensor MRI of the healthy brachial plexus. PLoS One 2018; 13:e0196975. [PMID: 29742154 PMCID: PMC5942843 DOI: 10.1371/journal.pone.0196975] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/24/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Diffusion Tensor MRI (DT-MRI) is a promising tool for the evaluation of brachial plexus pathology. Therefore, we introduce and evaluate a fast DT-MRI protocol (8min33s scanning with 5–10 min postprocessing time) for the brachial plexus. Materials and methods Thirty healthy volunteers within three age-groups (18–35, 36–55, and > 56) received DT-MRI of the brachial-plexus twice. Means of fractional-anisotropy (FA), mean-diffusivity (MD), axial-diffusivity (AD), and radial-diffusivity (RD) for the individual roots and trunks were evaluated. A stepwise forward approach was applied to test for correlations with age, sex, body-mass-index (BMI), bodysurface, height, and bodyweight. Within-subject, intra-rater, and inter-rater repeatability were assessed using Bland-Altman analysis, coefficient of variation (CV), intraclass-correlation (ICC), and minimal detectable difference (MDD). Results No differences between sides and root levels were found. MD, AD, and RD correlated (P < 0.05) with bodyweight. Within-subject quantification proved repeatable with CVs for FA, MD, AD, and RD of 16%, 12%, 11%, and 14%, respectively. Discussion The DT-MRI protocol was fast and repeatable. Found correlations should be considered in future studies of brachial plexus pathology.
Collapse
Affiliation(s)
- Jos Oudeman
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Camiel Verhamme
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Mattan W. A. Caan
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
23
|
Keller S, Wang ZJ, Golsari A, Kim AC, Kooijman H, Adam G, Yamamura J. Feasibility of peripheral nerve MR neurography using diffusion tensor imaging adapted to skeletal muscle disease. Acta Radiol 2018; 59:560-568. [PMID: 28795588 DOI: 10.1177/0284185117726100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Diffusion tensor imaging (DTI) of peripheral nerves may provide additional information about nerve involvement in muscular disorders, but is considered difficult due to different optimal scan parameters tailored to magnetic resonance (MR) signal properties of muscle and neural tissues. Purpose To assess the feasibility of sciatic nerve DTI using two different approaches of region of interest (ROI)-localization in DTI scans with b-values 500 s/mm2, in participants with muscular disorders and in controls. Material and Methods DTI of the thigh was conducted on a 3T system in ten patients (6 men, 4 women; mean age =54 ± 15 years) with neuromuscular disorders and ten controls. T1-weighted (T1W) images were co-registered to fractional anisotropy (FA) color-encoded images. The apparent diffusion coefficient (ADC), FA, and fiber track length (FTL) were analyzed by two operators using a freehand ROI and a single-point ROI covering the sciatic nerve. Interclass correlation coefficient (ICC) and Bland-Altman analysis were used for evaluation of inter-operator and inter-technical agreement, respectively. Results Three-dimensional visualization of sciatic nerve fiber was achievable using both techniques. The ICC of DTI metrics showed excellent inter-operator agreement both in patients and controls. Bland-Altman analysis revealed good agreement of both techniques. A maximum FTL was achieved using the single-point ROI technique, but with a lower inter-operator agreement (ICC = 0.99 vs. 0.83). The ADC and maximum FTL were significantly decreased in patients compared to controls. Conclusion Both ROI localization techniques are feasible to analyze the sciatic nerve in the setting of muscular disease. A maximum FTL is reached using the single-point ROI, however, at the cost of lower inter-operator agreement.
Collapse
Affiliation(s)
- Sarah Keller
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Zhiyue J Wang
- Childrens Medical Center Dallas, Department of Radiology, University of Texas Southwestern Medical Center, TX, USA
| | - Amir Golsari
- Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Catherine Kim
- The Permanente Medical Group, Department Stroke and Neurovascular Imaging, San Francisco, CA, USA
| | - Hendrik Kooijman
- Philips Medical Systems, MR Clinical Science SMC, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
24
|
Lichtenstein T, Sprenger A, Weiss K, Slebocki K, Cervantes B, Karampinos D, Maintz D, Fink GR, Henning TD, Lehmann HC. MRI biomarkers of proximal nerve injury in CIDP. Ann Clin Transl Neurol 2017; 5:19-28. [PMID: 29376089 PMCID: PMC5771316 DOI: 10.1002/acn3.502] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the utility of nerve diffusion tensor imaging (DTI), nerve cross‐sectional area, and muscle magnetic resonance imaging (MRI) multiecho Dixon for assessing proximal nerve injury in chronic inflammatory demyelinating polyneuropathy (CIDP). Methods In this prospective observational cohort study, 11 patients with CIDP and 11 healthy controls underwent a multiparametric MRI protocol with DTI of the sciatic nerve and assessment of muscle proton‐density fat fraction of the biceps femoris and the quadriceps femoris muscles by multiecho Dixon MRI. Patients were longitudinally evaluated by MRI, clinical examination, and nerve conduction studies at baseline and after 6 months. Results In sciatic nerves of CIDP patients, mean cross‐sectional area was significantly higher and fractional anisotropy value was significantly lower, compared to controls. In contrast, muscle proton‐density fat fraction was significantly higher in thigh muscles of patients with CIDP, compared to controls. MRI parameters showed high reproducibility at baseline and 6 months. Interpretation Advanced MRI parameters demonstrate subclinical proximal nerve damage and intramuscular fat accumulation in CIDP. Data suggest DTI and multiecho Dixon MRI might be useful in estimating axonal damage and neurogenic muscle changes in CIDP.
Collapse
Affiliation(s)
- Thorsten Lichtenstein
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Alina Sprenger
- Department of Neurology University Hospital of Cologne Cologne Germany
| | - Kilian Weiss
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany.,Philips Healthcare Germany Hamburg Germany
| | - Karin Slebocki
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Barbara Cervantes
- Cognitive Neuroscience Institute of Diagnostic and Interventional Radiology Technical University Munich Munich Germany
| | - Dimitrios Karampinos
- Cognitive Neuroscience Institute of Diagnostic and Interventional Radiology Technical University Munich Munich Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Gereon R Fink
- Department of Neurology University Hospital of Cologne Cologne Germany.,Institute of Neuroscience and Medicine (INM-3) Research Centre Juelich Jülich Germany
| | - Tobias D Henning
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany.,Department of Neuroradiology Krankenhaus der Barmherzigen Brüder Trier Germany
| | - Helmar C Lehmann
- Department of Neurology University Hospital of Cologne Cologne Germany
| |
Collapse
|
25
|
Wako Y, Nakamura J, Eguchi Y, Hagiwara S, Miura M, Kawarai Y, Sugano M, Nawata K, Yoshino K, Toguchi Y, Masuda Y, Matsumoto K, Suzuki T, Orita S, Ohtori S. Diffusion tensor imaging and tractography of the sciatic and femoral nerves in healthy volunteers at 3T. J Orthop Surg Res 2017; 12:184. [PMID: 29187253 PMCID: PMC5707804 DOI: 10.1186/s13018-017-0690-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background The aim was to clarify the normal fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of the sciatic and femoral nerves at the level of the hip joint and to visualize the neural tracts with diffusion tensor imaging (DTI). Methods Twenty-four healthy volunteers (12 men and 12 women, age 20–29 years) underwent DTI for visualization with tractography and quantification of FA and ADC values on a 3 Tesla MRI (b value = 800 s/mm2, motion probing gradient, 11 directions, time to repeat/echo time = 9000/72.6 ms, axial slice orientation, slice thickness = 3.0 mm with no inter-slice gap, field of view = 320 × 320 mm, 96 × 192 matrix, 75 slices, number of acquisitions = 4). Regions of interest in the sciatic nerve were defined at the femoral head, the S1 root, and the midpoint levels. The femoral nerve was evaluated at 3–4 cm proximal to the femoral head level. Results The tractography of the sciatic and femoral nerves were visualized in all participants. The mean FA values of the sciatic nerve were increased distally from the S1 root level, through the midpoint, and to the femoral head level (0.314, 0.446, 0.567, p = 0.001, respectively). The mean FA values of the femoral nerve were 0.565. The mean ADC values of the sciatic nerves were significantly lower in the S1 root level than in the midpoint and the femoral head level (1.481, 1.602, 1.591 × 10−3 × 10−3 mm2/s, p = 0.001, respectively). The ADC values of the femoral nerve were 1.439 × 10−3 mm2/s. FA and ADC values showed moderate to substantial inter- and intra-observer reliability without significant differences in gender or laterality. Conclusion Visualization and quantification of the sciatic and femoral nerves simultaneously around the hip joint were achieved in healthy young volunteers with DTI. Clinical application of DTI is expected to contribute to hip pain research.
Collapse
Affiliation(s)
- Yasushi Wako
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan.
| | - Junichi Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yawara Eguchi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido city, Chiba, 284-0003, Japan
| | - Shigeo Hagiwara
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Michiaki Miura
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yuya Kawarai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Masahiko Sugano
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Kento Nawata
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Kensuke Yoshino
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yasunari Toguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Takane Suzuki
- Department of Bioenvironmental Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba city, Chiba, 260-8677, Japan
| |
Collapse
|
26
|
|
27
|
Jeon T, Fung MM, Koch KM, Tan ET, Sneag DB. Peripheral nerve diffusion tensor imaging: Overview, pitfalls, and future directions. J Magn Reson Imaging 2017; 47:1171-1189. [DOI: 10.1002/jmri.25876] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/09/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tina Jeon
- Department of Radiology and Imaging; Hospital for Special Surgery; New York New York USA
| | - Maggie M. Fung
- MR Apps & Workflow; GE Healthcare; New York New York USA
| | - Kevin M. Koch
- Department of Radiology; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Ek T. Tan
- GE Global Research Center; Niskayuna New York USA
| | - Darryl B. Sneag
- Department of Radiology and Imaging; Hospital for Special Surgery; New York New York USA
| |
Collapse
|
28
|
Martín Noguerol T, Barousse R, Socolovsky M, Luna A. Quantitative magnetic resonance (MR) neurography for evaluation of peripheral nerves and plexus injuries. Quant Imaging Med Surg 2017; 7:398-421. [PMID: 28932698 DOI: 10.21037/qims.2017.08.01] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Traumatic conditions of peripheral nerves and plexus have been classically evaluated by morphological imaging techniques and electrophysiological tests. New magnetic resonance imaging (MRI) studies based on 3D fat-suppressed techniques are providing high accuracy for peripheral nerve injury evaluation from a qualitative point of view. However, these techniques do not provide quantitative information. Diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) are functional MRI techniques that are able to evaluate and quantify the movement of water molecules within different biological structures. These techniques have been successfully applied in other anatomical areas, especially in the assessment of central nervous system, and now are being imported, with promising results for peripheral nerve and plexus evaluation. DWI and DTI allow performing a qualitative and quantitative peripheral nerve analysis, providing valuable pathophysiological information about functional integrity of these structures. In the field of trauma and peripheral nerve or plexus injury, several derived parameters from DWI and DTI studies such as apparent diffusion coefficient (ADC) or fractional anisotropy (FA) among others, can be used as potential biomarkers of neural damage providing information about fiber organization, axonal flow or myelin integrity. A proper knowledge of physical basis of these techniques and their limitations is important for an optimal interpretation of the imaging findings and derived data. In this paper, a comprehensive review of the potential applications of DWI and DTI neurographic studies is performed with a focus on traumatic conditions, including main nerve entrapment syndromes in both peripheral nerves and brachial or lumbar plexus.
Collapse
Affiliation(s)
| | - Rafael Barousse
- Peripheral Nerve and Plexus Department, Centro Rossi, Buenos Aires, Argentina
| | - Mariano Socolovsky
- Peripheral Nerve and Plexus Surgery Unit, Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Antonio Luna
- MRI Unit, Neuroradiology Section, Clínica Las Nieves, SERCOSA, Health Time, Jaén, Spain.,Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
29
|
Chiou SY, Hellyer PJ, Sharp DJ, Newbould RD, Patel MC, Strutton PH. Relationships between the integrity and function of lumbar nerve roots as assessed by diffusion tensor imaging and neurophysiology. Neuroradiology 2017; 59:893-903. [PMID: 28744730 PMCID: PMC5559579 DOI: 10.1007/s00234-017-1869-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/14/2017] [Indexed: 01/02/2023]
Abstract
Purpose Diffusion tensor imaging (DTI) has shown promise in the measurement of peripheral nerve integrity, although the optimal way to apply the technique for the study of lumbar spinal nerves is unclear. The aims of this study are to use an improved DTI acquisition to investigate lumbar nerve root integrity and correlate this with functional measures using neurophysiology. Methods Twenty healthy volunteers underwent 3 T DTI of the L5/S1 area. Regions of interest were applied to L5 and S1 nerve roots, and DTI metrics (fractional anisotropy, mean, axial and radial diffusivity) were derived. Neurophysiological measures were obtained from muscles innervated by L5/S1 nerves; these included the slope of motor-evoked potential input-output curves, F-wave latency, maximal motor response, and central and peripheral motor conduction times. Results DTI metrics were similar between the left and right sides and between vertebral levels. Conversely, significant differences in DTI measures were seen along the course of the nerves. Regression analyses revealed that DTI metrics of the L5 nerve correlated with neurophysiological measures from the muscle innervated by it. Conclusion The current findings suggest that DTI has the potential to be used for assessing lumbar spinal nerve integrity and that parameters derived from DTI provide quantitative information which reflects their function.
Collapse
Affiliation(s)
- S Y Chiou
- The Nick Davey Laboratory, Division of Surgery, Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - P J Hellyer
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK.,Department of Bioengineering, Imperial College London, London, UK
| | - D J Sharp
- Computational, Cognitive and Clinical Neuroimaging Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | | | - M C Patel
- Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - P H Strutton
- The Nick Davey Laboratory, Division of Surgery, Human Performance Group, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
| |
Collapse
|
30
|
Vaeggemose M, Pham M, Ringgaard S, Tankisi H, Ejskjaer N, Heiland S, Poulsen PL, Andersen H. Magnetic Resonance Neurography Visualizes Abnormalities in Sciatic and Tibial Nerves in Patients With Type 1 Diabetes and Neuropathy. Diabetes 2017; 66:1779-1788. [PMID: 28432188 DOI: 10.2337/db16-1049] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 04/17/2017] [Indexed: 11/13/2022]
Abstract
This study evaluates whether diffusion tensor imaging magnetic resonance neurography (DTI-MRN), T2 relaxation time, and proton spin density can detect and grade neuropathic abnormalities in patients with type 1 diabetes. Patients with type 1 diabetes (n = 49) were included-11 with severe polyneuropathy (sDPN), 13 with mild polyneuropathy (mDPN), and 25 without polyneuropathy (nDPN)-along with 30 healthy control subjects (HCs). Clinical examinations, nerve conduction studies, and vibratory perception thresholds determined the presence and severity of DPN. DTI-MRN covered proximal (sciatic nerve) and distal (tibial nerve) nerve segments of the lower extremity. Fractional anisotropy (FA) and the apparent diffusion coefficient (ADC) were calculated, as were T2 relaxation time and proton spin density obtained from DTI-MRN. All magnetic resonance findings were related to the presence and severity of neuropathy. FA of the sciatic and tibial nerves was lowest in the sDPN group. Corresponding with this, proximal and distal ADCs were highest in patients with sDPN compared with patients with mDPN and nDPN, as well as the HCs. DTI-MRN correlated closely with the severity of neuropathy, demonstrating strong associations with sciatic and tibial nerve findings. Quantitative group differences in proton spin density were also significant, but less pronounced than those for DTI-MRN. In conclusion, DTI-MRN enables detection in peripheral nerves of abnormalities related to DPN, more so than proton spin density or T2 relaxation time. These abnormalities are likely to reflect pathology in sciatic and tibial nerve fibers.
Collapse
Affiliation(s)
- Michael Vaeggemose
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Mirko Pham
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | | | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Ejskjaer
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Per L Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- International Diabetic Neuropathy Consortium (IDNC), Aarhus University, Aarhus, Denmark
| |
Collapse
|
31
|
Simon NG, Lagopoulos J, Paling S, Pfluger C, Park SB, Howells J, Gallagher T, Kliot M, Henderson RD, Vucic S, Kiernan MC. Peripheral nerve diffusion tensor imaging as a measure of disease progression in ALS. J Neurol 2017; 264:882-890. [PMID: 28265751 DOI: 10.1007/s00415-017-8443-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 12/12/2022]
Abstract
Clinical trial design in amyotrophic lateral sclerosis (ALS) remains hampered by a lack of reliable and sensitive biomarkers of disease progression. The present study evaluated peripheral nerve diffusion tensor imaging (DTI) as a surrogate marker of axonal degeneration in ALS. Longitudinal studies were undertaken in 21 ALS patients studied at 0 and 3 months, and 19 patients at 0, 3 and 6 months, with results compared to 13 age-matched controls. Imaging metrics were correlated across a range of functional assessments including amyotrophic lateral sclerosis functional rating scale revised (ALSFRS-R), lower limb muscle strength (Medical Research Council sum score, MRCSS-LL), compound muscle action potential amplitudes and motor unit number estimation (MUNE). Fractional anisotropy was reduced at baseline in ALS patients in the tibial (p < 0.05), and peroneal nerve (p < 0.05). Fractional anisotropy and axial diffusivity declined in the tibial nerve between baselines, 3- and 6-month scans (p < 0.01). From a functional perspective, ALSFRS-R correlated with fractional anisotropy values from tibial (R = 0.75, p < 0.001) and peroneal nerves (R = 0.52, p = 0.001). Similarly, peroneal nerve MUNE values correlated with fractional anisotropy values from the tibial (R = 0.48, p = 0.002) and peroneal nerve (R = 0.39, p = 0.01). There were correlations between the change in ALSFRS-R and tibial nerve axial diffusivity (R = 0.38, p = 0.02) and the change in MRCSS-LL and peroneal nerve fractional anisotropy (R = 0.44, p = 0.009). In conclusion, this study has demonstrated that some peripheral nerve DTI metrics are sensitive to axonal degeneration in ALS. Further, that DTI metrics correlated with measures of functional disability, strength and neurophysiological measures of lower motor neuron loss.
Collapse
Affiliation(s)
- Neil G Simon
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, NSW, Australia.
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience-Thomson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Sita Paling
- Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Casey Pfluger
- Centre for Clinical Research, School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Susanna B Park
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - James Howells
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| | - Thomas Gallagher
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Michel Kliot
- Department of Neurosurgery, Stanford Neurosience Health Center, Palo Alto, CA, USA
| | - Robert D Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Steve Vucic
- Westmead Clinical School, C24 Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
32
|
Joshi AR, Holtmann L, Bobylev I, Schneider C, Ritter C, Weis J, Lehmann HC. Loss of Schwann cell plasticity in chronic inflammatory demyelinating polyneuropathy (CIDP). J Neuroinflammation 2016; 13:255. [PMID: 27677703 PMCID: PMC5039906 DOI: 10.1186/s12974-016-0711-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/06/2016] [Indexed: 12/04/2022] Open
Abstract
Background Chronic inflammatory demyelinating polyneuropathy (CIDP) is often associated with chronic disability, which can be accounted to incomplete regeneration of injured axons. We hypothesized that Schwann cell support for regenerating axons may be altered in CIDP, which may account for the poor clinical recovery seen in many patients. Methods We exposed human and rodent Schwann cells to sera from CIDP patients and controls. In a model of chronic nerve denervation, we transplanted these conditioned Schwann cells intraneurally and assessed their capacity to support axonal regeneration by electrophysiology and morphometry. Results CIDP-conditioned Schwann cells were less growth supportive for regenerating axons as compared to Schwann cells exposed to control sera. The loss of Schwann cell support was associated with lower levels of granulocyte-macrophage colony-stimulating factor (GM-CSF) in CIDP sera and correlated with altered expression of c-Jun and p57kip2 in Schwann cells. The inactivation of these regulatory factors resulted in an altered expression of neurotrophins including BDNF, GDNF, and NGF in CIDP-conditioned Schwann cells in vitro. Conclusions Our study provides evidence that pro-regenerative functions of Schwann cells are affected in CIDP. It thereby offers a possible explanation for the clinical observation that in many CIDP patients recovery is incomplete despite sufficient immunosuppressive treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0711-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Abhijeet R Joshi
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, Cologne, Germany
| | - Laura Holtmann
- Department of Otorhinolaryngology, University Hospital Essen, Essen, Germany
| | - Ilja Bobylev
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, Cologne, Germany
| | | | - Christian Ritter
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany
| | - Helmar C Lehmann
- Department of Neurology, University Hospital of Cologne, Cologne, Germany. .,Center for Molecular Medicine Cologne, Cologne, Germany.
| |
Collapse
|
33
|
Vaeggemose M, Pham M, Ringgaard S, Tankisi H, Ejskjaer N, Heiland S, Poulsen PL, Andersen H. Diffusion tensor imaging MR neurography for the detection of polyneuropathy in type 1 diabetes. J Magn Reson Imaging 2016; 45:1125-1134. [PMID: 27472827 DOI: 10.1002/jmri.25415] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/22/2016] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate if diffusion tensor imaging MR neurography (DTI-MRN) can detect lesions of peripheral nerves in patients with type 1 diabetes. MATERIALS AND METHODS Eleven type 1 diabetic patients with polyneuropathy (DPN), 10 type 1 diabetic patients without polyneuropathy (nDPN), and 10 healthy controls (HC) were investigated with a 3T MRI scanner. Clinical examinations, nerve-conduction studies, and vibratory-perception thresholds determined the presence of DPN. DTI-MRN (voxel size: 1.4 × 1.4 × 3 mm3 ; b-values: 0, 800 s/mm2 ) covered proximal (sciatic nerve) and distal regions of the lower extremity (tibial nerve). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were calculated and compared to T2 -relaxometry and proton-spin density obtained from a multiecho turbo spin echo (TSE) sequence. Furthermore, we evaluated DTI reproducibility, repeatability, and diagnostic accuracy. RESULTS DTI-MRN could accurately discriminate between DPN, nDPN, and HC. The proximal FA was lowest in DPN (DPN 0.37 ± 0.06; nDPN 0.47 ± 0.03; HC 0.49 ± 0.06; P < 0.01). In addition, distal FA was lowest in DPN (DPN 0.31 ± 0.05; nDPN 0.41 ± 0.07; HC 0.43 ± 0.08; P < 0.01). Likewise, proximal ADC was highest in DPN (DPN 1.69 ± 0.25 × 10-3 mm2 /s; nDPN 1.50 ± 0.06 × 10-3 mm2 /s; HC 1.42 ± 0.12 × 10-3 mm2 /s; P < 0.01) as was distal ADC (DPN 1.87 ± 0.45 × 10-3 mm2 /s; nDPN 1.59 ± 0.19 × 10-3 mm2 /s; HC 1.57 ± 0.26 × 10-3 mm2 /s; P = 0.09). The combined interclass-correlation (ICC) coefficient of DTI reproducibility and repeatability was high in the sciatic nerve (ICC: FA = 0.86; ADC = 0.85) and the tibial nerve (ICC: FA = 0.78; ADC = 0.66). T2 -relaxometry and proton-spin-density did not enable detection of neuropathy. CONCLUSION DTI-MRN accurately detects DPN by lower nerve FA and higher ADC. These alterations are likely to reflect proximal and distal nerve fiber pathology. LEVEL OF EVIDENCE 1 J. Magn. Reson. Imaging 2017;45:1125-1134.
Collapse
Affiliation(s)
- Michael Vaeggemose
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Danish Diabetes Academy, Odense, Denmark
| | - Mirko Pham
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Per L Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
34
|
Bernabeu Á, López-Celada S, Alfaro A, Mas JJ, Sánchez-González J. Is diffusion tensor imaging useful in the assessment of the sciatic nerve and its pathologies? Our clinical experience. Br J Radiol 2016; 89:20150728. [PMID: 27459247 DOI: 10.1259/bjr.20150728] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness of diffusion tensor imaging (DTI) in the clinical setting as a complementary tool to conventional MRI in the study and assessment of the sciatic nerve and its pathologies. METHODS 17 patients diagnosed with different types of sciatic neuropathy and 10 healthy controls underwent a conventional MRI and a DTI study in a 3-T MR scanner (Achieva(®) 3-T X-Series; Philips Healthcare, Netherlands). RESULTS In the control group, we were able to track and visualize the common sciatic nerve and its main branches from hip to foot. In the patient group, the affected sciatic nerves presented statistically significant lower fractional anisotropy values and higher apparent diffusion coefficient values when compared with controls, suggesting nerve damage. In all cases, DTI offered complementary information for diagnosis and/or confirmation of the suspected pathology. When compared with conventional MRI, DTI showed higher sensitivity for nerve damage detection. CONCLUSION DTI offers a significant improvement and an important complement to visualize the sciatic nerve and its main branches. In patients with sciatic nerve pathology DTI allows to a better detection and characterization of the nerve damage. ADVANCES IN KNOWLEDGE DTI enables in vivo dissection of the sciatic nerve white matter fibres; its use offers a significant improvement and complement to conventional MRI.
Collapse
Affiliation(s)
- Ángela Bernabeu
- 1 Magnetic Resonance Department, Inscanner SL, Alicante, Spain
| | | | - Arantxa Alfaro
- 2 Department of Neurology, Hospital Vega Baja de Orihuela, Alicante, Spain.,3 CIBER-BBN, Madrid, Spain
| | - Jesús J Mas
- 4 Orthopaedic Surgery Department, Clinica Vistahermosa, Alicante, Spain
| | | |
Collapse
|
35
|
Markvardsen LH, Vaeggemose M, Ringgaard S, Andersen H. Diffusion tensor imaging can be used to detect lesions in peripheral nerves in patients with chronic inflammatory demyelinating polyneuropathy treated with subcutaneous immunoglobulin. Neuroradiology 2016; 58:745-52. [DOI: 10.1007/s00234-016-1692-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/20/2016] [Indexed: 01/12/2023]
|
36
|
Hou ZJ, Huang Y, Fan ZW, Li XC, Cao BY. Changes in lumbosacral spinal nerve roots on diffusion tensor imaging in spinal stenosis. Neural Regen Res 2016; 10:1860-4. [PMID: 26807125 PMCID: PMC4705802 DOI: 10.4103/1673-5374.170317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Lumbosacral degenerative disc disease is a common cause of lower back and leg pain. Conventional T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) scans are commonly used to image spinal cord degeneration. However, these modalities are unable to image the entire lumbosacral spinal nerve roots. Thus, in the present study, we assessed the potential of diffusion tensor imaging (DTI) for quantitative assessment of compressed lumbosacral spinal nerve roots. Subjects were 20 young healthy volunteers and 31 patients with lumbosacral stenosis. T2WI showed that the residual dural sac area was less than two-thirds that of the corresponding normal area in patients from L3 to S1 stenosis. On T1WI and T2WI, 74 lumbosacral spinal nerve roots from 31 patients showed compression changes. DTI showed thinning and distortion in 36 lumbosacral spinal nerve roots (49%) and abruption in 17 lumbosacral spinal nerve roots (23%). Moreover, fractional anisotropy values were reduced in the lumbosacral spinal nerve roots of patients with lumbosacral stenosis. These findings suggest that DTI can objectively and quantitatively evaluate the severity of lumbosacral spinal nerve root compression.
Collapse
Affiliation(s)
- Zhong-Jun Hou
- Department of Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yong Huang
- Department of Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zi-Wen Fan
- Department of Orthopedics, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xin-Chun Li
- Department of Radiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Bing-Yi Cao
- Department of Radiology, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| |
Collapse
|
37
|
Schneider C, Bucher F, Cursiefen C, Fink GR, Heindl LM, Lehmann HC. Corneal confocal microscopy detects small fiber damage in chronic inflammatory demyelinating polyneuropathy (CIDP). J Peripher Nerv Syst 2015; 19:322-7. [PMID: 25582791 DOI: 10.1111/jns.12098] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 12/21/2022]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune-mediated peripheral neuropathy with multifocal involvement. Reliable biomarkers for diagnosis, disease progression, and treatment response remain to be developed. We assessed the utility of corneal confocal microscopy (CCM) as a diagnostic marker for CIDP in 16 patients. CCM parameters including corneal nerve fiber density (NFD), nerve fiber length, number of main nerve trunks, number of nerve branches, nerve tortuosity, and dendritic cell density (DCD) were compared to those from 15 healthy controls and correlated with clinical and electrophysiological findings. CIDP patients had a significantly lower corneal NFD compared to healthy controls. The total nerve fiber length and the number of nerve branches were significantly decreased, whereas nerve tortuosity was increased in patients with CIDP. There was no positive correlation between corneal NFD and clinical or electrophysiological assessments. The average DCD was not significantly different in CIDP patients and controls. CCM measures suggest damage to small sensory afferents in the cornea in CIDP patients. Further studies are needed to compare different neuropathic conditions and to explore longitudinal changes of CCM parameters.
Collapse
|
38
|
Diffusion Tensor Imaging Adds Diagnostic Accuracy in Magnetic Resonance Neurography. Invest Radiol 2015; 50:498-504. [DOI: 10.1097/rli.0000000000000156] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
39
|
Rangavajla G, Mokarram N, Masoodzadehgan N, Pai SB, Bellamkonda RV. Noninvasive imaging of peripheral nerves. Cells Tissues Organs 2015; 200:69-77. [PMID: 25766202 DOI: 10.1159/000369451] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 12/19/2022] Open
Abstract
Recent developments in the field of peripheral nerve imaging extend the capabilities of imaging modalities to assist in the diagnosis and treatment of patients with peripheral nerve maladies. Methods such as magnetic resonance imaging (MRI) and its derivative diffusion tensor imaging (DTI), ultrasound (US) and positron emission tomography (PET) are capable of assessing nerve structure and function following injury and relating the state of the nerve to electrophysiological and histological analysis. Of the imaging methods surveyed here, each offered unique and interesting advantages related to the field. MRI offered the opportunity to visualize immune activity on the injured nerve throughout the course of the regeneration process, and DTI offered numerical characterization of the injury and the ability to develop statistical bases for diagnosing injury. US extends imaging to the treatment phase by enabling more precise analgesic applications following surgery, and PET represents a novel method of assessing nerve injury through analysis of relative metabolism rates in injured and healthy tissue. Exciting new possibilities to enhance and extend the abilities of imaging methods are also discussed, including innovative contrast agents, some of which enable multimodal imaging approaches and present opportunities for treatment application.
Collapse
|
40
|
Accuracy of MRI in diagnosing peripheral nerve disease: a systematic review of the literature. AJR Am J Roentgenol 2015; 203:1303-9. [PMID: 25415709 DOI: 10.2214/ajr.13.12403] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE MRI is increasingly being used to evaluate extracranial peripheral nerve disease in clinical practice. The objective of this study was to systematically review the accuracy of MRI in distinguishing normal from abnormal extracranial peripheral nerves. CONCLUSION There is significant heterogeneity between studies investigating the accuracy of MRI. Studies have shown that nerve T2-weighted or STIR hyperintensity, nerve enlargement, and nerve flattening are associated with peripheral nerve disease.
Collapse
|
41
|
Merkies ISJ, Faber CG, Lauria G. Advances in diagnostics and outcome measures in peripheral neuropathies. Neurosci Lett 2015; 596:3-13. [PMID: 25703220 DOI: 10.1016/j.neulet.2015.02.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/05/2015] [Accepted: 02/17/2015] [Indexed: 12/13/2022]
Abstract
Peripheral neuropathies are a group of acquired and hereditary disorders presenting with different distribution and nerve fiber class involvement. The overall prevalence is 2.4%, increasing to 8% in the elderly population. However, the frequency may vary depending on the underlying pathogenesis and association with systemic diseases. Distal symmetric polyneuropathy is the most common form, though multiple mononeuropathies, non-length dependent neuropathy and small fiber neuropathy can occur and may require specific diagnostic tools. The use of uniform outcome measures in peripheral neuropathies is important to improve the quality of randomized controlled trials, enabling comparison between studies. Recent developments in defining the optimal set of outcome measures in inflammatory neuropathies may serve as an example for other conditions. Diagnostic and outcome measure advances in peripheral neuropathies will be discussed.
Collapse
Affiliation(s)
- Ingemar S J Merkies
- Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands; Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Giuseppe Lauria
- 3rd Neurology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy.
| |
Collapse
|
42
|
Simon NG, Kliot M. Diffusion weighted MRI and tractography for evaluating peripheral nerve degeneration and regeneration. Neural Regen Res 2015; 9:2122-4. [PMID: 25657731 PMCID: PMC4316443 DOI: 10.4103/1673-5374.147941] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/04/2022] Open
Affiliation(s)
- Neil G Simon
- Prince of Wales Clinical School, University of New South Wales, Australia; Central Clinical School, The University of Sydney, Australia
| | - Michel Kliot
- Department of Neurological Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
43
|
Dortch RD, Dethrage LM, Gore JC, Smith SA, Li J. Proximal nerve magnetization transfer MRI relates to disability in Charcot-Marie-Tooth diseases. Neurology 2014; 83:1545-53. [PMID: 25253751 DOI: 10.1212/wnl.0000000000000919] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objectives of this study were (1) to develop a novel magnetization transfer ratio (MTR) MRI assay of the proximal sciatic nerve (SN), which is inaccessible via current tools for assessing peripheral nerves, and (2) to evaluate the resulting MTR values as a potential biomarker of myelin content changes in patients with Charcot-Marie-Tooth (CMT) diseases. METHODS MTR was measured in the SN of patients with CMT type 1A (CMT1A, n = 10), CMT type 2A (CMT2A, n = 3), hereditary neuropathy with liability to pressure palsies (n = 3), and healthy controls (n = 21). Additional patients without a genetically confirmed subtype (n = 4), but whose family histories and electrophysiologic tests were consistent with CMT, were also included. The relationship between MTR and clinical neuropathy scores was assessed, and the interscan and inter-rater reliability of MTR was estimated. RESULTS Mean volumetric MTR values were significantly decreased in the SN of patients with CMT1A (33.8 ± 3.3 percent units) and CMT2A (31.5 ± 1.9 percent units) relative to controls (37.2 ± 2.3 percent units). A significant relationship between MTR and disability scores was also detected (p = 0.01 for genetically confirmed patients only, p = 0.04 for all patients). From interscan and inter-rater reliability analyses, proximal nerve MTR values were repeatable at the slicewise and mean volumetric levels. CONCLUSIONS MTR measurements may be a viable biomarker of proximal nerve pathology in patients with CMT.
Collapse
Affiliation(s)
- Richard D Dortch
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN.
| | - Lindsey M Dethrage
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
| | - John C Gore
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
| | - Seth A Smith
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
| | - Jun Li
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
| |
Collapse
|
44
|
|
45
|
Matthews TP, Zhang C, Yao DK, Maslov K, Wang LV. Label-free photoacoustic microscopy of peripheral nerves. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:16004. [PMID: 24395587 PMCID: PMC3881606 DOI: 10.1117/1.jbo.19.1.016004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 05/19/2023]
Abstract
Peripheral neuropathy is a common neurological problem that affects millions of people worldwide. Diagnosis and treatment of this condition are often hindered by the difficulties in making objective, noninvasive measurements of nerve fibers. Photoacoustic microscopy (PAM) has the ability to obtain high resolution, specific images of peripheral nerves without exogenous contrast. We demonstrated the first proof-of-concept imaging of peripheral nerves using PAM. As validated by both standard histology and photoacoustic spectroscopy, the origin of photoacoustic signals is myelin, the primary source of lipids in the nerves. An extracted sciatic nerve sandwiched between two layers of chicken tissue was imaged by PAM to mimic the in vivo case. Ordered fibrous structures inside the nerve, caused by the bundles of myelin-coated axons, could be observed clearly. With further technical improvements, PAM can potentially be applied to monitor and diagnose peripheral neuropathies.
Collapse
Affiliation(s)
- Thomas Paul Matthews
- Washington University in St. Louis, Department of Biomedical Engineering, Campus Box 1097, One Brookings Drive, St. Louis, Missouri 63130
| | - Chi Zhang
- Washington University in St. Louis, Department of Biomedical Engineering, Campus Box 1097, One Brookings Drive, St. Louis, Missouri 63130
| | - Da-Kang Yao
- Washington University in St. Louis, Department of Biomedical Engineering, Campus Box 1097, One Brookings Drive, St. Louis, Missouri 63130
| | - Konstantin Maslov
- Washington University in St. Louis, Department of Biomedical Engineering, Campus Box 1097, One Brookings Drive, St. Louis, Missouri 63130
| | - Lihong V. Wang
- Washington University in St. Louis, Department of Biomedical Engineering, Campus Box 1097, One Brookings Drive, St. Louis, Missouri 63130
- Address all correspondence to: Lihong V. Wang, E-mail:
| |
Collapse
|