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Galijasevic M, Steiger R, Treichl SA, Ho WM, Mangesius S, Ladenhauf V, Deeg J, Gruber L, Ouaret M, Regodic M, Lenhart L, Pfausler B, Grams AE, Petr O, Thomé C, Gizewski ER. Could Phosphorous MR Spectroscopy Help Predict the Severity of Vasospasm? A Pilot Study. Diagnostics (Basel) 2024; 14:841. [PMID: 38667486 PMCID: PMC11049300 DOI: 10.3390/diagnostics14080841] [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: 02/22/2024] [Revised: 04/02/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
One of the main causes of the dismal prognosis in patients who survive the initial bleeding after aneurysmal subarachnoidal hemorrhage is the delayed cerebral ischaemia caused by vasospasm. Studies suggest that cerebral magnesium and pH may potentially play a role in the pathophysiology of this adverse event. Using phosphorous magnetic resonance spectrocopy (31P-MRS), we calculated the cerebral magnesium (Mg) and pH levels in 13 patients who suffered from aSAH. The values between the group that developed clinically significant vasospasm (n = 7) and the group that did not (n = 6) were compared. The results of this study show significantly lower cerebral Mg levels (p = 0.019) and higher pH levels (p < 0.001) in the cumulative group (all brain voxels together) in patients who developed clinically significant vasospasm. Further clinical studies on a larger group of carefully selected patients are needed in order to predict clinically significant vasospasm.
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Affiliation(s)
- Malik Galijasevic
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ruth Steiger
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephanie Alice Treichl
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Wing Man Ho
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Stephanie Mangesius
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Valentin Ladenhauf
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Johannes Deeg
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Miar Ouaret
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Milovan Regodic
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Lukas Lenhart
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Astrid Ellen Grams
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ondra Petr
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.A.T.); (W.M.H.); (O.P.); (C.T.)
| | - Elke Ruth Gizewski
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (S.M.); (V.L.); (J.D.); (L.G.); (M.O.); (M.R.); (L.L.); (A.E.G.); (E.R.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Lu W, Sun Y, Gao H, Qiu J. A review of multi-modal magnetic resonance imaging studies on perimenopausal brain: a hint towards neural heterogeneity. Eur Radiol 2023; 33:5282-5297. [PMID: 36977851 DOI: 10.1007/s00330-023-09549-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
The population ageing process worldwide is leading to an increasing number of women in the perimenopausal phase. Many of the perimenopausal symptoms, such as headache, depression, insomnia, and cognitive decline, are neurological in nature. Therefore, the study of the perimenopausal brain is of great importance. In addition, relevant studies can also provide an imaging basis for multiple therapies to treat perimenopausal symptoms. Because of its non-invasive nature, magnetic resonance imaging (MRI) has now been widely applied to the study of perimenopausal brains, revealing alterations in the brain associated with symptoms during the menopause transition. In this review, we collected papers and works of literature on the perimenopausal brain using MRI techniques in the Web of Science database. We firstly described the general principles and analysis methods of different MRI modalities briefly and then reviewed the structural, functional, perfusion, and metabolic compounds changes in the brain of perimenopausal women respectively, and described the latest advances in probing the perimenopausal brain using MRI, resulting in summary diagrams and figures. Based on the summary of existing works of the literature, this review further provided a perspective on multi-modal MRI studies in the perimenopausal brain, suggesting that population-based, multi-center, and longitudinal studies will be beneficial to the comprehensive understanding of changes in the perimenopausal brain. In addition, we found a hint towards neural heterogeneity in the perimenopausal brain, which should be addressed by future MRI studies to provide more help for the precise diagnosis and personalized treatment of perimenopausal symptoms. KEY POINTS: • Perimenopause is not only a physiological transition but also a period of neurological transition. • Multi-modal MRI studies have revealed that perimenopause is accompanied by alterations in the brain, which is implicated in many perimenopausal symptoms. • The diversity in the multi-modal MRI findings may give a hint to neural heterogeneity in the perimenopausal brain.
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Affiliation(s)
- Weizhao Lu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Taian, 271000, China
| | - Yuanyuan Sun
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 619 Changcheng Road, Taian, 271016, China
| | - Hui Gao
- Department of Gynaecology, Beijing Tian Tan Hospital, Beijing, China
| | - Jianfeng Qiu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No. 366 Taishan Street, Taian, 271000, China.
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Parasoglou P, Osorio RS, Khegai O, Kovbasyuk Z, Miller M, Ho A, Dehkharghani S, Wisniewski T, Convit A, Mosconi L, Brown R. Phosphorus metabolism in the brain of cognitively normal midlife individuals at risk for Alzheimer's disease. NEUROIMAGE. REPORTS 2022; 2:100121. [PMID: 36532654 PMCID: PMC9757821 DOI: 10.1016/j.ynirp.2022.100121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Neurometabolic abnormalities and amyloid-beta plaque deposition are important early pathophysiologic changes in Alzheimer's disease (AD). This study investigated the relationship between high-energy phosphorus-containing metabolites, glucose uptake, and amyloid plaque using phosphorus magnetic resonance spectroscopy (31P-MRS) and positron emission tomography (PET). METHODS We measured 31P-MRS, fluorodeoxyglucose (FDG)-PET, and Pittsburgh Compound B (PiB)-PET in a cohort of 20 cognitively normal middle-aged adults at risk for AD. We assessed 31P-MRS reliability by scanning a separate cohort of 13 healthy volunteers twice each. We calculated the coefficient-of-variation (CV) of metabolite ratios phosphocreatine-to-adenosine triphosphate (PCr/α-ATP), inorganic phosphate (Pi)-to-α-ATP, and phosphomonoesters-to-phosphodiesters (PME/PDE), and pH in pre-defined brain regions. We performed linear regression analysis to determine the relationship between 31P measurements and tracer uptake, and Dunn's multiple comparison tests to investigate regional differences in phosphorus metabolism. Finally, we performed linear regression analysis on 31P-MRS measurements in both cohorts to investigate the relationship of phosphorus metabolism with age. RESULTS Most regional 31P metabolite ratio and pH inter- and intra-day CVs were well below 10%. There was an inverse relationship between FDG-SUV levels and metabolite ratios PCr/α-ATP, Pi/α-ATP, and PME/PDE in several brain regions in the AD risk group. There were also several regional differences among 31P metabolites and pH in the AD risk group including elevated PCr/α-ATP, depressed PME/PDE, and elevated pH in the temporal cortices. Increased PCr/α-ATP throughout the brain was associated with aging. CONCLUSIONS Phosphorus spectroscopy in the brain can be performed with high repeatability. Phosphorus metabolism varies with region and age, and is related to glucose uptake in adults at risk for AD. Phosphorus spectroscopy may be a valuable approach to study early changes in brain energetics in high-risk populations.
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Affiliation(s)
- Prodromos Parasoglou
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ricardo S. Osorio
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Oleksandr Khegai
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Zanetta Kovbasyuk
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Margo Miller
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Amanda Ho
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - Seena Dehkharghani
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Neurology, Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Department of Neurology, Center for Cognitive Neurology, New York University Grossman School of Medicine, New York, NY, USA
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
- Nathan S Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Ryan Brown
- Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
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Thomas AM, Barkhof F, Bulte JWM. Opportunities for Molecular Imaging in Multiple Sclerosis Management: Linking Probe to Treatment. Radiology 2022; 303:486-497. [PMID: 35471110 PMCID: PMC9131169 DOI: 10.1148/radiol.211252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Imaging has been a critical component of multiple sclerosis (MS) management for nearly 40 years. The visual information derived from structural MRI, that is, signs of blood-brain barrier disruption, inflammation and demyelination, and brain and spinal cord atrophy, are the primary metrics used to evaluate therapeutic efficacy in MS. The development of targeted imaging probes has expanded our ability to evaluate and monitor MS and its therapies at the molecular level. Most molecular imaging probes evaluated for MS applications are small molecules initially developed for PET, nearly half of which are derived from U.S. Food and Drug Administration-approved drugs and those currently undergoing clinical trials. Superparamagnetic and fluorinated particles have been used for tracking circulating immune cells (in situ labeling) and immunosuppressive or remyelinating therapeutic stem cells (ex vivo labeling) clinically using proton (hydrogen 1 [1H]) and preclinically using fluorine 19 MRI. Translocator protein PET and 1H MR spectroscopy have been demonstrated to complement imaging metrics from structural (gadolinium-enhanced) MRI in nine and six trials for MS disease-modifying therapies, respectively. Still, despite multiple demonstrations of the utility of molecular imaging probes to evaluate the target location and to elucidate the mechanisms of disease-modifying therapies for MS applications, their use has been sparse in both preclinical and clinical settings.
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Affiliation(s)
- Aline M Thomas
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, and the Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, the Johns Hopkins University School of Medicine, 733 N Broadway, Room 659, Baltimore, MD 21205 (A.M.T., J.W.M.B.); and Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands (F.B.)
| | - Frederik Barkhof
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, and the Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, the Johns Hopkins University School of Medicine, 733 N Broadway, Room 659, Baltimore, MD 21205 (A.M.T., J.W.M.B.); and Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands (F.B.)
| | - Jeff W M Bulte
- From the Russell H. Morgan Department of Radiology and Radiological Science, Division of MR Research, and the Cellular Imaging Section and Vascular Biology Program, Institute for Cell Engineering, the Johns Hopkins University School of Medicine, 733 N Broadway, Room 659, Baltimore, MD 21205 (A.M.T., J.W.M.B.); and Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands (F.B.)
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Rietzler A, Steiger R, Mangesius S, Walchhofer LM, Gothe RM, Schocke M, Gizewski ER, Grams AE. Energy metabolism measured by 31P magnetic resonance spectroscopy in the healthy human brain. J Neuroradiol 2021; 49:370-379. [PMID: 34871672 DOI: 10.1016/j.neurad.2021.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Phosphorous magnetic resonance spectroscopy (31P-MRS) allows a non-invasive analysis of phosphorus-containing compounds in vivo. The present study investigated the influence of brain region, hemisphere, age, sex and brain volume on 31P-MRS metabolites in healthy adults. MATERIALS AND METHODS Supratentorial brain 31P-MRS spectra of 125 prospectively recruited healthy volunteers (64 female, 61 male) aged 20 to 85 years (mean: 49.4 ± 16.9 years) were examined with a 3D-31P-MRS sequence at 3T, and the compounds phosphocreatine (PCr), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were measured. From this data, the metabolite ratios PCr/ATP, Pi/ATP and PCr/Pi were calculated for different brain regions. In addition, volumes of gray matter, white matter and cerebrospinal fluid were determined. RESULTS For all metabolite ratios significant regional differences and in several regions sex differences were found. In some brain regions and for some metabolites hemispheric differences were detected. In addition, changes with aging were found, which differed between women and men. CONCLUSIONS The present results indicate that 31P-MRS metabolism varies throughout the brain, with age and between sexes, and therefore have important practical implications for the design and the interpretation of future 31P-MRS studies under physiological conditions and in patients with various cerebral diseases.
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Affiliation(s)
- Andreas Rietzler
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
| | | | - Raffaella Matteucci Gothe
- UMIT - Center of Statistical Consulting and Continuing Education, Private University for Health Sciences, Medical Informatics and Technology, Hall, Austria.
| | - Michael Schocke
- RKU - University and Rehabilitation Clinics Ulm, Ulm, Germany.
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
| | - Astrid Ellen Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria; Neuroimaging Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
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Changes in Brain Energy and Membrane Metabolism in Glioblastoma following Chemoradiation. Curr Oncol 2021; 28:5041-5053. [PMID: 34940063 PMCID: PMC8700426 DOI: 10.3390/curroncol28060424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/17/2022] Open
Abstract
Brain parenchyma infiltration with glioblastoma (GB) cannot be entirely visualized by conventional magnetic resonance imaging (MRI). The aim of this study was to investigate changes in the energy and membrane metabolism measured with phosphorous MR spectroscopy (31P-MRS) in the presumably “normal-appearing” brain following chemoradiation therapy (CRT) in GB patients in comparison to healthy controls. Twenty (seven female, thirteen male) GB patients underwent a 31P-MRS scan prior to surgery (baseline) and after three months of standard CRT (follow-up examination. The regions of interest “contrast-enhancing (CE) tumor” (if present), “adjacent to the (former) tumor”, “ipsilateral distant” hemisphere, and “contralateral” hemisphere were compared, differentiating between patients with stable (SD) and progressive disease (PD). Metabolite ratios PCr/ATP, Pi/ATP, PCr/Pi, PME/PDE, PME/PCr, and PDE/ATP were investigated. In PD, energy and membrane metabolism in CE tumor areas have a tendency to “normalize” under therapy. In different “normal-appearing” brain areas of GB patients, the energy and membrane metabolism either “normalized” or were “disturbed”, in comparison to baseline or controls. Differences were also detected between patients with SD and PD. 31P-MRS might contribute as an additional imaging biomarker for outcome measurement, which remains to be investigated in a larger cohort.
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Ruhm L, Dorst J, Avdievitch N, Wright AM, Henning A. 3D 31 P MRSI of the human brain at 9.4 Tesla: Optimization and quantitative analysis of metabolic images. Magn Reson Med 2021; 86:2368-2383. [PMID: 34219281 DOI: 10.1002/mrm.28891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/14/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To present 31 P whole brain MRSI with a high spatial resolution to probe quantitative tissue analysis of 31 P MRSI at an ultrahigh field strength of 9.4 Tesla. METHODS The study protocol included a 31 P MRSI measurement with an effective resolution of 2.47 mL. For SNR optimization, the nuclear Overhauser enhancement at 9.4 Tesla was investigated. A sensitivity correction was achieved by applying a low rank approximation of the γ-adenosine triphosphate signal. Group analysis and regression on individual volunteers were performed to investigate quantitative concentration differences between different tissue types. RESULTS Differences in gray and white matter tissue 31 P concentrations could be investigated for 12 different 31 P resonances. In addition, the first highly resolved quantitative MRSI images measured at B0 = 9.4 Tesla of 31 P detectable metabolites with high SNR could be presented. CONCLUSION With an ultrahigh field strength B0 = 9.4 Tesla, 31 P MRSI moves further toward quantitative metabolic imaging, and subtle differences in concentrations between different tissue types can be detected.
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Affiliation(s)
- Loreen Ruhm
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,IMPRS for Cognitive and Systems Neuroscience, Eberhard-Karls University of Tübingen, Germany
| | - Johanna Dorst
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,IMPRS for Cognitive and Systems Neuroscience, Eberhard-Karls University of Tübingen, Germany
| | - Nikolai Avdievitch
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
| | - Andrew Martin Wright
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,IMPRS for Cognitive and Systems Neuroscience, Eberhard-Karls University of Tübingen, Germany
| | - Anke Henning
- High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, Texas, USA
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Ricigliano VA, Tonietto M, Palladino R, Poirion E, De Luca A, Branzoli F, Bera G, Maillart E, Stankoff B, Bodini B. Thalamic energy dysfunction is associated with thalamo-cortical tract damage in multiple sclerosis: A diffusion spectroscopy study. Mult Scler 2021; 27:528-538. [PMID: 33566723 DOI: 10.1177/1352458520921362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diffusion-weighted 1H magnetic resonance spectroscopy (DW-MRS) allows to quantify creatine-phosphocreatine brain diffusivity (ADC(tCr)), whose reduction in multiple sclerosis (MS) has been proposed as a proxy of energy dysfunction. OBJECTIVE To investigate whether thalamic ADC(tCr) changes are associated with thalamo-cortical tract damage in MS. METHODS Twenty patients with MS and 13 healthy controls (HC) were enrolled in a DW-MRS and DW imaging (DWI) study. From DW-MRS, ADC(tCr) and total N-acetyl-aspartate diffusivity (ADC(tNAA)) were extracted in the thalami. Three thalamo-cortical tracts and one non-thalamic control tract were reconstructed from DWI. Fractional anisotropy (FA), mean (MD), axial (AD), and radial diffusivity (RD), reflecting microstructural integrity, were extracted for each tract. Associations between thalamic ADC(tCr) and tract metrics were assessed using linear regression models adjusting for age, sex, thalamic volume, thalamic ADC(tNAA), and tract-specific lesion load. RESULTS Lower thalamic ADC(tCr) was associated with higher MD and RD of thalamo-cortical projections in MS (MD: p = 0.029; RD: p = 0.017), but not in HC (MD: p = 0.625, interaction term between thalamic ADC(tCr) and group = 0.019; RD: p = 0.320, interaction term = 0.05). Thalamic ADC(tCr) was not associated with microstructural changes of the control tract. CONCLUSION Reduced thalamic ADC(tCr) correlates with thalamo-cortical tract damage in MS, showing that pathologic changes in thalamic energy metabolism are associated with structural degeneration of connected fibers.
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Affiliation(s)
- Vito Ag Ricigliano
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Matteo Tonietto
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France / Paris-Saclay University, CEA, CNRS, Inserm, BioMaps, Service Hospitalier Fréderic Joliot, Orsay, France
| | - Raffaele Palladino
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK/Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Emilie Poirion
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | - Alberto De Luca
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Francesca Branzoli
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France / Centre de Neuroimagerie de la Recherche, Paris Brain Institute, ICM, Paris, France
| | - Geraldine Bera
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France
| | | | - Bruno Stankoff
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France / Neurology Department, St Antoine Hospital, APHP, Paris, France
| | - Benedetta Bodini
- Sorbonne University, Paris Brain Institute, ICM, Pitié Salpêtrière Hospital, Inserm UMR S 1127, CNRS UMR 7225, Paris, France / Neurology Department, St Antoine Hospital, APHP, Paris, France
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Hatchondo L, Vallée A, Vallée R, Jaafari N, Maillochaud S, Naudin M, Vallée JN, Guillevin R, Guillevin C. Altered phospholipid and high-energy phosphate metabolism in the basal ganglia and thalamus of severe obsessive compulsive patients with treatment resistance: A phosphorus 31 nuclear magnetic resonance spectroscopy study. Psychiatry Res Neuroimaging 2021; 307:111217. [PMID: 33199172 DOI: 10.1016/j.pscychresns.2020.111217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Cerebral metabolism in obsessive-compulsive-disorder(OCD) has been the subject of numerous studies using proton magnetic resonance spectroscopy(MRS). Despite heterogeneous results, some studies have unraveled membrane turnover and energy metabolism abnormalities in different brain regions, suggesting that alterations in these processes may contribute to the pathophysiology. So far, no authors have explored phospholipids and high-energy phosphate metabolism using 31P-MRS, which allows in vivo quantification of phosphorus metabolites that are considered to be related to membrane turnover and energy metabolism. MATERIALS AND METHODS The aim of our study was to describe and compare brain metabolic changes using 31P-MRS in the striatum and the thalamus, between 23 severe OCD patients and 22 healthy controls. All subject underwent a clinical examination and a same 31P-MRS protocol. RESULTS Significantly, increased concentrations of PC, PDE,PME,GPC,PME/PCr,PDE/PCr were found in patients compared to controls in the striatum and the thalamus. PCr and tATP were decreased in the striatum. Finally, significant correlations were found in the striatum and the thalamus between illness duration and some specific measured parameters. CONCLUSION Our results showed significant modifications of the membrane and energy metabolism in the basal ganglia of severe OCD patients and suggests a link between energetic buffer and serotonin metabolism disorder.
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Affiliation(s)
- Laura Hatchondo
- I3M Laboratory, DACTIM-MIS team, Laboratoire de mathématiques Appliqués (LMA) CNRS 7348, Poitiers University, France
| | - Alexandre Vallée
- I3M Laboratory, DACTIM-MIS team, Laboratoire de mathématiques Appliqués (LMA) CNRS 7348, Poitiers University, France; University Hospital of Poitiers, 2 rue de la milétrie, 86021 Poitiers, France
| | - Rodolphe Vallée
- I3M Laboratory, DACTIM-MIS team, Laboratoire de mathématiques Appliqués (LMA) CNRS 7348, Poitiers University, France; Avicenne University hospital, Paris 13 University, AP-HP, 93009 Bobigny, France
| | - Nemat Jaafari
- Clinical Research Unit of Psychiatry - Henri Laborit Hospital, Poitiers, France; Poitiers University, France.
| | - Sylvie Maillochaud
- Clinical Research Unit of Psychiatry - Henri Laborit Hospital, Poitiers, France.
| | - Mathieu Naudin
- I3M Laboratory, DACTIM-MIS team, Laboratoire de mathématiques Appliqués (LMA) CNRS 7348, Poitiers University, France; University Hospital of Poitiers, 2 rue de la milétrie, 86021 Poitiers, France.
| | - Jean-Noël Vallée
- Amiens-Picardie University Hospital, Picardie Jules Verne (UPJV) University, Amiens, France
| | - Rémy Guillevin
- I3M Laboratory, DACTIM-MIS team, Laboratoire de mathématiques Appliqués (LMA) CNRS 7348, Poitiers University, France; University Hospital of Poitiers, 2 rue de la milétrie, 86021 Poitiers, France.
| | - Carole Guillevin
- I3M Laboratory, DACTIM-MIS team, Laboratoire de mathématiques Appliqués (LMA) CNRS 7348, Poitiers University, France; University Hospital of Poitiers, 2 rue de la milétrie, 86021 Poitiers, France.
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10
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Ostojic SM. Brain creatine for predicting clinical course in white matter disorders. Mult Scler Relat Disord 2020; 45:102441. [DOI: 10.1016/j.msard.2020.102441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
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11
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Abstract
Multiple sclerosis (MS) is a complex and debilitating neurodegenerative disease, with unknown cause(s), unpredictable prognosis, and rather limited treatment options. MS is often accompanied by various metabolic disturbances, with impaired creatine metabolism may play a role in its pathogenesis and the clinical course of the disease. This review summarizes human trials describing alterations in creatine levels in the nervous system and other tissues during MS, affects how certain medications for MS affect brain creatine concentrations, and discusses a possible demand for exogenous creatine as an adjunct therapeutic agent in the management of MS. Creatine metabolism seems to be dysfunctional in MS, indicating a low metabolic state of the brain and other relevant organs in this unpredictable demyelinating disease. A disease-driven brain creatine deficit could be seen as a distinctive pathological facet of severe MS that might be approached with targeted therapies in aim to restore creatine homeostasis.
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Affiliation(s)
- Sergej M Ostojic
- FSPE Applied Bioenergetics Lab, University of Novi Sad, Novi Sad, Serbia.,Faculty of Health Sciences, University of Pecs, Pecs, Hungary
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12
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Phosphorus magnetic resonance spectroscopy and fatigue in multiple sclerosis. J Neural Transm (Vienna) 2020; 127:1177-1183. [DOI: 10.1007/s00702-020-02221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/17/2020] [Indexed: 02/03/2023]
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13
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Kirov II, Tal A. Potential clinical impact of multiparametric quantitative MR spectroscopy in neurological disorders: A review and analysis. Magn Reson Med 2020; 83:22-44. [PMID: 31393032 PMCID: PMC6814297 DOI: 10.1002/mrm.27912] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/06/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Unlike conventional MR spectroscopy (MRS), which only measures metabolite concentrations, multiparametric MRS also quantifies their longitudinal (T1 ) and transverse (T2 ) relaxation times, as well as the radiofrequency transmitter inhomogeneity (B1+ ). To test whether knowledge of these additional parameters can improve the clinical utility of brain MRS, we compare the conventional and multiparametric approaches in terms of expected classification accuracy in differentiating controls from patients with neurological disorders. THEORY AND METHODS A literature review was conducted to compile metabolic concentrations and relaxation times in a wide range of neuropathologies and regions of interest. Simulations were performed to construct receiver operating characteristic curves and compute the associated areas (area under the curve) to examine the sensitivity and specificity of MRS for detecting each pathology in each region. Classification accuracy was assessed using metabolite concentrations corrected using population-averages for T1 , T2 , and B1+ (conventional MRS); using metabolite concentrations corrected using per-subject values (multiparametric MRS); and using an optimal linear multiparametric estimator comprised of the metabolites' concentrations and relaxation constants (multiparametric MRS). Additional simulations were conducted to find the minimal intra-subject precision needed for each parameter. RESULTS Compared with conventional MRS, multiparametric approaches yielded area under the curve improvements for almost all neuropathologies and regions of interest. The median area under the curve increased by 0.14 over the entire dataset, and by 0.24 over the 10 instances with the largest individual increases. CONCLUSIONS Multiparametric MRS can substantially improve the clinical utility of MRS in diagnosing and assessing brain pathology, motivating the design and use of novel multiparametric sequences.
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Affiliation(s)
- Ivan I. Kirov
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, United States of America
| | - Assaf Tal
- Department of Chemical and Biological Physics, Weizmann Institute of Science, 234 Herzel St., Rehovot 7610001, Israel
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14
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Swanberg KM, Landheer K, Pitt D, Juchem C. Quantifying the Metabolic Signature of Multiple Sclerosis by in vivo Proton Magnetic Resonance Spectroscopy: Current Challenges and Future Outlook in the Translation From Proton Signal to Diagnostic Biomarker. Front Neurol 2019; 10:1173. [PMID: 31803127 PMCID: PMC6876616 DOI: 10.3389/fneur.2019.01173] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023] Open
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) offers a growing variety of methods for querying potential diagnostic biomarkers of multiple sclerosis in living central nervous system tissue. For the past three decades, 1H-MRS has enabled the acquisition of a rich dataset suggestive of numerous metabolic alterations in lesions, normal-appearing white matter, gray matter, and spinal cord of individuals with multiple sclerosis, but this body of information is not free of seeming internal contradiction. The use of 1H-MRS signals as diagnostic biomarkers depends on reproducible and generalizable sensitivity and specificity to disease state that can be confounded by a multitude of influences, including experiment group classification and demographics; acquisition sequence; spectral quality and quantifiability; the contribution of macromolecules and lipids to the spectroscopic baseline; spectral quantification pipeline; voxel tissue and lesion composition; T1 and T2 relaxation; B1 field characteristics; and other features of study design, spectral acquisition and processing, and metabolite quantification about which the experimenter may possess imperfect or incomplete information. The direct comparison of 1H-MRS data from individuals with and without multiple sclerosis poses a special challenge in this regard, as several lines of evidence suggest that experimental cohorts may differ significantly in some of these parameters. We review the existing findings of in vivo1H-MRS on central nervous system metabolic abnormalities in multiple sclerosis and its subtypes within the context of study design, spectral acquisition and processing, and metabolite quantification and offer an outlook on technical considerations, including the growing use of machine learning, by future investigations into diagnostic biomarkers of multiple sclerosis measurable by 1H-MRS.
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Affiliation(s)
- Kelley M Swanberg
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - Karl Landheer
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - David Pitt
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States.,Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, United States
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15
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MacMillan EL, Schubert JJ, Vavasour IM, Tam R, Rauscher A, Taylor C, White R, Garren H, Clayton D, Levesque V, Li DK, Kolind SH, Traboulsee AL. Magnetic resonance spectroscopy evidence for declining gliosis in MS patients treated with ocrelizumab versus interferon beta-1a. Mult Scler J Exp Transl Clin 2019; 5:2055217319879952. [PMID: 31662881 PMCID: PMC6796216 DOI: 10.1177/2055217319879952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 01/07/2023] Open
Abstract
Background Magnetic resonance spectroscopy quantitatively monitors biomarkers of
neuron-myelin coupling (N-acetylaspartate (NAA)), and inflammation (total
creatine (tCr), total choline (tCho), myo-inositol (mI)) in the brain. Objective This study aims to investigate how ocrelizumab and interferon beta-1a
differentially affects imaging biomarkers of neuronal-myelin coupling and
inflammation in patients with relapsing multiple sclerosis (MS). Methods Forty patients with relapsing MS randomized to either treatment were scanned
at 3T at baseline and weeks 24, 48, and 96 follow-up. Twenty-four healthy
controls were scanned at weeks 0, 48, and 96. NAA, tCr, tCho, mI, and
NAA/tCr were measured in a single large supra-ventricular voxel. Results There was a time × treatment interaction in NAA/tCr
(p = 0.04), primarily driven by opposing tCr trends between
treatment groups after 48 weeks of treatment. Patients treated with
ocrelizumab showed a possible decline in mI after week 48 week, and stable
tCr and tCho levels. Conversely, the interferon beta-1a treated group showed
possible increases in mI, tCr, and tCho over 96 weeks. Conclusions Results from this exploratory study suggest that over 2 years, ocrelizumab
reduces gliosis compared with interferon beta-1a, demonstrated by declining
ml, and stable tCr and tCho. Ocrelizumab may improve the physiologic milieu
by decreasing neurotoxic factors that are generated by inflammatory
processes.
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Affiliation(s)
| | | | | | - Roger Tam
- Department of Medicine, University of British Columbia
| | | | | | - Rick White
- Statistics, University of British Columbia
| | | | | | | | - David Kb Li
- Department of Radiology, University of British Columbia
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16
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Guillevin C, Agius P, Naudin M, Herpe G, Ragot S, Maubeuge N, Philippe Neau J, Guillevin R. 1 H- 31 P magnetic resonance spectroscopy: effect of biotin in multiple sclerosis. Ann Clin Transl Neurol 2019; 6:1332-1337. [PMID: 31353859 PMCID: PMC6649368 DOI: 10.1002/acn3.50825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 01/05/2023] Open
Abstract
Biotin is thought to improve functional impairment in progressive multiple sclerosis (MS) by upregulating bioenergetic metabolism. We enrolled 19 patients suffering from progressive MS (5 primary and 14 secondary Progressive-MS). Using cerebral multinuclear magnetic resonance spectroscopy (MMRS) and clinical evaluation before and after 6 months of biotin cure, we showed significant modifications of: PME/PDE, ATP, and lactate resonances; an improvement of EDSS Neuroscore. Our results are consistent with metabolic pathways concerned with biotin action and could suggest the usefulness of MMRS for monitoring.
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Affiliation(s)
- Carole Guillevin
- DACTIM‐MIS Team – LMA CNRS 7348Poitiers University Medical CenterPoitiers CedexFrance
- Radiology DepartmentPoitiers University Medical CenterPoitiersFrance
| | - Pierre Agius
- DACTIM‐MIS Team – LMA CNRS 7348Poitiers University Medical CenterPoitiers CedexFrance
- Neurology DepartmentPoitiers University Medical CenterPoitiersFrance
| | - Mathieu Naudin
- DACTIM‐MIS Team – LMA CNRS 7348Poitiers University Medical CenterPoitiers CedexFrance
- Radiology DepartmentPoitiers University Medical CenterPoitiersFrance
| | - Guillaume Herpe
- DACTIM‐MIS Team – LMA CNRS 7348Poitiers University Medical CenterPoitiers CedexFrance
- Radiology DepartmentPoitiers University Medical CenterPoitiersFrance
| | - Stéphanie Ragot
- CIC INSERM 1402Poitiers University Medical CenterPoitiersFrance
| | - Nicolas Maubeuge
- Neurology DepartmentPoitiers University Medical CenterPoitiersFrance
| | | | - Rémy Guillevin
- DACTIM‐MIS Team – LMA CNRS 7348Poitiers University Medical CenterPoitiers CedexFrance
- Radiology DepartmentPoitiers University Medical CenterPoitiersFrance
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17
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Dyslexia and age related effects in the neurometabolites concentration in the visual and temporo-parietal cortex. Sci Rep 2019; 9:5096. [PMID: 30911032 PMCID: PMC6434036 DOI: 10.1038/s41598-019-41473-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/28/2019] [Indexed: 01/18/2023] Open
Abstract
Several etiological theories, in particular neuronal noise and impaired auditory sampling, predicted neurotransmission deficits in dyslexia. Neurometabolites also affect white matter microstructure, where abnormalities were previously reported in dyslexia. However findings from only few magnetic resonance spectroscopy studies using diverse age groups, different brain regions, data processing and reference scaling are inconsistent. We used MEGA-PRESS single-voxel spectroscopy in two ROIs: left temporo-parietal and occipital cortex in 36 adults and 52 children, where half in each group had dyslexia. Dyslexics, on average, had significantly lower total N-acetylaspartate (tNAA) than controls in the occipital cortex. Adults compared to children were characterized by higher choline and creatine in both areas, higher tNAA in left temporo-parietal and lower glutamate in the visual cortex, reflecting maturational changes in cortical microstructure and metabolism. Although the current findings do not support the proposed etiological theories of dyslexia, they show, for the first time, that tNAA, considered to be a neurochemical correlate of white matter integrity, is deficient in the visual cortex in both children and adults with dyslexia. They also point that several neurotransmitters, including ones previously used as reference, change with age.
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18
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Kerschbaumer J, Pinggera D, Steiger R, Rietzler A, Wöhrer A, Riedmann M, Grams AE, Thomé C, Freyschlag CF. Results of Phosphorus Magnetic Resonance Spectroscopy for Brain Metastases Correlate with Histopathologic Results. World Neurosurg 2019; 127:e172-e178. [PMID: 30878742 DOI: 10.1016/j.wneu.2019.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Brain metastases (BMs) are classically well-circumscribed lesions. Still, the amount of edema in these neoplasms suggests either mechanisms of infiltration or defense. A better understanding of the mechanisms within the edema of BMs seems reasonable to preoperatively identify areas of potential infiltration and resect them. BMs represent tumors with high energy demand and cell turnover; therefore, they qualify for preoperative investigation with phosphorus-31 magnetic resonance spectroscopy (31PMRS), which reveals information about those characteristics. METHODS Ten patients with BMs were included in this trial. All underwent preoperative standard magnetic resonance imaging with additional 31PMRS. In all patients, 1 voxel within the contrast-enhancing tumor (CE+), 1 voxel at the border (including CE+ areas and surrounding T2-hyperintensive [T2+] areas), and 1 distant voxel purely including T2+ areas were determined by a neuroradiologist and a neurosurgeon. A frameless stereotactic biopsy was performed after craniotomy. Subsequently, the metabolites of the 31PMRS were analyzed and compared with the histopathologic results. RESULTS Ratios, reflecting resynthesis (CE+/border/T2+: 1.109 ± 0.192/1.112 ± 0.158/1.083 ± 0.097), hydrolysis (0.303 ± 0.089/0.360 ± 0.122/0.321 ± 0.089), energy demand (4.227 ± 2.35/3.453 ± 1.284/3.599 ± 0.833), and membrane turnover (1.239 ± 0.2611/3.453 ± 1.284/3.599 ± 0.283) were calculated and compared intraindividually with a voxel from the contralateral side (resynthesis/hydrolysis/energy demand/membrane turnover: 1.063 ± 0.085/0.335 ± 0.073/3.317 ± 0.7573/0.784 ± 0.186), respectively. Resynthesis showed a trend toward higher ratios in CE+ and border biopsies without reaching statistical significances. This trend was also seen concerning energy demand. Membrane turnover was significantly higher in CE+, border zone, and also in the T2+ areas compared with controls (P > 0.001). CONCLUSIONS 31PMRS in BMs provides information on metabolic changes in tumor and surrounding edema. There is proof of enhanced metabolism in tissue without histologic tumor manifestation.
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Affiliation(s)
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Rietzler
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Adelheid Wöhrer
- Institute of Neurology, Medical University Vienna, Vienna, Austria
| | - Marina Riedmann
- Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid Ellen Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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19
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Ryan MC, Kochunov P, Sherman PM, Rowland LM, Wijtenburg SA, Acheson A, Hong LE, Sladky J, McGuire S. Miniature pig magnetic resonance spectroscopy model of normal adolescent brain development. J Neurosci Methods 2018; 308:173-182. [PMID: 30099002 DOI: 10.1016/j.jneumeth.2018.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND We are developing the miniature pig (Sus scrofa domestica), an in-vivo translational, gyrencephalic model for brain development, as an alternative to laboratory rodents/non-human primates. We analyzed longitudinal changes in adolescent pigs using proton magnetic resonance spectroscopy (1H-MRS) and examined the relationship with white matter (WM) integrity derived from diffusion weighted imaging (DWI). NEW METHOD Twelve female Sinclair™ pigs underwent three imaging/spectroscopy sessions every 23.95 ± 3.73 days beginning at three months of age using a clinical 3 T scanner. 1H-MRS data were collected using 1.2 × 1.0 × 3.0 cm voxels placed in left and right hemisphere WM using a Point Resolved Spectroscopy sequence (TR = 2000 ms, TE = 30 ms). Concentrations of N-acetylaspartate, myo-inositol (MI), glutamate + glutamine, choline, creatine, and macromolecules (MM) 09 and 14 were averaged from both hemispheres. DWI data were collected using 15 shells of b-values (b = 0-3500 s/mm2) with 32 directions/shell and fit using the WM Tract Integrity model to calculate fractional anisotropy (FA), kurtosis anisotropy (KA) and permeability-diffusivity index. RESULTS MI and MM09 significantly declined with age. Increased FA and KA significantly correlated with decline in MI and MM09. Correlations lost significance once corrected for age. COMPARISON WITH EXISTING METHODS MRI scanners/protocols can be used to collect 1H-MRS and DWI data in pigs. Pigs have a larger, more complex, gyrencephalic brain than laboratory rodents but are less complex than non-human primates, thus satisfying the "replacement" principle of animal research. CONCLUSIONS Longitudinal effects in MRS measurements were similar to those reported in adolescent humans. MRS changes correlated with diffusion measurements indicating ongoing WM myelination/maturation.
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Affiliation(s)
- Meghann C Ryan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228, United States.
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228, United States.
| | - Paul M Sherman
- U.S. Air Force School of Aerospace Medicine, Aeromedical Research Department, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433-7913, United States; Department of Radiology, 59thMedical Wing, 1100 Wilford Hall Loop, Bldg 4551, Joint Base San Antonio, TX, 78236, United States.
| | - Laura M Rowland
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228, United States.
| | - S Andrea Wijtenburg
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228, United States.
| | - Ashley Acheson
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St., Little Rock, AR, 72205, United States.
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, 55 Wade Avenue, Catonsville, MD 21228, United States.
| | - John Sladky
- U.S. Air Force School of Aerospace Medicine, Aeromedical Research Department, 2510 5th Street, Building 840, Wright-Patterson AFB, OH 45433-7913, United States; Department of Neurology, 59th Medical Wing, 1100 Wilford Hall Loop, Bldg 4551, Joint Base San Antonio, Lackland AFB, TX, 78236, United States.
| | - Stephen McGuire
- Department of Neurology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States.
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20
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Wang R, Fan Q, Zhang Z, Chen Y, Zhu Y, Li Y. Anterior thalamic radiation structural and metabolic changes in obsessive-compulsive disorder: A combined DTI-MRS study. Psychiatry Res Neuroimaging 2018; 277:39-44. [PMID: 29807209 DOI: 10.1016/j.pscychresns.2018.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/13/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022]
Abstract
Numerous studies indicate the cortico-striato-thalamo-cortical (CSTC) circuit plays an important role in the pathophysiology of obsessive-compulsive disorder (OCD). The anterior thalamic radiation (ATR), as a major fiber in the fronto-thalamic circuitry, contributes to symptomology of OCD. However, the underlying biochemical mechanism in relation with its structural alteration remains not understood. This study investigated the structural abnormality of ATR and its correlation with thalamic metabolic alteration in OCD, using diffusion tensor image (DTI) and proton magnetic resonance spectroscopy (1H-MRS). Twenty-six unmedicated adult OCD patients and twenty-six matched healthy controls participated in DTI study. Thirteen OCD patients and thirteen healthy controls, a subset of DTI participants, took part in MRS study. The results showed that mean fiber length of right ATR negatively correlated with ipsilateral thalamic choline (Cho) level in OCD patients. Additionally, significantly higher Cho concentration was detected in right thalamus of OCD patients compared to healthy controls. Moreover, the mean fractional anisotropy (FA) value of right ATR positively correlated with patients Yale-Brown Obsessive Compulsive Scale (YBOCS) total score, as well as YBOCS compulsion score. These results suggested the coupling of structural and metabolic changes in right ATR, which might serve as a multi-modal biomarker contributing to the pathogenesis of OCD.
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Affiliation(s)
- Ruilin Wang
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qing Fan
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030,China.
| | - Zongfeng Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030,China
| | - Yongjun Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030,China
| | - Yajing Zhu
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yao Li
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
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21
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Vallée A, Lecarpentier Y, Guillevin R, Vallée JN. Demyelination in Multiple Sclerosis: Reprogramming Energy Metabolism and Potential PPARγ Agonist Treatment Approaches. Int J Mol Sci 2018; 19:ijms19041212. [PMID: 29659554 PMCID: PMC5979570 DOI: 10.3390/ijms19041212] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022] Open
Abstract
Demyelination in multiple sclerosis (MS) cells is the site of several energy metabolic abnormalities driven by dysregulation between the opposed interplay of peroxisome proliferator-activated receptor γ (PPARγ) and WNT/β-catenin pathways. We focus our review on the opposing interactions observed in demyelinating processes in MS between the canonical WNT/β-catenin pathway and PPARγ and their reprogramming energy metabolism implications. Demyelination in MS is associated with chronic inflammation, which is itself associated with the release of cytokines by CD4+ Th17 cells, and downregulation of PPARγ expression leading to the upregulation of the WNT/β-catenin pathway. Upregulation of WNT/β-catenin signaling induces activation of glycolytic enzymes that modify their energy metabolic behavior. Then, in MS cells, a large portion of cytosolic pyruvate is converted into lactate. This phenomenon is called the Warburg effect, despite the availability of oxygen. The Warburg effect is the shift of an energy transfer production from mitochondrial oxidative phosphorylation to aerobic glycolysis. Lactate production is correlated with increased WNT/β-catenin signaling and demyelinating processes by inducing dysfunction of CD4+ T cells leading to axonal and neuronal damage. In MS, downregulation of PPARγ decreases insulin sensitivity and increases neuroinflammation. PPARγ agonists inhibit Th17 differentiation in CD4+ T cells and then diminish release of cytokines. In MS, abnormalities in the regulation of circadian rhythms stimulate the WNT pathway to initiate the demyelination process. Moreover, PPARγ contributes to the regulation of some key circadian genes. Thus, PPARγ agonists interfere with reprogramming energy metabolism by directly inhibiting the WNT/β-catenin pathway and circadian rhythms and could appear as promising treatments in MS due to these interactions.
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Affiliation(s)
- Alexandre Vallée
- Délégation à la Recherche Clinique et à l'Innovation (DRCI), Hôpital Foch, 92150 Suresnes, France.
| | - Yves Lecarpentier
- Centre de Recherche Clinique, Grand Hôpital de l'Est Francilien (GHEF), 77100 Meaux, France.
| | - Rémy Guillevin
- Data Analysis and Computations Through Imaging Modeling-Mathématiques (DACTIM), Unité mixte de recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 7348 (Laboratoire de Mathématiques et Application), University of Poitiers, Centre Hospitalier Universitaire (CHU) de Poitiers, 86000 Poitiers, France.
| | - Jean-Noël Vallée
- Centre Hospitalier Universitaire (CHU) Amiens Picardie, University of Picardie Jules Verne (UPJV), 80000 Amiens, France.
- LMA (Laboratoire de Mathématiques et Applications), Unité mixte de recherche (UMR), Centre National de la Recherche Scientifique (CNRS) 7348, Université de Poitiers, 86000 Poitiers, France.
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22
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Schmitz B, Wang X, Barker PB, Pilatus U, Bronzlik P, Dadak M, Kahl KG, Lanfermann H, Ding XQ. Effects of Aging on the Human Brain: A Proton and Phosphorus MR Spectroscopy Study at 3T. J Neuroimaging 2018; 28:416-421. [DOI: 10.1111/jon.12514] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Birte Schmitz
- Institute of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Germany
| | - Xin Wang
- Russell H Morgan Department of Radiology and Radiological Science; Johns Hopkins University School of Medicine; Baltimore MD
- Southeast Nebraska Cancer Center; Lincoln NE
| | - Peter B. Barker
- Russell H Morgan Department of Radiology and Radiological Science; Johns Hopkins University School of Medicine; Baltimore MD
| | - Ulrich Pilatus
- Institute of Neuroradiology; Goethe University; Frankfurt am Main Germany
| | - Paul Bronzlik
- Institute of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Germany
| | - Mete Dadak
- Institute of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Germany
| | - Kai G. Kahl
- Department of Psychiatry; Social Psychiatry and Psychotherapy; Hannover Medical School; Germany
| | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Germany
| | - Xiao-Qi Ding
- Institute of Diagnostic and Interventional Neuroradiology; Hannover Medical School; Germany
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23
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Hatchondo L, Jaafari N, Langbour N, Maillochaud S, Herpe G, Guillevin R, Guillevin C. 1H magnetic resonance spectroscopy suggests neural membrane alteration in specific regions involved in obsessive-compulsive disorder. Psychiatry Res Neuroimaging 2017; 269:48-53. [PMID: 28938221 DOI: 10.1016/j.pscychresns.2017.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/23/2022]
Affiliation(s)
- Laura Hatchondo
- University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France; Clinical Research Unit of Psychiatry - Henri Laborit Hospital, Poitiers, France; DACTIM-MIS team LMA/ CNRS 7348, Poitiers University, France.
| | - Nematollah Jaafari
- Clinical Research Unit of Psychiatry - Henri Laborit Hospital, Poitiers, France.
| | - Nicolas Langbour
- Clinical Research Unit of Psychiatry - Henri Laborit Hospital, Poitiers, France.
| | - Sylvie Maillochaud
- Clinical Research Unit of Psychiatry - Henri Laborit Hospital, Poitiers, France.
| | - Guillaume Herpe
- University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France; Department of Medical Imaging - University Hospital of Poitiers, France; DACTIM-MIS team LMA/ CNRS 7348, Poitiers University, France.
| | - Rémy Guillevin
- University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France; Department of Medical Imaging - University Hospital of Poitiers, France; DACTIM-MIS team LMA/ CNRS 7348, Poitiers University, France.
| | - Carole Guillevin
- University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France; Department of Medical Imaging - University Hospital of Poitiers, France; DACTIM-MIS team LMA/ CNRS 7348, Poitiers University, France.
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24
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Donadieu M, Le Fur Y, Maarouf A, Gherib S, Ridley B, Pini L, Rapacchi S, Confort-Gouny S, Guye M, Schad LR, Maudsley AA, Pelletier J, Audoin B, Zaaraoui W, Ranjeva JP. Metabolic counterparts of sodium accumulation in multiple sclerosis: A whole brain 23Na-MRI and fast 1H-MRSI study. Mult Scler 2017; 25:39-47. [DOI: 10.1177/1352458517736146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Increase of brain total sodium concentrations (TSC) is present in multiple sclerosis (MS), but its pathological involvement has not been assessed yet. Objective: To determine in vivo the metabolic counterpart of brain sodium accumulation. Materials/methods: Whole brain 23Na-MR imaging and 3D-1H-EPSI data were collected in 21 relapsing-remitting multiple sclerosis (RRMS) patients and 20 volunteers. Metabolites and sodium levels were extracted from several regions of grey matter (GM), normal-appearing white matter (NAWM) and white matter (WM) T2 lesions. Metabolic and ionic levels expressed as Z-scores have been averaged over the different compartments and used to explain sodium accumulations through stepwise regression models. Results: MS patients showed significant 23Na accumulations with lower choline and glutamate–glutamine (Glx) levels in GM; 23Na accumulations with lower N-acetyl aspartate (NAA), Glx levels and higher Myo-Inositol (m-Ins) in NAWM; and higher 23Na, m-Ins levels with lower NAA in WM T2 lesions. Regression models showed associations of TSC increase with reduced NAA in GM, NAWM and T2 lesions, as well as higher total-creatine, and smaller decrease of m-Ins in T2 lesions. GM Glx levels were associated with clinical scores. Conclusion: Increase of TSC in RRMS is mainly related to neuronal mitochondrial dysfunction while dysfunction of neuro-glial interactions within GM is linked to clinical scores.
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Affiliation(s)
- Maxime Donadieu
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France/Siemens Healthineers, Saint-Denis, France
| | - Yann Le Fur
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Adil Maarouf
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France/APHM, Timone University Hospital, Department of Neurology, Marseille, FranceCNRS, CRMBM UMR 7339, Medical School of Marseille, Aix-Marseille University, Marseille, France/AP-HM, CHU Timone, Department of Imaging, CEMEREM, Marseille, France/AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Soraya Gherib
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Ben Ridley
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Lauriane Pini
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Stanislas Rapacchi
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Sylviane Confort-Gouny
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Maxime Guye
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Andrew A Maudsley
- Department of Radiology, University of Miami School of Medicine, Miami, FL, USA
| | - Jean Pelletier
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France/APHM, Timone University Hospital, Department of Neurology, Marseille, FranceCNRS, CRMBM UMR 7339, Medical School of Marseille, Aix-Marseille University, Marseille, France/AP-HM, CHU Timone, Department of Imaging, CEMEREM, Marseille, France/AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Bertrand Audoin
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France/APHM, Timone University Hospital, Department of Neurology, Marseille, FranceCNRS, CRMBM UMR 7339, Medical School of Marseille, Aix-Marseille University, Marseille, France/AP-HM, CHU Timone, Department of Imaging, CEMEREM, Marseille, France/AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Wafaa Zaaraoui
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
| | - Jean-Philippe Ranjeva
- Aix-Marseille University, CNRS, CRMBM, APHM, Marseille, France/Timone University Hospital, CEMEREM, Marseille, France
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25
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Wenger KJ, Hattingen E, Franz K, Steinbach J, Bähr O, Pilatus U. In vivo Metabolic Profiles as Determined by 31P and short TE 1H MR-Spectroscopy : No Difference Between Patients with IDH Wildtype and IDH Mutant Gliomas. Clin Neuroradiol 2017; 29:27-36. [PMID: 28983683 DOI: 10.1007/s00062-017-0630-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/15/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Previous ex vivo spectroscopic data from tissue samples revealed differences in phospholipid metabolites between isocitrate dehydrogenase mutated (IDHmut) and IDH wildtype (IDHwt) gliomas. We investigated whether these changes can be found in vivo using 1H-decoupled 31P magnetic resonance spectroscopic imaging (MRSI) with 3D chemical shift imaging (CSI) at 3 T in patients with low and high-grade gliomas. METHODS The study included 33 prospectively enrolled, mostly untreated patients who met spectral quality criteria according to the World Health Organization (WHO II n = 7, WHO III n = 17, WHO IV n = 9; 25 patients IDHmut, 8 patients IDHwt). The MRSI protocol included 1H decoupled 31P MRSI with 3D CSI (3D 31P CSI), 2D 1H CSI and a 1H single voxel spectroscopy sequence (TE 30 ms) from the tumor area. For 1H MRS, absolute metabolite concentration values were calculated (phantom replacement method). For 31P MRS, metabolite intensity ratios were calculated for the choline (C) and ethanolamine (E)-containing metabolites. RESULTS In our patient cohort we did not find significant differences for the ratio of phosphocholine (PC) and phosphoethanolamine (PE), PC/PE, (p = 0.24) for IDHmut compared to IDHwt gliomas. Furthermore, we found no elevated ratios of glycerophosphocholine (GPC) and glycerophosphoethanolamine (GPE), GPC/GPE, (p = 0.68) or GPC/PE (p = 0.12) for IDHmut gliomas. Even the ratio (PC+GPC)/(PE+GPE) showed no significant differences with respect to mutation status (p = 0.16). Nonetheless, changes related to tumor grade regarding intracellular pH (pHi) and phospholipid metabolism as well as absolute metabolite concentrations of co-registered 2D 1H CSI data for tumor and control tissue showed the anticipated results. CONCLUSION Using 3D-CSI data acquisition, in vivo 31P MR spectroscopic measurement of phospholipid metabolites could not distinguish between IDHmut and IDHwt.
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Affiliation(s)
- Katharina J Wenger
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany. .,Institute of Neuroradiology, University Hospital Bonn, Sigmund-Freud Straße 25, 53127, Bonn, Germany.
| | - Kea Franz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Joachim Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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26
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Kirov II, Liu S, Tal A, Wu WE, Davitz MS, Babb JS, Rusinek H, Herbert J, Gonen O. Proton MR spectroscopy of lesion evolution in multiple sclerosis: Steady-state metabolism and its relationship to conventional imaging. Hum Brain Mapp 2017; 38:4047-4063. [PMID: 28523763 DOI: 10.1002/hbm.23647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 04/17/2017] [Accepted: 05/01/2017] [Indexed: 12/21/2022] Open
Abstract
Although MRI assessment of white matter lesions is essential for the clinical management of multiple sclerosis, the processes leading to the formation of lesions and underlying their subsequent MRI appearance are incompletely understood. We used proton MR spectroscopy to study the evolution of N-acetyl-aspartate (NAA), creatine (Cr), choline (Cho), and myo-inositol (mI) in pre-lesional tissue, persistent and transient new lesions, as well as in chronic lesions, and related the results to quantitative MRI measures of T1-hypointensity and T2-volume. Within 10 patients with relapsing-remitting course, there were 180 regions-of-interest consisting of up to seven semi-annual follow-ups of normal-appearing white matter (NAWM, n = 10), pre-lesional tissue giving rise to acute lesions which resolved (n = 3) or persisted (n = 3), and of moderately (n = 9) and severely hypointense (n = 6) chronic lesions. Compared with NAWM, pre-lesional tissue had higher Cr and Cho, while compared with lesions, pre-lesional tissue had higher NAA. Resolving acute lesions showed similar NAA levels pre- and post-formation, suggesting no long-term axonal damage. In chronic lesions, there was an increase in mI, suggesting accumulating astrogliosis. Lesion volume was a better predictor of axonal health than T1-hypointensity, with lesions larger than 1.5 cm3 uniformly exhibiting very low (<4.5 millimolar) NAA concentrations. A positive correlation between longitudinal changes in Cho and in lesion volume in moderately hypointense lesions implied that lesion size is mediated by chronic inflammation. These and other results are integrated in a discussion on the steady-state metabolism of lesion evolution in multiple sclerosis, viewed in the context of conventional MRI measures. Hum Brain Mapp 38:4047-4063, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ivan I Kirov
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Shu Liu
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Assaf Tal
- Department of Chemical Physics, Weizmann Institute of Science, Rehovot, Israel
| | - William E Wu
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Matthew S Davitz
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - James S Babb
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Henry Rusinek
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Joseph Herbert
- Multiple Sclerosis Comprehensive Care Center, New York University Langone Medical Center, New York, New York
| | - Oded Gonen
- Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
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27
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Kauv P, Ayache SS, Créange A, Chalah MA, Lefaucheur JP, Hodel J, Brugières P. Adenosine Triphosphate Metabolism Measured by Phosphorus Magnetic Resonance Spectroscopy: A Potential Biomarker for Multiple Sclerosis Severity. Eur Neurol 2017; 77:316-321. [PMID: 28467982 DOI: 10.1159/000475496] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 03/30/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND/AIMS Phosphorus magnetic resonance spectroscopy (31P-MRS) has previously shown abnormal changes in energy metabolites in the brain of multiple sclerosis (MS) patients. However, the relationship between these energy metabolites - particularly adenosine triphosphate (ATP) - and the disease severity remains unclear. The objective of this study was to determine whether measuring ATP metabolites can help to predict disease severity in MS patients. METHODS 31P-MRS at 3 tesla was performed in 9 relapsing remitting (RRMS), 9 secondary progressive MS patients (SPMS), and 10 age-matched healthy controls. ATP metabolites (expressed as %) in normally appearing white matter of the centrum semiovale were compared between patients and healthy controls. The relationship between Expanded Disability Status Scale (EDSS) and ATP metabolites was evaluated. RESULTS RRMS and SPMS patients had higher phosphocreatine (PCr) and lower phosphodiesters than healthy controls. In addition, RRMS patients had higher β-ATP% than SPMS patients. β-ATP% was negatively correlated with EDSS in all patients. CONCLUSION Our findings suggest a defective PCr metabolism in both patient groups, and a higher state of energy production in RRMS that might reflect a compensatory mechanism in face of the increased needs. The correlation of β-ATP with EDSS makes it a candidate biomarker for assessing MS disease severity.
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Affiliation(s)
- Paul Kauv
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France
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28
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29
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Wenger KJ, Hattingen E, Franz K, Steinbach JP, Bähr O, Pilatus U. Intracellular pH measured by 31 P-MR-spectroscopy might predict site of progression in recurrent glioblastoma under antiangiogenic therapy. J Magn Reson Imaging 2017; 46:1200-1208. [PMID: 28165649 DOI: 10.1002/jmri.25619] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/15/2016] [Indexed: 01/05/2023] Open
Abstract
PURPOSE In solid tumors, changes in the expression/activity of plasma membrane ion transporters facilitate proton efflux and enable tumor cells to maintain a higher intracellular pH (pHi ), while the microenvironment (pHe ) is commonly more acidic. This supports various tumor-promoting mechanisms. We propose that these changes in pH take place before a magnetic resonance imaging (MRI)-detectable brain tumor recurrence occurs. MATERIALS AND METHODS We enrolled 66 patients with recurrent glioblastoma, treated with bevacizumab. Patients received a baseline and 8-week follow-up MRI including 1 H/31 P MRSI (spectroscopy) on a 3T clinical scanner, until progressive disease according to Response Assessment in Neuro-Oncology (RANO) criteria occurred. Fourteen patients showed a distant or diffuse tumor recurrence (subsequent tumor) during treatment and were therefore selected for further evaluation. At the site of the subsequent tumor, an area of interest for MRSI voxel selection was retrospectively defined on radiographically unaffected baseline MRI sequences. RESULTS Before treatment, pHi in the area of interest (subsequent tumor) was significantly higher than pHi of the contralateral normal-appearing tissue (control; P < 0.001). It decreased at the time of best response (P = 0.06), followed by a significant increase at progression (P = 0.03; baseline mean: 7.06, median: 7.068, SD: 0.032; best response mean: 7.044, median: 7.036, SD: 0.025; progression mean: 7.08, median: 7.095, SD 0.035). Until progression, the subsequent tumor was not detectable on standard MRI sequences. The area of existing tumor responded similar, but changes were not significant (decrease P = 0.22; increase P = 0.28). CONCLUSION Elevated pHi in radiographically unaffected tissue at baseline might precede MRI-detectable progression in patients with recurrent glioblastoma treated with bevacizumab. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1200-1208.
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Affiliation(s)
- Katharina J Wenger
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Kea Franz
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oliver Bähr
- Dr. Senckenberg Institute of Neurooncology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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30
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Choi IY, Lee P, Hughes AJ, Denney DR, Lynch SG. Longitudinal changes of cerebral glutathione (GSH) levels associated with the clinical course of disease progression in patients with secondary progressive multiple sclerosis. Mult Scler 2016; 23:956-962. [PMID: 27620894 DOI: 10.1177/1352458516669441] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increased oxidative stress leads to loss of glutathione (GSH). We have reported lower cerebral GSH in patients with secondary progressive multiple sclerosis (SPMS), indicating the involvement of oxidative stress in multiple sclerosis (MS) pathophysiology. OBJECTIVE This study expanded upon our earlier work by examining longitudinal changes in cerebral GSH in patients with SPMS in relation to their clinical status. METHODS A total of 13 patients with SPMS (Expanded Disability Status Scale (EDSS) = 4.0-6.5; MS duration = 21.2 ± 8.7 years) and 12 controls were studied over 3-5 years. GSH mapping was acquired from frontal and parietal regions using a multiple quantum chemical shift imaging technique at 3 T. Clinical assessments of the patient's disability included EDSS, gait, motor strength, ataxia, tremor, brainstem function and vision changes. RESULTS Brain GSH concentrations in patients were lower than those in controls for both baseline and 3- to 5-year follow-ups. Longitudinal GSH changes of patients were associated with their neurologist's blinded appraisal of their clinical progression. Patients judged to have worsening clinical status had significantly greater declines in frontal GSH concentrations than those with stable clinical status. CONCLUSION GSH provides a distinct measure associated with the disease progression in SPMS, possibly due to its dynamic alignment with pathogenic processes of MS related to oxidative stress.
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Affiliation(s)
- In-Young Choi
- Hoglund Brain Imaging Center and Departments of Molecular & Integrative Physiology and Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Phil Lee
- Hoglund Brain Imaging Center and Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Abbey J Hughes
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Douglas R Denney
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Sharon G Lynch
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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31
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Fatigue in Multiple Sclerosis: Assessing Pontine Involvement Using Proton MR Spectroscopic Imaging. PLoS One 2016; 11:e0149622. [PMID: 26895076 PMCID: PMC4760929 DOI: 10.1371/journal.pone.0149622] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 02/03/2016] [Indexed: 12/22/2022] Open
Abstract
Background/Objective The underlying mechanism of fatigue in multiple sclerosis (MS) remains poorly understood. Our study investigates the involvement of the ascending reticular activating system (ARAS), originating in the pontine brainstem, in MS patients with symptoms of fatigue. Methods Female relapsing-remitting MS patients (n = 17) and controls (n = 15) underwent a magnetic resonance spectroscopic imaging protocol at 1.5T. Fatigue was assessed in every subject using the Fatigue Severity Scale (FSS). Using an FSS cut-off of 36, patients were categorized into a low (n = 9, 22 ± 10) or high (n = 10, 52 ± 6) fatigue group. The brain metabolites N-acetylaspartate (NAA) and total creatine (tCr) were measured from sixteen 5x5x10 mm3 spectroscopic imaging voxels in the rostral pons. Results MS patients with high fatigue had lower NAA/tCr concentration in the tegmental pons compared to control subjects. By using NAA and Cr values in the cerebellum for comparison, these NAA/tCr changes in the pons were driven by higher tCr concentration, and that these changes were focused in the WM regions. Discussion/Conclusion Since there were no changes in NAA concentration, the increase in tCr may be suggestive of gliosis, or an imbalanced equilibrium of the creatine and phosphocreatine ratio in the pons of relapsing-remitting MS patients with fatigue.
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Donadieu M, Le Fur Y, Lecocq A, Maudsley AA, Gherib S, Soulier E, Confort-Gouny S, Pariollaud F, Ranjeva MP, Pelletier J, Guye M, Zaaraoui W, Audoin B, Ranjeva JP. Metabolic voxel-based analysis of the complete human brain using fast 3D-MRSI: Proof of concept in multiple sclerosis. J Magn Reson Imaging 2016; 44:411-9. [PMID: 26756662 DOI: 10.1002/jmri.25139] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To detect local metabolic abnormalities over the complete human brain in multiple sclerosis (MS) patients, we used optimized fast volumic echo planar spectroscopic imaging (3D-EPSI). MATERIALS AND METHODS Weighted mean combination of two 3D-EPSI covering the whole brain acquired at 3T in AC-PC and AC-PC+15° axial planes was performed to obtain high-quality metabolite maps for five metabolites: N-acetyl aspartate (NAA), glutamate+glutamine (Glx), choline (Cho), myo-inositol (m-Ins), and creatine+phosphocreatine (tCr). After spatial normalization, maps from 19 patients suffering from relapsing-remitting MS were compared to 19 matched controls using statistical mapping analyses to determine the topography of metabolic abnormalities. Probabilistic white matter (WM) T2 lesion maps and gray matter (GM) atrophy maps were also generated. RESULTS Two-group analysis of variance (ANOVA) (SPM8, P < 0.005, false discovery rate [FDR]-corrected P < 0.05 at the cluster level with age and sex as confounding covariates) comparing patients and controls matched for age and sex showed clusters of abnormal metabolite levels with 1) decreased NAA (around -15%) and Glx (around 20%) predominantly in GM within prefrontal cortices, motor cortices, bilateral thalami, and mesial temporal cortices in line with neuronal/neuro-astrocytic dysfunction; 2) increased m-Ins (around + 20%) inside WM T2 lesions and in the normal-appearing WM of temporal-occipital lobes, suggesting glial activation. CONCLUSION We demonstrate the ability to noninvasively map over the complete brain-from vertex to cerebellum-with a validated sequence, the metabolic abnormalities associated with MS, for characterizing the topography of pathological processes affecting widespread areas of WM and GM and its functional impact. J. Magn. Reson. Imaging 2016;44:411-419.
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Affiliation(s)
- Maxime Donadieu
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France
| | - Yann Le Fur
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France
| | - Angèle Lecocq
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France
| | - Andrew A Maudsley
- Miller School of Medicine, University of Miami, Department of Radiology, Miami, Florida, USA
| | - Soraya Gherib
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Elisabeth Soulier
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France
| | - Sylviane Confort-Gouny
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France
| | - Fanelly Pariollaud
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Marie-Pierre Ranjeva
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Jean Pelletier
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Maxime Guye
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France
| | - Wafaa Zaaraoui
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle d'Imagerie, CEMEREM, Marseille, France
| | - Bertrand Audoin
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France.,AP-HM, CHU Timone, Pôle de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Jean-Philippe Ranjeva
- Aix Marseille Université, CNRS, CRMBM UMR 7339, Medical School of Marseille, Marseille, France
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Hamed SA, Mekkawy MA, Abozaid H. Differential diagnosis of a vanishing brain space occupying lesion in a child. World J Clin Cases 2015; 3:956-964. [PMID: 26601100 PMCID: PMC4644899 DOI: 10.12998/wjcc.v3.i11.956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/30/2015] [Accepted: 08/07/2015] [Indexed: 02/05/2023] Open
Abstract
We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-year-old child admitted to the department of Neurology at September 2009 with a history of subacute onset of fever, anorexia, vomiting, blurring of vision and right hemiparesis since one month. Magnetic resonance imaging (MRI) of the brain revealed presence of intra-axial large mass (25 mm × 19 mm) in the left temporal lobe and the brainstem which showed hypointense signal in T1W and hyperintense signals in T2W and fluid attenuated inversion recovery (FLAIR) images and homogenously enhanced with gadolinium (Gd). It was surrounded by vasogenic edema with mass effect. Intravenous antibiotics, mannitol (2 g/12 h per 2 d) and dexamethasone (8 mg/12 h) were given to relief manifestations of increased intracranial pressure. Whole craniospinal radiotherapy (brain = 4000 CGy/20 settings per 4 wk; Spinal = 2600/13 settings per 3 wk) was given based on the high suspicion of neoplastic lesion (lymphoma or glioma). Marked clinical improvement (up to complete recovery) occurred within 15 d. Tapering of the steroid dose was done over the next 4 mo. Follow up with MRI after 3 mo showed small lesion in the left antero-medial temporal region with hypointense signal in T1W and hyperintense signals in T2W and FLAIR images but did not enhance with Gd. At August 2012, the patient developed recurrent generalized epilepsy. His electroencephalography showed the presence of left temporal focus of epileptic activity. MRI showed the same lesion as described in the follow up. The diffusion weighted images were normal. The seizures frequency was decreased with carbamazepine therapy (300 mg/12 h). At October 2014, single voxel proton (1H) MR spectroscopy (MRS) showed reduced N-acetyl-aspartate (NAA)/creatine (Cr), choline (Cho)/Cr, NAA/Cho ratios consistent with absence of a neoplasm and highly suggested presence of gliosis. A solitary brain mass in a child poses a considerable diagnostic difficulty. MRS provided valuable diagnostic differentiation between tumor and pseudotumor lesions.
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Vigneswaran S, Rojas JHV, Garvey L, Taylor-Robinson S, Winston A. Differences in the variability of cerebral proton magnetic resonance spectroscopy (1H-MRS) measurements within three HIV-infected cohorts. Neuroradiol J 2015; 28:545-54. [PMID: 26493269 DOI: 10.1177/1971400915609867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Cerebral functional impairment remains prevalent in effectively treated HIV-infected subjects. As the results of formal cognitive testing are highly variable, surrogate markers to accurately measure cerebral function parameters are needed. Such markers include measurement of cerebral metabolite ratios (CMR) using proton magnetic resonance spectroscopy (1H-MRS). However, data on the inter-subject variability of CMR are sparse. Our aim was to assess inter-subject variability in CMRs within three different HIV-infected cohorts. METHODS Cerebral 1H-MRS was performed using a Phillips Achieva™ 1.5 Tesla magnetic resonance scanner in HIV-infected subjects as follows: 12 subjects before (group 1) and after intensification of antiretroviral therapy with maraviroc (group 2) and 13 subjects with acute viral hepatitis C (HCV) co-infection (group 3). The coefficients of variation (CV) for CMRs in each group were determined and compared using non-parametric tests to determine whether the inter-subject variability differed significantly. All baseline characteristics between the groups were similar. RESULTS Overall CVs for all CMRs in groups 1, 2 and 3 were 32.3%, 33.2% and 23.4%, respectively (group 1 vs. 2, p=0.863; group 1 vs. 3, p=0.076). On testing for differences in variability between individual CMRs, two metabolites in the right basal ganglia (RBG) had statistically significantly different CVs when comparing group 1 with group 3: N-acetyl aspartate/creatine (NAA/Cr), p=0.029 and myo-Inositol/creatine (mI/Cr), p=0.016. CONCLUSION The variability of 1H MRS-measurable CMRs in HIV-infected individuals was lower in those with acute HCV co-infection (group 3).We can conclude that the use of these CMRs in 1H MRS imaging in patients with HIV/acute HCV co-infection is more reliable to assess cerebral function than in patients with HIV infection alone. This has implications for future sample size estimations.
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Affiliation(s)
| | - Jaime H Vera Rojas
- Division of medicine, Brighton and Sussex Medical School Department of HIV and GU Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Lucy Garvey
- Department of HIV and GU Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Simon Taylor-Robinson
- Department of Medicine, Faculty of Medicine, Imperial College London, St Mary's Hospital Campus, London, UK
| | - Alan Winston
- Department of HIV and GU Medicine, Imperial College Healthcare NHS Trust, London, UK
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Ciccarelli O, Barkhof F, Bodini B, Stefano ND, Golay X, Nicolay K, Pelletier D, Pouwels PJW, Smith SA, Wheeler-Kingshott CAM, Stankoff B, Yousry T, Miller DH. Pathogenesis of multiple sclerosis: insights from molecular and metabolic imaging. Lancet Neurol 2014; 13:807-22. [DOI: 10.1016/s1474-4422(14)70101-2] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Amorini AM, Nociti V, Petzold A, Gasperini C, Quartuccio E, Lazzarino G, Di Pietro V, Belli A, Signoretti S, Vagnozzi R, Lazzarino G, Tavazzi B. Serum lactate as a novel potential biomarker in multiple sclerosis. Biochim Biophys Acta Mol Basis Dis 2014; 1842:1137-43. [DOI: 10.1016/j.bbadis.2014.04.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/13/2014] [Accepted: 04/04/2014] [Indexed: 12/26/2022]
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Weidauer S, Nichtweiss M, Hattingen E. Differential diagnosis of white matter lesions: Nonvascular causes-Part II. Clin Neuroradiol 2014; 24:93-110. [PMID: 24519493 DOI: 10.1007/s00062-013-0267-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/17/2013] [Indexed: 12/29/2022]
Abstract
The knowledge of characteristic lesion patterns is important in daily practice imaging, as the radiologist increasingly is required to provide precise differential diagnosis despite unspecific clinical symptoms like cognitive impairment and missed elaborated neurological workup. This part II dealing with nonvascular white matter changes of proven cause and diagnostic significance aimed to assist the evaluation of diseases exhibiting lesions exclusively or predominantly located in the white matter. The etiologies commented on are classified as follows: (a) toxic-metabolic, (b) leukodystrophies and mitochondriopathies, (c) infectious, (d) neoplastic, and (e) immune mediated. The respective mode of lesion formation is characterized, and typical radiological findings are displayed. More or less symmetrical lesion patterns on the one hand as well as focal and multifocal ones on the other are to be analyzed with reference to clinical data and knowledge of predilection sites characterizing major disease categories. Complementing spinal cord imaging may be useful not only in acute and relapsing demyelinating diseases but in certain leukodystrophies as well. In neuromyelitis optica (NMO), the detection of a specific antibody and some recently published observations may lead to a new understanding of certain deep white matter lesions occasionally complicating systemic autoimmune disease.
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Affiliation(s)
- S Weidauer
- Department of Neurology, Sankt Katharinen Hospital, Teaching Hospital of the Goethe University, Seckbacher Landstraße 65, 60389, Frankfurt am Main, Germany,
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Novak J, Wilson M, Macpherson L, Arvanitis TN, Davies NP, Peet AC. Clinical protocols for ³¹P MRS of the brain and their use in evaluating optic pathway gliomas in children. Eur J Radiol 2014; 83:e106-12. [PMID: 24331847 PMCID: PMC4029084 DOI: 10.1016/j.ejrad.2013.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 10/28/2013] [Accepted: 11/02/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In vivo (31)P Magnetic Resonance Spectroscopy (MRS) measures phosphorus-containing metabolites that play an essential role in many disease processes. An advantage over (1)H MRS is that total choline can be separated into phosphocholine and glycerophosphocholine which have opposite associations with tumour grade. We demonstrate (31)P MRS can provide robust metabolic information on an acceptable timescale to yield information of clinical importance. METHODS All MRI examinations were carried out on a 3T whole body scanner with all (31)P MRS scans conducted using a dual-tuned (1)H/(31)P head coil. Once optimised on phantoms, the protocol was tested in six healthy volunteers (four male and two female, mean age: 25±2.7). (31)P MRS was then implemented on three children with optic pathway gliomas. RESULTS (31)P MRS on volunteers showed that a number of metabolite ratios varied significantly (p<0.05 ANOVA) across different structures of the brain, whereas PC/GPC did not. Standard imaging showed the optic pathway gliomas were enhancing on T1-weighted imaging after contrast injection and have high tCho on (1)H MRS, both of which are associated with high grade lesions. (31)P MRS showed the phosphocholine/glycerophosphocholine ratio to be low (<0.6) which suggests low grade tumours in keeping with their clinical behaviour and the histology of most biopsied optic pathway gliomas. CONCLUSION (31)P MRS can be implemented in the brain as part of a clinical protocol to provide robust measurement of important metabolites, in particular providing a greater understanding of cases where tCho is raised on (1)H MRS.
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Affiliation(s)
- Jan Novak
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Birmingham Children's Hospital, Birmingham, United Kingdom.
| | - Martin Wilson
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Birmingham Children's Hospital, Birmingham, United Kingdom.
| | | | - Theodoros N Arvanitis
- Birmingham Children's Hospital, Birmingham, United Kingdom; School of Electronic, Electrical and Computer Engineering, University of Birmingham, Birmingham, United Kingdom.
| | - Nigel P Davies
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Birmingham Children's Hospital, Birmingham, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Medical Physics RRPPS, Birmingham, United Kingdom.
| | - Andrew C Peet
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Birmingham Children's Hospital, Birmingham, United Kingdom.
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Morris G, Maes M. Myalgic encephalomyelitis/chronic fatigue syndrome and encephalomyelitis disseminata/multiple sclerosis show remarkable levels of similarity in phenomenology and neuroimmune characteristics. BMC Med 2013; 11:205. [PMID: 24229326 PMCID: PMC3847236 DOI: 10.1186/1741-7015-11-205] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 08/15/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND 'Encephalomyelitis disseminata' (multiple sclerosis) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are both classified as diseases of the central nervous system by the World Health Organization. This review aims to compare the phenomenological and neuroimmune characteristics of MS with those of ME/CFS. DISCUSSION There are remarkable phenomenological and neuroimmune overlaps between both disorders. Patients with ME/CFS and MS both experience severe levels of disabling fatigue and a worsening of symptoms following exercise and resort to energy conservation strategies in an attempt to meet the energy demands of day-to-day living. Debilitating autonomic symptoms, diminished cardiac responses to exercise, orthostatic intolerance and postural hypotension are experienced by patients with both illnesses. Both disorders show a relapsing-remitting or progressive course, while infections and psychosocial stress play a large part in worsening of fatigue symptoms. Activated immunoinflammatory, oxidative and nitrosative (O+NS) pathways and autoimmunity occur in both illnesses. The consequences of O+NS damage to self-epitopes is evidenced by the almost bewildering and almost identical array of autoantibodies formed against damaged epitopes seen in both illnesses. Mitochondrial dysfunctions, including lowered levels of ATP, decreased phosphocreatine synthesis and impaired oxidative phosphorylation, are heavily involved in the pathophysiology of both MS and ME/CFS. The findings produced by neuroimaging techniques are quite similar in both illnesses and show decreased cerebral blood flow, atrophy, gray matter reduction, white matter hyperintensities, increased cerebral lactate and choline signaling and lowered acetyl-aspartate levels. SUMMARY This review shows that there are neuroimmune similarities between MS and ME/CFS. This further substantiates the view that ME/CFS is a neuroimmune illness and that patients with MS are immunologically primed to develop symptoms of ME/CFS.
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Affiliation(s)
- Gerwyn Morris
- Tir Na Nog, Pembrey, Llanelli, UK
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Michael Maes
- Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
- Department of Psychiatry, Deakin University, Geelong, Australia
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Rovira A, Auger C, Alonso J. Magnetic resonance monitoring of lesion evolution in multiple sclerosis. Ther Adv Neurol Disord 2013; 6:298-310. [PMID: 23997815 DOI: 10.1177/1756285613484079] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Disease activity in multiple sclerosis (MS) is strongly linked to the formation of new lesions, which involves a complex sequence of inflammatory, degenerative, and reparative processes. Conventional magnetic resonance imaging (MRI) techniques, such as T2-weighted and gadolinium-enhanced T1-weighted sequences, are highly sensitive in demonstrating the spatial and temporal dissemination of demyelinating plaques in the brain and spinal cord. Hence, these techniques can provide quantitative assessment of disease activity in patients with MS, and they are commonly used in monitoring treatment efficacy in clinical trials and in individual cases. However, the correlation between conventional MRI measures of disease activity and the clinical manifestations of the disease, particularly irreversible disability, is weak. This has been explained by a process of exhaustion of both structural and functional redundancies that increasingly prevents repair and recovery, and by the fact that these imaging techniques do not suffice to explain the entire spectrum of the disease process and lesion development. Nonconventional MRI techniques, such as magnetization transfer imaging, diffusion-weighted imaging, and proton magnetic resonance spectroscopy, which can selectively measure the more destructive aspects of MS pathology and monitor the reparative mechanisms of this disease, are increasingly being used for serial analysis of new lesion formation and provide a better approximation of the pathological substrate of MS plaques. These nonconventional MRI-based measures better assess the serial changes in newly forming lesions and improve our understanding of the relationship between the damaging and reparative mechanisms that occur in MS.
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Affiliation(s)
- Alex Rovira
- Magnetic Resonance Unit (IDI), Department of Radiology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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Wagner M, Jurcoane A, Hildebrand C, Güresir E, Vatter H, Zanella FE, Berkefeld J, Pilatus U, Hattingen E. Metabolic changes in patients with aneurysmal subarachnoid hemorrhage apart from perfusion deficits: neuronal mitochondrial injury? AJNR Am J Neuroradiol 2013; 34:1535-41. [PMID: 23436053 DOI: 10.3174/ajnr.a3420] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neuronal damage in aSAH apart from perfusion deficits has been widely discussed. We aimed to test if cerebral injury occurs in aSAH independently from visible perfusion deficit by measuring cerebral metabolites in patients with aSAH without infarction or impaired perfusion. MATERIALS AND METHODS We performed 3T MR imaging including (1)H-MR spectroscopy, DWI, and MR perfusion in 58 patients with aSAH and 11 age-matched and sex-matched control patients with incidental aneurysm. We compared changes of NAA, Cho, Glx, Lac, and Cr between all patients with aSAH and controls, between patients with and without visible perfusion deficit or infarction and controls, and between patients with and without visible perfusion deficit or infarction by using the Wilcoxon signed-rank test. RESULTS We found that NAA significantly (P < .005) decreased in all patients with aSAH. Cho was significantly increased in all patients compared with controls (P < .05). In patients without impaired perfusion or infarction, Glx was significantly decreased compared with both controls (P = .005) and patients with impaired perfusion or infarction (P = .006). CONCLUSIONS The significant decrease of NAA and Glx in patients with aSAH but without impaired perfusion or infarction strongly suggests global metabolic changes independent from visible perfusion deficits that might reflect neuronal mitochondrial injury. Further, impaired perfusion in aSAH seems to induce additional metabolic changes from increasing neuronal stress that might, to some extent, mask the global metabolic changes.
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Rovira A, Alonso J. 1H magnetic resonance spectroscopy in multiple sclerosis and related disorders. Neuroimaging Clin N Am 2013; 23:459-74. [PMID: 23928200 DOI: 10.1016/j.nic.2013.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Proton magnetic resonance spectroscopy ((1)H-MRS) is an unconventional technique that allows noninvasive characterization of metabolic abnormalities in the central nervous system. (1)H-MRS provides important insights into the chemical-pathologic changes that occur in patients with multiple sclerosis (MS). In this review article we present the main brain and spinal cord (1)H-MRS features in MS, their diagnostic value in differentiating pseudotumoral demyelinating lesions from primary brain tumors, and their relationship with clinical variables. Last, some data related to the use of (1)H-MRS in therapeutic trials is presented.
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Affiliation(s)
- Alex Rovira
- Department of Radiology, Magnetic Resonance Unit (IDI), Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Barcelona 08035, Spain.
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Biomarkers in Multiple Sclerosis: An Up-to-Date Overview. Mult Scler Int 2013; 2013:340508. [PMID: 23401777 PMCID: PMC3564381 DOI: 10.1155/2013/340508] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/13/2012] [Accepted: 12/18/2012] [Indexed: 12/16/2022] Open
Abstract
During the last decades, the effort of establishing satisfactory biomarkers for multiple sclerosis has been proven to be very difficult, due to the clinical and pathophysiological complexities of the disease. Recent knowledge acquired in the domains of genomics-immunogenetics and neuroimmunology, as well as the evolution in neuroimaging, has provided a whole new list of biomarkers. This variety, though, leads inevitably to confusion in the effort of decision making concerning strategic and individualized therapeutics. In this paper, our primary goal is to provide the reader with a list of the most important characteristics that a biomarker must possess in order to be considered as reliable. Additionally, up-to-date biomarkers are further divided into three subgroups, genetic-immunogenetic, laboratorial, and imaging. The most important representatives of each category are presented in the text and for the first time in a summarizing workable table, in a critical way, estimating their diagnostic potential and their efficacy to correlate with phenotypical expression, neuroinflammation, neurodegeneration, disability, and therapeutical response. Special attention is given to the "gold standards" of each category, like HLA-DRB1∗ polymorphisms, oligoclonal bands, vitamin D, and conventional and nonconventional imaging techniques. Moreover, not adequately established but quite promising, recently characterized biomarkers, like TOB-1 polymorphisms, are further discussed.
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Brennan BP, Rauch SL, Jensen JE, Pope HG. A critical review of magnetic resonance spectroscopy studies of obsessive-compulsive disorder. Biol Psychiatry 2013; 73:24-31. [PMID: 22831979 PMCID: PMC3504626 DOI: 10.1016/j.biopsych.2012.06.023] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/22/2012] [Accepted: 06/22/2012] [Indexed: 01/07/2023]
Abstract
Functional neuroimaging studies have converged to suggest that cortico-striatal-thalamo-cortical (CSTC) circuit dysfunction is a core pathophysiologic feature of obsessive-compulsive disorder (OCD). Now, complementary approaches examining regional neurochemistry are beginning to yield additional insights with regard to the neurobiology of aberrant CSTC circuitry in OCD. In particular, proton magnetic resonance spectroscopy, which allows for the in vivo quantification of various neurochemicals in the CSTC circuit and other brain regions, has recently been used extensively in studies of OCD patients. In this review, we summarize the diverse and often seemingly inconsistent findings of these studies, consider methodological factors that might help to explain these inconsistencies, and discuss several convergent findings that tentatively seem to be emerging. We conclude with suggestions for possible future proton magnetic resonance spectroscopy studies in OCD.
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Affiliation(s)
- Brian P Brennan
- Biological Psychiatry Laboratory, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
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Levin BE, Katzen HL, Maudsley A, Post J, Myerson C, Govind V, Nahab F, Scanlon B, Mittel A. Whole-brain proton MR spectroscopic imaging in Parkinson's disease. J Neuroimaging 2012; 24:39-44. [PMID: 23228009 DOI: 10.1111/j.1552-6569.2012.00733.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 05/03/2012] [Accepted: 05/28/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE To examine the distributions of proton magnetic resonance spectroscopy (MRS) observed metabolites in Parkinson's disease (PD) throughout the whole brain. METHODS Twelve PD patients and 18 age-matched controls were studied using neuropsychological testing, MRI and volumetric MR spectroscopic imaging. Average values of signal normalized metabolite values for N-acetyl-aspartate, total-creatine, and total-choline (NAA, total-Cre, total-Cho, respectively) and their ratios were calculated for gray matter (GM) and white matter (WM) in each lobar brain region. RESULTS Analyses revealed altered metabolite values in PD subjects relative to controls within the GM of the temporal lobe (right: elevated Cre, P = .027; decreased NAA/Cre, P = .019; decreased Cho/Cre, P = .001 and left: decreased NAA/Cre; P = .001, decreased Cho/Cre, P = .007); the right occipital lobe (decreased NAA, P = .032 and NAA/Cre, P = .016); and the total cerebrum GM (decreased NAA/Cre, P = .029). No meaningful correlations were obtained between abnormal metabolite values and the neuropsychological measures. CONCLUSIONS PD is associated with widespread alterations of brain metabolite concentrations, with a primary finding of increased creatine. Higher creatine values in our PD sample may reflect greater neuronal energy expenditure early in the disease process that is compensatory. This is the first whole brain MRS study of PD that has examined metabolite changes across a large fraction of the brain volume, including the cortical mantle.
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Affiliation(s)
- Bonnie E Levin
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL; Department of Psychology, University of Miami, Coral Gables, FL
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Kirov II, Tal A, Babb JS, Herbert J, Gonen O. Serial proton MR spectroscopy of gray and white matter in relapsing-remitting MS. Neurology 2012; 80:39-46. [PMID: 23175732 DOI: 10.1212/wnl.0b013e31827b1a8c] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize and follow the diffuse gray and white matter (GM/WM) metabolic abnormalities in early relapsing-remitting multiple sclerosis using proton magnetic resonance spectroscopic imaging ((1)H-MRSI). METHODS Eighteen recently diagnosed, mildly disabled patients (mean baseline time from diagnosis 32 months, mean Expanded Disability Status Scale [EDSS] score 1.3), all on immunomodulatory medication, were scanned semiannually for 3 years with T1-weighted and T2-weighted MRI and 3D (1)H-MRSI at 3 T. Ten sex- and age-matched controls were followed annually. Global absolute concentrations of N-acetylaspartate (NAA), choline (Cho), creatine (Cr), and myo-inositol (mI) were obtained for all GM and WM in the 360 cm(3) (1)H-MRSI volume of interest. RESULTS Patients' average WM Cr, Cho, and mI concentrations (over all time points), 5.3 ± 0.4, 1.6 ± 0.1, and 5.1 ± 0.7 mM, were 8%, 12%, and 11% higher than controls' (p ≤ 0.01), while their WM NAA, 7.4 ± 0.7 mM, was 6% lower (p = 0.07). There were increases with time of patients' WM Cr: 0.1 mM/year, Cho: 0.02 mM/year, and NAA: 0.1 mM/year (all p < 0.05). None of the patients' metabolic concentrations correlated with their EDSS score, relapse rate, GM/WM/CSF fractions, or lesion volume. CONCLUSIONS Diffuse WM glial abnormalities were larger in magnitude than the axonal abnormalities and increased over time independently of conventional clinical or imaging metrics and despite immunomodulatory treatment. In contrast, the axonal abnormalities showed partial recovery, suggesting that patients' lower WM NAA levels represented a dysfunction, which may abate with treatment. Absence of detectable diffuse changes in GM suggests that injury there is minimal, focal, or heterogeneous between cortex and deep GM nuclei.
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Affiliation(s)
- Ivan I Kirov
- Department of Radiology, New York University School of Medicine, New York, NY, USA
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Mellergård J, Tisell A, Dahlqvist Leinhard O, Blystad I, Landtblom AM, Blennow K, Olsson B, Dahle C, Ernerudh J, Lundberg P, Vrethem M. Association between change in normal appearing white matter metabolites and intrathecal inflammation in natalizumab-treated multiple sclerosis. PLoS One 2012; 7:e44739. [PMID: 23028598 PMCID: PMC3444490 DOI: 10.1371/journal.pone.0044739] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/06/2012] [Indexed: 12/22/2022] Open
Abstract
Background Multiple sclerosis (MS) is associated not only with focal inflammatory lesions but also diffuse pathology in the central nervous system (CNS). Since there is no firm association between the amount of focal inflammatory lesions and disease severity, diffuse pathology in normal appearing white matter (NAWM) may be crucial for disease progression. Immunomodulating treatments for MS reduce the number of focal lesions, but possible effects on diffuse white matter pathology are less studied. Furthermore, it is not known whether intrathecal levels of inflammatory or neurodegenerative markers are associated with development of pathology in NAWM. Methods Quantitative proton magnetic resonance spectroscopy (1H-MRS) was used to investigate NAWM in 27 patients with relapsing MS before and after one year of treatment with natalizumab as well as NAWM in 20 healthy controls at baseline. Changes in 1H-MRS metabolite concentrations during treatment were also correlated with a panel of intrathecal markers of inflammation and neurodegeneration in 24 of these 27 patients. Results The group levels of 1H-MRS metabolite concentrations were unchanged pre-to posttreatment, but a pattern of high magnitude correlation coefficients (r = 0.43–0.67, p<0.0005–0.03) were found between changes in individual metabolite concentrations (total creatine and total choline) and levels of pro-inflammatory markers (IL-1β and CXCL8). Conclusions Despite a clinical improvement and a global decrease in levels of inflammatory markers in cerebrospinal fluid during treatment, high levels of pro-inflammatory CXCL8 and IL-1β were associated with an increase in 1H-MRS metabolites indicative of continued gliosis development and membrane turnover in NAWM.
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Affiliation(s)
- Johan Mellergård
- Neurology, Department of Clinical and Experimental Medicine, Division of Neuroscience, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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van Horssen J, Witte ME, Ciccarelli O. The role of mitochondria in axonal degeneration and tissue repair in MS. Mult Scler 2012; 18:1058-67. [PMID: 22723572 DOI: 10.1177/1352458512452924] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Axonal injury is a key feature of multiple sclerosis (MS) pathology and is currently seen as the main correlate for permanent clinical disability. Although little is known about the pathogenetic mechanisms that drive axonal damage and loss, there is accumulating evidence highlighting the central role of mitochondrial dysfunction in axonal degeneration and associated neurodegeneration. The aim of this topical review is to provide a concise overview on the involvement of mitochondrial dysfunction in axonal damage and destruction in MS. Hereto, we will discuss putative pathological mechanisms leading to mitochondrial dysfunction and recent imaging studies performed in vivo in patients with MS. Moreover, we will focus on molecular mechanisms and novel imaging studies that address the role of mitochondrial metabolism in tissue repair. Finally, we will briefly review therapeutic strategies aimed at improving mitochondrial metabolism and function under neuroinflammatory conditions.
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Affiliation(s)
- J van Horssen
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, The Netherlands.
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Kauppinen RA. Magnetic resonance imaging reveals slow-down of global cerebral oxygen metabolism in multiple sclerosis. J Cereb Blood Flow Metab 2012; 32:401-2. [PMID: 22214902 PMCID: PMC3293126 DOI: 10.1038/jcbfm.2011.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Risto A Kauppinen
- School of Experimental Psychology and Clinical Research and Imaging Centre, University of Bristol, Bristol, UK.
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