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Sastre-Garriga J, Vidal-Jordana A, Toosy AT, Enzinger C, Granziera C, Frederiksen J, Ciccarelli O, Filippi M, Montalban X, Tintore M, Pareto D, Rovira À. Value of Optic Nerve MRI in Multiple Sclerosis Clinical Management: A MAGNIMS Position Paper and Future Perspectives. Neurology 2024; 103:e209677. [PMID: 39018513 PMCID: PMC11271394 DOI: 10.1212/wnl.0000000000209677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/17/2024] [Indexed: 07/19/2024] Open
Abstract
The optic nerve is frequently involved in multiple sclerosis (MS). However, MRI of the optic nerve is considered optional in the differential diagnosis of optic neuropathy symptoms either at presentation or in established MS. In addition, unlike spinal cord imaging in comparable scenarios, no role is currently recommended for optic nerve MRI in patients presenting with optic neuritis for its confirmation, to plan therapeutic strategy, within the MS diagnostic framework, nor for the detection of subclinical activity in established MS. In this article, evidence related to these 3 aspects will be summarized and gaps in knowledge will be highlighted, including (1) the acquisition challenges and novel sequences that assess pathologic changes within the anterior visual pathways; (2) the clinical implications of quantitative magnetic resonance studies of the optic nerve, focusing on atrophy measures, magnetization transfer, and diffusion tensor imaging; and (3) the relevant clinical studies performed to date. Finally, an algorithm for the application of optic nerve MRI will be proposed to guide future studies aimed at addressing our knowledge gaps.
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Affiliation(s)
- Jaume Sastre-Garriga
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Angela Vidal-Jordana
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Ahmed T Toosy
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Christian Enzinger
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Cristina Granziera
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Jette Frederiksen
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Olga Ciccarelli
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Massimo Filippi
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Xavier Montalban
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Mar Tintore
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Deborah Pareto
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
| | - Àlex Rovira
- From the Department of Neurology (J.S.-G., A.V.-J., X.M., M.T.), Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain; NMR Research Unit (A.T.T.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, United Kingdom; Department of Neurology and Division of Neuroradiology (C.E.), Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Austria; Translational Imaging in Neurology (ThINk) Basel (C.G.), Department of Biomedical Engineering, Faculty of Medicine, University of Basel; Neurology Department and MS Center, University Hospital Basel, Switzerland; Department of Neurology (J.F.), Rigshospitalet-Glostrup, and University of Copenhagen, Glostrup, Denmark; NMR Research Unit (O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research, United Kingdom; Neuroimaging Research Unit (M.F.), Division of Neuroscience and Neurology Unit, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy; and Section of Neuroradiology and Magnetic Resonance Unit (D.P., A.R.), Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
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Rovira À, Vidal-Jordana A, Auger C, Sastre-Garriga J. Optic Nerve Imaging in Multiple Sclerosis and Related Disorders. Neuroimaging Clin N Am 2024; 34:399-420. [PMID: 38942524 DOI: 10.1016/j.nic.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Optic neuritis is a common feature in multiple sclerosis and in 2 other autoimmune demyelinating disorders such as aquaporin-4 IgG antibody-associated neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Although serologic testing is critical for differentiating these different autoimmune-mediated disorders, MR imaging, which is the preferred imaging modality for assessing the optic nerve, can provide valuable information, suggesting a specific diagnosis and guiding the appropriate serologic testing.
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Affiliation(s)
- Àlex Rovira
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain.
| | - Angela Vidal-Jordana
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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Rovira À, Auger C, Sceppacuercia S, Torres C. Typical and Emerging Diagnostic MRI Features in Multiple Sclerosis. Can Assoc Radiol J 2024:8465371241261847. [PMID: 39044390 DOI: 10.1177/08465371241261847] [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: 07/25/2024] Open
Abstract
Magnetic resonance imaging (MRI) stands as the most sensitive paraclinical technique for detecting the demyelinating lesions characteristic of multiple sclerosis (MS). Consequently, MRI plays a pivotal role in establishing an accurate and timely diagnosis of the disease, ultimately based on the application of the McDonald criteria. Early diagnosis is particularly important as it facilitates the prompt initiation of disease-modifying treatments, deemed most effective during the initial phases of MS. This review article examines the recommended standardized MRI protocol, as well as the classic imaging features of MS in the brain, optic nerve, and spinal cord, capable of discriminating, in most cases, MS from other disorders that can mimic this disease. Additionally, novel MR imaging findings, such as the central vein sign and paramagnetic rim lesion, which have been proposed as new imaging biomarkers to enhance diagnostic specificity for MS, are also discussed. These emerging features are likely to be incorporated in the future iterations of the McDonald criteria, and therefore, radiologists should be familiar with their appearance and with the optimal MRI protocols required for their detection.
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Affiliation(s)
- Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
- Vall d'Hebron Research Institute, Barcelona, Spain
| | | | - Carlos Torres
- Department of Radiology, University of Ottawa, The Ottawa Hospital Civic and General Campus, Ottawa, ON, Canada
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Prillard D, Charbonneau F, Clavel P, Vignal-Clermont C, Deschamps R, de la Motte MB, Guillaume J, Savatovsky J, Lecler A. Comparison of a Whole-Brain Contrast-Enhanced 3D TSE T1WI versus Orbits Contrast-Enhanced 2D Coronal T1WI at 3T MRI for the Detection of Optic Nerve Enhancement in Patients with Acute Loss of Visual Acuity. AJNR Am J Neuroradiol 2024; 45:965-970. [PMID: 38902008 DOI: 10.3174/ajnr.a8233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 02/07/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND PURPOSE MR imaging is the technique of choice for patients presenting with acute loss of visual acuity with no obvious ophthalmologic cause. The goal of our study was to compare orbits contrast-enhanced 2D coronal T1WI with a whole-brain contrast-enhanced 3D (WBCE-3D) TSE T1WI at 3T for the detection of optic nerve enhancement. MATERIALS AND METHODS This institutional review board-approved retrospective single-center study included patients presenting with acute loss of vision who underwent 3T MR imaging from November 2014 to February 2020. Two radiologists, blinded to all data, individually assessed the presence of enhancement of the optic nerve on orbits contrast-enhanced 2D T1WI and WBCE-3D T1WI separately and in random order. A McNemar test and a Cohen κ method were used for comparing the 2 MR imaging sequences. RESULTS One thousand twenty-three patients (638 women and 385 men; mean age, 42 [SD, 18.3] years) were included. There was a strong concordance between WBCE-3D T1WI and orbits contrast-enhanced 2D T1WI when detecting enhancement of the optic nerve: κ = 0.87 (95% CI, 0.84-0.90). WBCE-3D T1WI was significantly more likely to detect canalicular enhancement compared with orbits contrast-enhanced 2D T1WI: 178/1023 (17.4%) versus 138/1023 (13.5%) (P < .001) and 108/1023 (10.6%) versus 90/1023 (8.8%) (P = .04), respectively. The WBCE-3D T1WI sequence detected 27/1023 (3%) instances of optic disc enhancement versus 0/1023 (0%) on orbits contrast-enhanced 2D T1WI. There were significantly fewer severe artifacts on WBCE-3D T1WI compared with orbits contrast-enhanced 2D T1WI: 68/1023 (6.6%) versus 101/1023 (9.8%) (P < .001). The median reader-reported confidence was significantly higher with coronal T1WI compared with 3D TSE T1WI: 5 (95% CI, 4-5) versus 3 (95% CI, 1-4; P < .001). CONCLUSIONS Our study showed that there was a strong concordance between WBCE-3D T1WI and orbits contrast-enhanced 2D T1WI when detecting enhancement of the optic nerve in patients with acute loss of visual acuity with no obvious ophthalmologic cause. WBCE-3D T1WI demonstrated higher sensitivity and specificity in diagnosing optic neuritis, particularly in cases involving the canalicular segments.
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Affiliation(s)
- David Prillard
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Frédérique Charbonneau
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Pierre Clavel
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | | | - Romain Deschamps
- Department of Neurology (R.D., M.B.d.l.M.), A. Rothschild Foundation Hospital, Paris, France
| | | | - Jessica Guillaume
- Department of Clinical Research (J.G.), A. Rothschild Foundation Hospital, Paris, France
| | - Julien Savatovsky
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
| | - Augustin Lecler
- From the Department of Neuroradiology (D.P., F.C., P.C., J.S., A.L.), A. Rothschild Foundation Hospital, Paris, France
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Vidal-Jordana A, Sastre-Garriga J, Tintoré M, Rovira À, Montalban X. Optic nerve topography in multiple sclerosis diagnostic criteria: Existing knowledge and future directions. Mult Scler 2024; 30:139-149. [PMID: 38243584 DOI: 10.1177/13524585231225848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Current diagnostic criteria for multiple sclerosis (MS) do not consider the optic nerve as a typical topography for establishing the diagnosis. Recent studies have proved the utility of optic nerve magnetic resonance imaging, optical coherence tomography and visual evoked potentials in detecting optic nerve lesions during the early stages of MS. In addition, emerging evidence supports the inclusion of optic nerve topography as a fifth region to fulfil the dissemination in space criteria. Anticipating a modification in the McDonald criteria, it is crucial for neurologists to familiarize with the diagnostic properties of each test in detecting optic nerve lesions and understand how to incorporate them into the MS diagnostic process. Therefore, the objective of this article is to review the existing evidence supporting the use of these tests in the diagnostic process of MS and provide a practical algorithm that can serve as a valuable guide for clinical practice.
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Affiliation(s)
- Angela Vidal-Jordana
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Neurology Department and Multiple Sclerosis Centre of Catalunya (Cemcat), Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
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Liu J, Shao X, Fan J, Wang Y, Cao Y, Tan G, Sugimoto K, Li B, Jia Z. Association of plasma sPD-1 and sPD-L1 with disease status and future relapse in AQP4-IgG (+) NMOSD. Ann Clin Transl Neurol 2024; 11:436-449. [PMID: 38069466 PMCID: PMC10863926 DOI: 10.1002/acn3.51964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune-mediated disorder with aquaporin 4-immunoglobulin G (AQP4-IgG) in most settings. Soluble programmed death-1 (sPD-1) and soluble programmed death ligand 1 (sPD-L1) play key roles in immunomodulation. We aim to assess the association of sPD-1 and sPD-L1 with cytokines and their clinical significance in AQP4-IgG (+) NMOSD. METHOD We measured plasma sPD-1, sPD-L1, and 10 cytokines levels of 66 AQP4-IgG (+) NMOSD patients, including 40 patients in attack (attack-NMOSD) and 26 patients in remission (remission-NMOSD) phases, and 28 healthy controls through ultrasensitive Simoa and SP-X platform, respectively. We also performed >2 years (median) of follow-up after testing and analyzed the relationship between the detection index and current and future clinical parameters. RESULT Plasma sPD-1 level discriminated attack-NMOSD from remission-NMOSD (AUC = 0.692, p = 0.009). sPD-1 and sPD-L1 levels positively correlated with IL-6 (rsPD-1 = 0.313; rsPD-L1 = 0.508), IFN-γ (rsPD-1 = 0.331; rsPD-L1 = 0.456), and TNF-α (rsPD-1 = 0.451; rsPD-L1 = 0.531) expression, as well as clinical indicators, including the EDSS score (rsPD-1 = 0.331; rsPD-L1 = 0.402), number of attacks (rsPD-1 = 0.431) and segments of spinal cord involvement (rsPD-1 = 0.462; rsPD-L1 = 0.508). The risk of relapse within 2 years after sampling was associated with higher sPD-1/sPD-L1 ratio in attack-NMOSD (p = 0.022; Exp(B) = 1.589). INTERPRETATION Plasma sPD-1 and sPD-L1 levels reflected current disease severity and activity, and predicted future relapses in AQP4-IgG (+) NMOSD, suggesting that they hold the potential to guide timely and targeted treatment.
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Affiliation(s)
- Jia Liu
- Institute for Brain DisordersBeijing University of Chinese MedicineBeijingChina
- Department of Neurology, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Xi Shao
- Department of NeurologyThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Jingya Fan
- Department of NeurologyThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Ying Wang
- Department of NeurologyThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Yuanbo Cao
- Department of NeurologyThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Guojun Tan
- Department of NeurologyThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Neurology (Hebei Medical University)Ministry of EducationShijiazhuangChina
- Neurological Laboratory of Hebei ProvinceShijiazhuangChina
| | - Kazuo Sugimoto
- Institute for Brain DisordersBeijing University of Chinese MedicineBeijingChina
- Department of Neurology, Dongzhimen HospitalBeijing University of Chinese MedicineBeijingChina
| | - Bin Li
- Department of NeurologyThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Neurology (Hebei Medical University)Ministry of EducationShijiazhuangChina
- Neurological Laboratory of Hebei ProvinceShijiazhuangChina
| | - Zhen Jia
- Department of NeurologyThe Second Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Neurology (Hebei Medical University)Ministry of EducationShijiazhuangChina
- Neurological Laboratory of Hebei ProvinceShijiazhuangChina
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Vidal-Jordana A, Rovira A, Calderon W, Arrambide G, Castilló J, Moncho D, Rahnama K, Collorone S, Toosy AT, Ciccarelli O, Papadopoulou A, Cerdá-Fuertes N, Lieb JM, Ruggieri S, Tortorella C, Gasperini C, Bisecco A, Capuano R, Gallo A, De Barros A, Salerno A, Auger C, Sastre-Garriga J, Tintore M, Montalban X. Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria: A Longitudinal, Prospective, Multicenter Study. Neurology 2024; 102:e200805. [PMID: 38165378 PMCID: PMC10834130 DOI: 10.1212/wnl.0000000000207805] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/20/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The optic nerve is not one of the areas of the CNS that can be used to demonstrate dissemination in space (DIS) within the 2017 McDonald criteria for the diagnosis of multiple sclerosis (MS). Objectives were (1) to assess whether optic nerve-MRI (ON-MRI), optical coherence tomography (OCT), and visual evoked potentials (VEP) detect optic nerve involvement in clinically isolated syndrome (CIS) and (2) to evaluate the contribution of the optic nerve topography to the current diagnostic criteria in a prospective, multicenter cohort. METHODS MAGNIMS centers were invited to provide prospective data on patients with CIS who underwent a visual assessment with at least 2 of 3 investigations (ON-MRI, OCT, or VEP) within 6 months of onset. Modified DIS criteria were constructed by adding the optic nerve topography, defined by each investigation separately and any combination of them, as the fifth area of the CNS. A risk assessment analysis and the performance of the different DIS criteria were analyzed using the diagnosis of MS according to the 2017 McDonald criteria as the primary outcome and new T2 lesions and/or a second relapse as the secondary outcome. RESULTS We included 157 patients with CIS from 5 MAGNIMS centers; 60/157 (38.2%) patients presented with optic neuritis. Optic nerve involvement on ON-MRI was found in 40.2% patients at study entry and in 72.5% of those with optic neuritis.At follow-up (mean 27.9 months, SD 14.5), 111/157 patients (70.7%) were diagnosed with MS according to the 2017 McDonald criteria. Fulfilling either 2017 DIS or any modified DIS criteria conferred a similar high risk for reaching primary and secondary outcomes. The modified DIS criteria had higher sensitivity (92.5% [with ON-MRI] vs 88.2%), but slightly lower specificity (80.0% [with GCIPL IEA ≥4 μm] vs 82.2%), with overall similar accuracy (86.6% [with ON-MRI] vs 86.5%) than 2017 DIS criteria. Consistent results were found for secondary outcomes. DISCUSSION In patients with CIS, the presence of an optic nerve lesion defined by MRI, OCT, or VEP is frequently detected, especially when presenting with optic neuritis. Our study supports the addition of the optic nerve as a fifth topography to fulfill DIS criteria.
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Affiliation(s)
- Angela Vidal-Jordana
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Alex Rovira
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Willem Calderon
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Georgina Arrambide
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Joaquín Castilló
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Dulce Moncho
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Kimia Rahnama
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Sara Collorone
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Ahmed T Toosy
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Olga Ciccarelli
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Athina Papadopoulou
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Nuria Cerdá-Fuertes
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Johanna M Lieb
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Serena Ruggieri
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Carla Tortorella
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Claudio Gasperini
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Alvino Bisecco
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Rocco Capuano
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Antonio Gallo
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Andrea De Barros
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Annalaura Salerno
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Cristina Auger
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Jaume Sastre-Garriga
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Mar Tintore
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
| | - Xavier Montalban
- From the Hospital Universitari Vall d'Hebron (A.V.-J., A.R., G.A., J.C., D.M., K.R., A.D.B., A.S., C.A., J.S.-G., M.T., X.M.), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR) (W.C.), Universitat Autònoma de Barcelona, Spain; University College London (UCL) (S.C., A.T.T., O.C.), United Kingdom; Institute of Neurology (O.C.), London, United Kingdom; University Hospital Basel (A.P., N.C.-F., J.M.L.), Switzerland; San Camillo-Forlanini Hospital (S.R., C.T., C.G.), Rome, Italy; University of Campania Luigi Vanvitelli (A.B., R.C., A.G.), Naples, Italy
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Osawa I, Nagawa K, Hara Y, Shimizu H, Tanaka S, Kozawa E. Utility of contrast-enhanced 3D STIR FLAIR imaging for evaluating pituitary adenomas at 3 Tesla. Eur J Radiol Open 2023; 11:100500. [PMID: 37408663 PMCID: PMC10319169 DOI: 10.1016/j.ejro.2023.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose To assess the usefulness of contrast-enhanced 3D STIR FLAIR imaging for evaluation of pituitary adenomas. Methods Patients with pituitary adenomas underwent MR examinations including contrast-enhanced 3D STIR FLAIR and 2D T1-weighted (T1W) imaging. We subjectively compared the two techniques in terms of 10 categories. In addition, images were rated by side-by-side comparisons into three outcomes: 3D STIR FLAIR imaging superior, equal, or 2D T1W imaging superior. Additionally, the added value of 3D STIR FLAIR imaging for adenoma detection over conventional MR imaging was assessed. Results Twenty-one patients were included in this study. 3D STIR FLAIR imaging offered significantly better images than 2D T1W imaging in terms of three categories, including overall visualization of the cranial nerves in the cavernous sinus (mean 4.0 vs. 2.8, p < 0.0001), visualization of the optic nerves and chiasm (mean 4.0 vs. 2.6, p < 0.0001), and severity of susceptibility artifacts (mean 0.0 vs. 0.4, p = 0.004). In the side-by-side comparison, 3D STIR FLAIR imaging was judged to be significantly superior to 2D T1W imaging for overall lesion conspicuity (62% vs. 19%, p = 0.049) and border between the adenoma and the pituitary gland (67% vs. 19%, p = 0.031). The addition of 3D STIR FLAIR imaging significantly improved the adenoma detection of conventional MR imaging. Conclusion 3D STIR FLAIR imaging improved overall lesion conspicuity compared to 2D T1W imaging. We suggest that 3D STIR FLAIR imaging is recommended as a supplemental technique when pituitary adenomas are invisible or equivocal on conventional imaging.
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Affiliation(s)
- Iichiro Osawa
- Correspondence to: 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
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9
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Panyaping T, Tunlayadechanont P, Jindahra P, Cheecharoen P. Diagnostic value of contrast-enhanced 3D FLAIR sequence in acute optic neuritis. Neuroradiol J 2023; 36:674-679. [PMID: 37205609 PMCID: PMC10649524 DOI: 10.1177/19714009231177360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
PURPOSE Contrast-enhanced fluid-attenuated inversion recovery (FLAIR) sequence of the brain has the potential for detecting optic nerve abnormality. This study aimed to compare the diagnostic value of whole-brain contrast-enhanced three-dimensional FLAIR with fat suppression (CE 3D FLAIR FS) sequence in detecting acute optic neuritis to dedicated orbit MRI and clinical diagnosis. MATERIALS AND METHODS Twenty-two patients with acute optic neuritis who underwent whole-brain CE-3D-FLAIR FS and dedicated orbit MRI were retrospectively included. The hypersignal FLAIR of the optic nerve on whole-brain CE-3D-FLAIR FS, enhancement, and hypersignal T2W on orbit images were assessed. The optic nerve to frontal white matter signal intensity ratio on CE-FLAIR FS was calculated as maximum signal intensity ratio (SIR) and mean SIR. RESULTS Twenty-six hypersignals of optic nerves were found on CE-FLAIR FS from 30 pathologic nerves. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CE FLAIR FS brain and dedicated orbital images for diagnosing acute optic neuritis were 77%, 93%, 96%, 65%, and 82% and 83%, 93%, 96%, 72%, and 86%, respectively. Optic nerve to frontal white matter SIR of the affected optic nerves was higher than that of normal optic nerves. Using a cutoff maximum SIR of 1.24 and cutoff mean SIR of 1.16, the sensitivity, specificity, PPV, NPV, and accuracy were 93%, 86%, 93%, 80%, and 89% and 93%, 86%, 93%, 86%, and 91%, respectively. CONCLUSION The hypersignal of the optic nerve on whole-brain CE 3D FLAIR FS sequence has qualitative and quantitative diagnostic potential in patients with acute optic neuritis.
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Affiliation(s)
- Theeraphol Panyaping
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Padcha Tunlayadechanont
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Panitha Jindahra
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
| | - Piyaphon Cheecharoen
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Mahidol University, Bangkok, Thailand
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10
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Hodel J, Vernooij MW, Beyer MK, Severino M, Leclerc X, Créange A, Wahab A, Badat N, Tolédano S, van den Hauwe L, Ramos A, Castellano A, Krainik A, Yousry T, Rovira À. Multiple sclerosis imaging in clinical practice: a European-wide survey of 428 centers and conclusions by the ESNR Working Group. Eur Radiol 2023; 33:7025-7033. [PMID: 37199796 DOI: 10.1007/s00330-023-09701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/23/2023] [Accepted: 03/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To evaluate compliance with the available recommendations, we assessed the current clinical practice of imaging in the evaluation of multiple sclerosis (MS). METHODS An online questionnaire was emailed to all members and affiliates. Information was gathered on applied MR imaging protocols, gadolinium-based contrast agents (GBCA) use and image analysis. We compared the survey results with the Magnetic Resonance Imaging in MS (MAGNIMS) recommendations considered as the reference standard. RESULTS A total of 428 entries were received from 44 countries. Of these, 82% of responders were neuroradiologists. 55% performed more than ten scans per week for MS imaging. The systematic use of 3 T is rare (18%). Over 90% follow specific protocol recommendations with 3D FLAIR, T2-weighted and DWI being the most frequently used sequences. Over 50% use SWI at initial diagnosis and 3D gradient-echo T1-weighted imaging is the most used MRI sequence for pre- and post-contrast imaging. Mismatches with recommendations were identified including the use of only one sagittal T2-weighted sequence for spinal cord imaging, the systematic use of GBCA at follow-up (over 30% of institutions), a delay time shorter than 5 min after GBCA administration (25%) and an inadequate follow-up duration in pediatric acute disseminated encephalomyelitis (80%). There is scarce use of automated software to compare images or to assess atrophy (13% and 7%). The proportions do not differ significantly between academic and non-academic institutions. CONCLUSIONS While current practice in MS imaging is rather homogeneous across Europe, our survey suggests that recommendations are only partially followed. CLINICAL RELEVANCE STATEMENT Hurdles were identified, mainly in the areas of GBCA use, spinal cord imaging, underuse of specific MRI sequences and monitoring strategies. This work will help radiologists to identify the mismatches between their own practices and the recommendations and act upon them. KEY POINTS • While current practice in MS imaging is rather homogeneous across Europe, our survey suggests that available recommendations are only partially followed. • Several hurdles have been identified through the survey that mainly lies in the areas of GBCA use, spinal cord imaging, underuse of specific MRI sequences and monitoring strategies.
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Affiliation(s)
- Jérôme Hodel
- Department of Radiology, Groupe Hospitalier Paris-Saint Joseph, Paris, France.
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mona K Beyer
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Xavier Leclerc
- Department of Neuroradiology, Lille University Hospital, Lille, France
| | - Alain Créange
- Department of Neurology, AP-HP, Henri Mondor University Hospital, Université Paris Est Créteil, 4391, Creteil, EA, France
| | - Abir Wahab
- Department of Neurology, AP-HP, Henri Mondor University Hospital, Université Paris Est Créteil, 4391, Creteil, EA, France
| | - Neesmah Badat
- Department of Radiology, Groupe Hospitalier Paris-Saint Joseph, Paris, France
| | - Sarah Tolédano
- Department of Radiology, Groupe Hospitalier Paris-Saint Joseph, Paris, France
| | - Luc van den Hauwe
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Ana Ramos
- Neuroradiology, Department of Radiology, University Hospital, 12 de Octubre, Madrid, Spain
| | - Antonella Castellano
- Neuroradiology Unit and CERMAC, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Alexandre Krainik
- Department of Neuroradiology, University Hospital of Grenoble, Grenoble, France
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, London, UK
- Neuroradiological Academic Unit, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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11
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Davion JB, Jougleux C, Lopes R, Leclerc X, Outteryck O. Relation between retina, cognition and brain volumes in MS: a consequence of asymptomatic optic nerve lesions. J Neurol 2023; 270:240-249. [PMID: 36018381 DOI: 10.1007/s00415-022-11348-9] [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: 07/05/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Asymptomatic optic nerve lesions are frequent in multiple sclerosis (MS) and their impact on cognition and/or brain volume has never been taken into account. PATIENTS AND METHODS We used the data from the cross-sectional Visual Ways in MS (VWIMS) study including relapsing remitting MS. All patients underwent brain and optic nerve Magnetic Resonance Imaging (MRI) including Double Inversion Recuperation (DIR) sequence, retinal OCT, and cognitive evaluation with the Brief International Cognitive Assessment in MS (BICAMS). We measured the association between OCT findings (thickness/volume of retinal layers) and extra-visual parameters (cerebral volumes and BICAMS scores) in optic nerves with and/or without the presence of DIR asymptomatic optic nerve hypersignal. RESULTS Between March and December 2017, we included 98 patients. Two patients were excluded. Over the 192 eyes, 73 had at least one clinical history of optic neuritis (ON-eyes) whereas 119 were asymptomatic (NON-eyes). Among the 119 NON-eyes, 58 had 3D-DIR optic nerve hypersignal (48.7%). We confirmed significant associations between some retinal OCT measures and some extra-visual parameters (cerebral volumes, cognitive scores) in NON-eyes. Unexpectedly, these associations were found when an asymptomatic optic nerve DIR-hypersignal was present on MRI, but not when it was absent. CONCLUSION Our study showed a relation between OCT measures and extra-visual parameters in NON-eyes MS patients. As a confusion factor, asymptomatic optic nerve lesions may be the explanation of the relation between OCT measures and extra-visual parameters. Retinal OCT seems to be far more a "window over the optic nerve" than a "window over the brain".
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Affiliation(s)
- Jean-Baptiste Davion
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Caroline Jougleux
- Department of Neurology, Multiple Sclerosis Center of Lille, Univ. Lille, 59000, Lille, France
| | - Renaud Lopes
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Xavier Leclerc
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France
| | - Olivier Outteryck
- Department of Neuroradiology, Univ. Lille, INSERM, CHU Lille, U1172, Degenerative and Vascular Cognitive Disorders, 59000, Lille, France.
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12
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Zhao J, Sun H, Zhu H, Chang Q, Wang J. Optic nerve lesion length is a biomarker of visual disability in the pre-chronic phase of Leber's hereditary optic neuropathy. Clin Neurol Neurosurg 2022; 224:107542. [PMID: 36459841 DOI: 10.1016/j.clineuro.2022.107542] [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: 09/30/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The current research aims to investigate relationships between the optic nerve (ON) lesion length with visual function in the pre-chronic phase ( illness duration < 12 months) of LHON. METHODS Orbital MRI was retrospectively analyzed for 45 patients with LHON in the pre-chronic phase. ON lesion length was measured by 2 trained independent readers and it was recorded as multiplication of the number of abnormal MRI slices and slice thickness on T2-STIR sequence in the coronal plane. Decimal visual acuity was converted to the logarithm of minimum angle of resolution. Intra-class correlation coefficients (ICCs) were used to assess intra- and inter-observer agreements. Pearson's correlation analysis and multivariate linear regression models were performed to analyze the correlations of the lesion length with best corrected visual acuity (BCVA) and visual field parameters. RESULTS 81 afflicted eyes were selected. The ICCs for intra-observer and inter-observer analyses were 0.989 and 0.980 respectively. Both Pearson's correlation analysis and multivariate linear regression models indicated a significant positive correlation between the BCVA or mean deviation (MD) and ON lesion length (rBCVA=0.368, PBCVA=0.001; rMD=-0.269, PMD=0.045) with a coefficient of determination (R2) of 0.152 and 0.114 respectively adjusted for patients' sex, age of onset, onset of vision loss to performance of MRI, mitochondrial DNA mutations. CONCLUSION ON length with T2-STIR hyperintensities was positively associated with both BCVA and MD, and it was suspected to be a biomarker of visual disability in the pre-chronic phase of LHON.
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Affiliation(s)
- Juan Zhao
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Houliang Sun
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Hongyu Zhu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Qinglin Chang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100176, China.
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13
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Costagli M, Lapucci C, Zacà D, Bruschi N, Schiavi S, Castellan L, Stemmer A, Roccatagliata L, Inglese M. Improved detection of multiple sclerosis lesions with T2-prepared double inversion recovery at 3T. J Neuroimaging 2022; 32:902-909. [PMID: 35776654 PMCID: PMC9544719 DOI: 10.1111/jon.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Double inversion recovery (DIR) imaging is used in multiple sclerosis (MS) clinical protocols to improve the detection of cortical and juxtacortical gray matter lesions by nulling confounding signals originating from the cerebrospinal fluid and white matter. Achieving a high isotropic spatial resolution, to depict the neocortex and its typically small lesions, is challenged by the reduced signal-to-noise ratio (SNR) determined by multiple tissue signal nulling. Here, we evaluate both conventional and optimized DIR implementations to improve tissue contrast (TC), SNR, and MS lesion conspicuity. METHODS DIR images were obtained from MS patients and healthy controls using both conventional and prototype implementations featuring a T2-preparation module (T2P), to improve SNR and TC, as well as an image reconstruction routine with iterative denoising (ID). We obtained quantitative measures of SNR and TC, and evaluated the visibility of MS cortical, cervical cord, and optic nerve lesions in the different DIR images. RESULTS DIR implementations adopting T2P and ID enabled improving the SNR and TC of conventional DIR. In MS patients, 34% of cortical, optic nerve, and cervical cord lesions were visible only in DIR images acquired with T2P, and not in conventional DIR images. In the studied cases, image reconstruction with ID did not improve lesion conspicuity. CONCLUSIONS DIR with T2P should be preferred to conventional DIR imaging in protocols studying MS patients, as it improves SNR and TC and determines an improvement in cortical, optic nerve, and cervical cord lesion conspicuity.
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Affiliation(s)
- Mauro Costagli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,Laboratory of Medical Physicsand Magnetic Resonance, IRCCS Stella Maris, Pisa, Italy
| | - Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Nicolò Bruschi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy
| | | | | | - Luca Roccatagliata
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Sciences (DINOGMI), University of Genoa, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
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14
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Denis M, Woillez JP, Smirnov VM, Drumez E, Lannoy J, Boucher J, Zedet M, Pruvo JP, Labreuche J, Zephir H, Leclerc X, Outteryck O. Optic Nerve Lesion Length at the Acute Phase of Optic Neuritis Is Predictive of Retinal Neuronal Loss. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/2/e1135. [PMID: 35091465 PMCID: PMC8802684 DOI: 10.1212/nxi.0000000000001135] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
Abstract
Background and Objectives Acute optic neuritis (ON) is a classical presenting symptom of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and anti–MOG-associated disorders. The resulting visual impairment is variable and can be severe. Clinicians are in need of predictive biomarkers to optimize the management of acute ON. In this longitudinal study (IRMANO, NCT03651662), we evaluated the ability of optic nerve lesion length measured on MRI at the acute phase of ON to predict retinal neuro-axonal loss and visual impairment at a chronic stage. Methods We conducted a longitudinal study (IRMANO, NCT03651662) of patients who presented a clinical episode of ON (≤8 weeks). All patients underwent a retinal optical coherence tomography (OCT) and a brain/optic nerve MRI, including 3D double-inversion recovery (DIR) sequence at the acute phase of ON and 12 months later. Primary outcomes were optic nerve DIR hypersignal lesion length, macular ganglion cell–inner plexiform layer (GCIPL) volume measured on OCT, and low-contrast monocular visual acuity (LCMVA). Results The study group included 51 patients (33 women, mean age of 32.4 years ± 7.9). We recruited patients with a clinically isolated syndrome (n = 20), a relapsing-remitting MS (n = 23), an isolated ON (n = 6), and a first clinical episode of NMOSD (n = 2). Optic nerve DIR hypersignal was observed in all but 1 symptomatic optic nerves. At inclusion, the mean optic nerve lesion length (in mm) was 12.35 ± 5.98. The mean GCIPL volume (in mm3) significantly decreased between inclusion (1.90 ± 0.18) and M12 (1.67 ± 0.21; p < 0.0001). Optic nerve lesion length at inclusion was significantly associated with GCIPL thinning (estimate ± SD; −0.012 ± 0.004; p = 0.0016) and LCMVA at M12 (0.016 ± 0.003; p < 0.001). Optic nerve lesion length significantly increased at M12 (15.76 ± 8.70; p = 0.0007). The increase in optic nerve lesion length was significantly associated with the GCIPL thinning between inclusion and M12 (−0.012 ± 0.003; p = 0.0011). Discussion At the acute phase of ON, optic nerve lesion length is an imaging biomarker predictive of retinal neuro-axonal loss and chronic visual impairment, which can help to stratify future therapeutic strategies in acute ON. Classification of Evidence This study provides Class I evidence that optic nerve lesion length measured on MRI during the acute phase of a first episode of ON is associated with long-term retinal neuro-axonal loss and visual impairment.
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15
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Orlowski H, Sharma A, Alvi F, Arora J, Parsons MS, Van Stavern GP. Evaluation of 2D FLAIR hyperintensity of the optic nerve and optic nerve head and visual parameters in idiopathic intracranial hypertension. J Neuroradiol 2021; 49:193-197. [PMID: 34688702 DOI: 10.1016/j.neurad.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/10/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE T2/FLAIR hyperintensity of the optic nerve/optic nerve head has been described as a sensitive finding in idiopathic intracranial hypertension using post-contrast 3D-T2/FLAIR imaging. The purpose of this study is to assess whether hyperintensity on non-enhanced 2D-T2/FLAIR imaging occurs more likely in diseased patients than controls and to evaluate the relationship between FLAIR signal and visual parameters MATERIALS AND METHODS: A retrospective case-control study was performed of patients with idiopathic intracranial hypertension and controls who underwent orbital MRI. Three neuroradiologists reviewed the FLAIR images, subjectively evaluating for hyperintense signal within the optic nerves/optic nerve heads using a 5-point Likert Scale. Quantitative assessment of optic nerve signal using regions of interests was performed. Clinical parameters were extracted. The diagnostic performance was evaluated, and Spearman correlation calculated to assess the relationship between FLAIR signal and visual outcomes. RESULTS The sensitivity of abnormal FLAIR signal within the optic nerves and optic nerve heads in patients with idiopathic intracranial hypertension ranged from 25-54% and 4-29%, respectively, with specificities ranging from 67-92% and 83-100%. Quantitative assessment revealed a significant difference in CNR between cases and controls in the left posterior optic nerve (p=.002). A positive linear relationship existed between abnormal optic nerve head signal and papilledema grade (OD: p=.02, OS: p=.008) but not with other visual parameters. CONCLUSION T2/FLAIR hyperintensity in the optic nerve/optic nerve head may support the diagnosis of idiopathic intracranial hypertension but its absence should not dissuade it. If present, abnormal signal in the optic nerve head correlates with papilledema.
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Affiliation(s)
- Hilary Orlowski
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd. St. Louis, MO, USA.
| | - Aseem Sharma
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd. St. Louis, MO, USA.
| | - Fatima Alvi
- Washington University School of Medicine, 660 S. Euclid Ave. St. Louis, MO, USA
| | - Jyoti Arora
- Division of Biostatistics, Washington University School of Medicine, 660 S. Euclid Ave, CB, St. Louis, MO 8067, USA
| | - Matthew S Parsons
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd. St. Louis, MO, USA
| | - Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 517 S. Euclid Ave, St. Louis, MO, USA
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Rovira À, Auger C. Beyond McDonald: updated perspectives on MRI diagnosis of multiple sclerosis. Expert Rev Neurother 2021; 21:895-911. [PMID: 34275399 DOI: 10.1080/14737175.2021.1957832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) is an essential paraclinical test to establish an accurate and early diagnosis of multiple sclerosis (MS), which is based on the application of the McDonald criteria. AREAS COVERED The objective of this article is to analyze, based on publicly available database since the publication of the 2017 McDonald diagnostic criteria, the clinical impact of these criteria, to discuss the potential inclusion within these criteria of the optic nerve to demonstrate dissemination in space, and to guide the acquisition and interpretation of MRI scans for diagnostic purposes. Finally, the authors will review emerging MRI features that could improve the specificity of MRI in the diagnosis of MS and consequently minimize the misdiagnosis of this disease. EXPERT OPINION Although the optic nerve has not been included as one of the topographies required to demonstrate demyelinating lesion disseminated in space in the 2017 McDonald criteria, new studies seem to show some improvement in the sensitivity of these criteria when this topography is considered. New radiological findings such as the central vein sign and iron rims, should be considered within the typical MRI features of this disease with the objective of minimizing MRI-based diagnostic errors.
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Affiliation(s)
- Àlex Rovira
- Section of Neuroradiology (Department of Radiology), Hospital Universitari Vall d'Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain.,Vall d´Hebron Research Institute, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology (Department of Radiology), Hospital Universitari Vall d'Hebron, Universitat Autònoma De Barcelona, Barcelona, Spain.,Vall d´Hebron Research Institute, Barcelona, Spain
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17
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Pravatà E, Roccatagliata L, Sormani MP, Carmisciano L, Lienerth C, Sacco R, Kaelin-Lang A, Cianfoni A, Zecca C, Gobbi C. Dedicated 3D-T2-STIR-ZOOMit Imaging Improves Demyelinating Lesion Detection in the Anterior Visual Pathways of Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2021; 42:1061-1068. [PMID: 33766824 DOI: 10.3174/ajnr.a7082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Demyelinating lesions in the anterior visual pathways represent an underestimated marker of disease dissemination in patients with MS. We prospectively investigated whether a dedicated high-resolution MR imaging technique, the 3D-T2-STIR-ZOOMit, improves demyelinating lesion detection compared with the current clinical standard sequence, the 2D-T2-STIR. MATERIALS AND METHODS 3T MR imaging of the anterior visual pathways (optic nerves, chiasm, and tracts) was performed using 3D-T2-STIR-ZOOMit and 2D-T2-STIR, in patients with MS and healthy controls. Two experienced neuroradiologists assessed, independently, demyelinating lesions using both sequences separately. 3D-T2-STIR-ZOOMit scan-rescan reproducibility was tested in 12 patients. The Cohen κ was used for interrater agreement, and the intraclass correlation coefficient for reproducibility. Between-sequence detection differences and the effects of location and previous acute optic neuritis were assessed using a binomial mixed-effects model. RESULTS Forty-eight patients with MS with (n = 19) or without (n = 29) past optic neuritis and 19 healthy controls were evaluated. Readers' agreement was strong (3D-T2-STIR-ZOOMit: 0.85; 2D-T2-STIR: 0.90). The 3D-T2-STIR-ZOOMit scan-rescan intraclass correlation coefficient was 0.97 (95% CI, 0.96-0.98; P < .001), indicating excellent reproducibility. Overall, 3D-T2-STIR-ZOOMit detected more than twice the demyelinating lesions (n = 89) than 2D-T2-STIR (n = 43) (OR = 2.7; 95% CI, 1.7-4.1; P < .001). In the intracranial anterior visual pathway segments, 33 of the 36 demyelinating lesions (91.7%) detected by 3D-T2-STIR-ZOOMit were not disclosed by 2D-T2-STIR. 3D-T2-STIR-ZOOMit increased detection of demyelinating lesion probability by 1.8-fold in patients with past optic neuritis (OR = 1.8; 95% CI, 1.2-3.1; P = .01) and 5.9-fold in patients without past optic neuritis (OR = 5.9; 95% CI, 2.5-13.8; P < .001). No false-positive demyelinating lesions were detected in healthy controls. CONCLUSIONS Dedicated 3D-T2-STIR-ZOOMit images improved substantially the detection of MS disease dissemination in the anterior visual pathways, particularly in the intracranial segments and in patients without past optic neuritis.
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Affiliation(s)
- E Pravatà
- From the Department of Neuroradiology (E.P., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - L Roccatagliata
- Department of Health Sciences (L.R., M.P.S., L.C.), University of Genova, Genova, Italy.,Dipartimento di Scienze della Salute - DISSAL (L.R., M.P.S.), Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - M P Sormani
- Department of Health Sciences (L.R., M.P.S., L.C.), University of Genova, Genova, Italy.,Dipartimento di Scienze della Salute - DISSAL (L.R., M.P.S.), Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - L Carmisciano
- Department of Health Sciences (L.R., M.P.S., L.C.), University of Genova, Genova, Italy
| | - C Lienerth
- Bayer Vital GmbH (C.L.), Leverkusen, Germany
| | - R Sacco
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - A Kaelin-Lang
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
| | - A Cianfoni
- From the Department of Neuroradiology (E.P., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
| | - C Zecca
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
| | - C Gobbi
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
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18
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Chow LS, Paley MNJ. Recent advances on optic nerve magnetic resonance imaging and post-processing. Magn Reson Imaging 2021; 79:76-84. [PMID: 33753137 DOI: 10.1016/j.mri.2021.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/27/2022]
Abstract
The optic nerve is known to be one of the largest nerve bundles in the human central nervous system. There have been many studies of optic nerve imaging and post-processing that have provided insights into pathophysiology of optic neuritis related to multiple sclerosis and neuromyelitis optica spectrum disorder, glaucoma, and Leber's hereditary optic neuropathy. There are many challenges in optic nerve imaging, due to the morphology of the nerve through its course to the optic chiasm, its mobility due to eye movements and the high signal from cerebrospinal fluid and orbital fat surrounding the optic nerve. Recently, many advanced and fast imaging sequences have been used with post-processing techniques in attempts to produce higher resolution images of the optic nerve for evaluating various diseases. Magnetic resonance imaging (MRI) is one of the most common imaging methodologies for the optic nerve. This review paper will focus on recent MRI advances in optic nerve imaging and explain several post-processing techniques being used for analysis of optic nerve images. Finally, some challenges and potential for future optic nerve studies will be discussed.
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Affiliation(s)
- Li Sze Chow
- Department of Electrical and Electronic Engineering, Faculty of Engineering and Built Environment, UCSI University, 1, Jalan Puncak Menara Gading, Taman Connaught, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Martyn N J Paley
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK.
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19
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Brownlee WJ, Galetta S. Optic Nerve in Multiple Sclerosis Diagnostic Criteria: An Aye to the Eyes? Neurology 2020; 96:139-140. [PMID: 33328321 DOI: 10.1212/wnl.0000000000011344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Wallace J Brownlee
- From the Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (W.J.B.), UCL Institute of Neurology, London, UK; and NYU Langone Health (S.G.), New York, NY.
| | - Steven Galetta
- From the Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation (W.J.B.), UCL Institute of Neurology, London, UK; and NYU Langone Health (S.G.), New York, NY
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20
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Riederer I, Sollmann N, Mühlau M, Zimmer C, Kirschke JS. Gadolinium-Enhanced 3D T1-Weighted Black-Blood MR Imaging for the Detection of Acute Optic Neuritis. AJNR Am J Neuroradiol 2020; 41:2333-2338. [PMID: 33122200 DOI: 10.3174/ajnr.a6807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE A 3D T1-weighted black-blood sequence was recently shown to improve the detection of contrast-enhancing lesions in the brain in patients with MS compared with a 3D T1-weighted MPRAGE sequence. We compared a contrast-enhanced 3D T1-weighted black-blood sequence with a dedicated orbital contrast-enhanced T1-weighted Dixon sequence in patients with acute optic neuritis. MATERIALS AND METHODS MR imaging data (3T) of 51 patients showing symptoms of acute optic neuritis were analyzed retrospectively, including whole-brain contrast-enhanced 3D T1-weighted black-blood and dedicated orbital coronal 2D or 3D contrast-enhanced T1-weighted Dixon sequences. Two neuroradiologists assessed the images for overall image quality, artifacts, diagnostic confidence, and visual contrast enhancement. Furthermore, the standardized contrast-to-noise ratio was calculated. The final diagnosis of acute optic neuritis was established on the basis of clinical presentation, visually evoked potentials, and optical coherence tomography. RESULTS Thirty of 51 patients were diagnosed with acute optic neuritis. Of those, 21 showed contrast-enhancing lesions in the optic nerves, similarly detectable on contrast-enhanced T1-weighted Dixon and contrast-enhanced T1-weighted black-blood images. Thus, the accuracy for each sequence was identical, with a resulting sensitivity of 70% and specificity of 90% or 100% (depending on the reader). Overall image quality, diagnostic confidence, visual contrast enhancement, and artifacts were rated similarly in contrast-enhanced 3D T1-weighted black-blood and dedicated orbital contrast-enhanced T1-weighted Dixon sequences. There was no significant difference (P = .27) in the mean standardized contrast-to-noise ratio between contrast-enhanced T1-weighted black-blood (1.76 ± 1.07) and contrast-enhanced T1-weighted Dixon (2.29 ± 2.49) sequences. CONCLUSIONS Contrast-enhanced 3D T1-weighted black-blood imaging is comparable in accuracy and qualitative/quantitative features with dedicated orbital contrast-enhanced T1-weighted Dixon imaging for the detection of acute optic neuritis. Therefore, when used, it has the potential to considerably shorten total patient imaging time.
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Affiliation(s)
- I Riederer
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.)
| | - N Sollmann
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.).,Neuroimaging Center TUM-NIC, Klinikum rechts der Isar (M.M. and N.S.), School of Medicine, Technical University of Munich, Munich, Germany
| | - M Mühlau
- Neurology (M.M.).,Neuroimaging Center TUM-NIC, Klinikum rechts der Isar (M.M. and N.S.), School of Medicine, Technical University of Munich, Munich, Germany
| | - C Zimmer
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.)
| | - J S Kirschke
- From the Department of Neuroradiology (I.R., N.S., C.Z., J.S.K.)
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21
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Murumkar VS, Biswas S, Saini JS, Prabhuraj AR. "Neuroimaging in ethambutol induced optic neuropathy: MRI in time can save the vision". Indian J Tuberc 2020; 68:408-411. [PMID: 34099211 DOI: 10.1016/j.ijtb.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022]
Abstract
Ethambutol is an integral part of Antitubercular therapy (ATT) and is often associated with optic neuropathy, However, neuroimaging of ethambutol induced optic neuropathy has been sparsely reported in the literature. We describe the case of a 45-year male patient, diagnosed as Tuberculous spondylodiscitis and was on ATT. Four months after ATT initiation, he presented with visual blurring in both the eyes with bitemporal hemianopia and central scotomas. Visual evoked potential (VEP) revealed prolonged latencies in N75 and P100 waveforms bilaterally. Magnetic Resonance Imaging (MRI) showed optic chiasma and bilateral optic tract hyperintensities on 3D Fluid Attenuated Inversion Recovery (FLAIR) and 3D Double Inversion Recovery (DIR) sequences. Ethambutol was discontinued immediately. On follow-up after 8 weeks, visual acuity reversed back to normal in both eyes.
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Affiliation(s)
- Vivek S Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - Shamick Biswas
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India.
| | - Jitender S Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
| | - A R Prabhuraj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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22
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Outteryck O, Lopes R, Drumez É, Labreuche J, Lannoy J, Hadhoum N, Boucher J, Vermersch P, Zedet M, Pruvo JP, Zéphir H, Leclerc X. Optical coherence tomography for detection of asymptomatic optic nerve lesions in clinically isolated syndrome. Neurology 2020; 95:e733-e744. [DOI: 10.1212/wnl.0000000000009832] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/06/2020] [Indexed: 12/24/2022] Open
Abstract
ObjectiveTo evaluate the ability of intereye retinal thickness difference (IETD) measured by optical coherence tomography (OCT) to detect asymptomatic optic nerve involvement in clinically isolated syndrome (CIS).MethodsWe conducted a cross-sectional study of patients who recently presented a CIS (≤4.5 months). All patients underwent OCT and brain/optic nerve MRI. Optic nerve involvement was defined clinically (episode of optic neuritis [ON] or not) and radiologically (optic nerve hypersignal on 3D double inversion recovery [3D-DIR]). We evaluated the sensitivity and specificity of previously published IETD thresholds and report the observed optimal thresholds for identifying symptomatic optic nerve involvement but also for identifying asymptomatic optic nerve involvement (optic nerve hypersignal without ON history). Primary outcomes were ganglion cell–inner plexiform layer (GC-IPL) and peripapillary retinal nerve fiber layer IETD.ResultsThe study group consisted of 130 patients. In the CIS with ON group, 3D-DIR showed a hypersignal in all 41 symptomatic optic nerves and in 11 asymptomatic optic nerves. In the CIS without ON group, 3D-DIR showed a unilateral optic nerve hypersignal in 22 patients and a bilateral optic nerve hypersignal in 7 patients. For the detection of symptomatic and asymptomatic optic nerve lesion, GC-IPL IETD had better performance. We found an optimal GC-IPL IETD threshold ≥2.83 µm (sensitivity 88.2, specificity 83.3%) for the detection of symptomatic lesions and an optimal GC-IPL IETD ≥1.42 µm (sensitivity 89.3%, specificity 72.6%) for the detection of asymptomatic lesions.ConclusionsDetection of asymptomatic optic nerve lesions in CIS requires lower IETD thresholds than previously reported. GC-IPL IETD represents an alternative biomarker to MRI for the detection of asymptomatic optic nerve lesions.Classification of evidenceThis study provides Class I evidence that OCT accurately identifies asymptomatic optic nerve involvement in patients with CIS.
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23
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Davion JB, Lopes R, Drumez É, Labreuche J, Hadhoum N, Lannoy J, Vermersch P, Pruvo JP, Leclerc X, Zéphir H, Outteryck O. Asymptomatic optic nerve lesions: An underestimated cause of silent retinal atrophy in MS. Neurology 2020; 94:e2468-e2478. [PMID: 32434868 DOI: 10.1212/wnl.0000000000009504] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/14/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the frequency of asymptomatic optic nerve lesions and their role in the asymptomatic retinal neuroaxonal loss observed in multiple sclerosis (MS). METHODS We included patients with remitting-relapsing MS in the VWIMS study (Analysis of Neurodegenerative Process Within Visual Ways In Multiple Sclerosis) (ClinicalTrials.gov Identifier: 03656055). Included patients underwent optical coherence tomography (OCT), optic nerve and brain MRI, and low-contrast visual acuity measurement. In eyes of patients with MS without optic neuritis (MS-NON), an optic nerve lesion on MRI (3D double inversion recovery [DIR] sequence) was considered as an asymptomatic lesion. We considered the following OCT/MRI measures: peripapillary retinal nerve fiber layer thickness, macular ganglion cell + inner plexiform layer (mGCIPL) volumes, optic nerve lesion length, T2 lesion burden, and fractional anisotropy within optic radiations. RESULTS An optic nerve lesion was detected in half of MS-NON eyes. Compared to optic nerves without any lesion and independently of the optic radiation lesions, the asymptomatic lesions were associated with thinner inner retinal layers (p < 0.0001) and a lower contrast visual acuity (p ≤ 0.003). Within eyes with asymptomatic optic nerve lesions, optic nerve lesion length was the only MRI measure significantly associated with retinal neuroaxonal loss (p < 0.03). Intereye mGCIPL thickness difference (IETD) was lower in patients with bilateral optic nerve DIR hypersignal compared to patients with unilateral hypersignal (p = 0.0317). For the diagnosis of history of optic neuritis, sensitivity of 3D DIR and of mGCIPL IETD were 84.9% and 63.5%, respectively. CONCLUSIONS Asymptomatic optic nerve lesions are an underestimated and preponderant cause of retinal neuroaxonal loss in MS. 3D DIR sequence may be more sensitive than IETD measured by OCT for the detection of optic nerve lesions.
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Affiliation(s)
- Jean-Baptiste Davion
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Renaud Lopes
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Élodie Drumez
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Julien Labreuche
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Nawal Hadhoum
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Julien Lannoy
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Patrick Vermersch
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Jean-Pierre Pruvo
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Xavier Leclerc
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Hélène Zéphir
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France
| | - Olivier Outteryck
- From the Department of Neuroradiology, INSERM, U1171-Degenerative and Vascular Cognitive Disorders (J.-B.D., R.L., J.-P.P., X.L., O.O.), Department of Biostatistics, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins (É.D., J.L.), and Department of Neurology, INSERM, U995-Lille Inflammation Research International Center (N.H., J.L., P.V., H.Z.), CHU Lille, Université de Lille, France.
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24
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Filippi M, Preziosa P, Banwell BL, Barkhof F, Ciccarelli O, De Stefano N, Geurts JJG, Paul F, Reich DS, Toosy AT, Traboulsee A, Wattjes MP, Yousry TA, Gass A, Lubetzki C, Weinshenker BG, Rocca MA. Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain 2020; 142:1858-1875. [PMID: 31209474 PMCID: PMC6598631 DOI: 10.1093/brain/awz144] [Citation(s) in RCA: 285] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022] Open
Abstract
MRI has improved the diagnostic work-up of multiple sclerosis, but inappropriate image interpretation and application of MRI diagnostic criteria contribute to misdiagnosis. Some diseases, now recognized as conditions distinct from multiple sclerosis, may satisfy the MRI criteria for multiple sclerosis (e.g. neuromyelitis optica spectrum disorders, Susac syndrome), thus making the diagnosis of multiple sclerosis more challenging, especially if biomarker testing (such as serum anti-AQP4 antibodies) is not informative. Improvements in MRI technology contribute and promise to better define the typical features of multiple sclerosis lesions (e.g. juxtacortical and periventricular location, cortical involvement). Greater understanding of some key aspects of multiple sclerosis pathobiology has allowed the identification of characteristics more specific to multiple sclerosis (e.g. central vein sign, subpial demyelination and lesional rims), which are not included in the current multiple sclerosis diagnostic criteria. In this review, we provide the clinicians and researchers with a practical guide to enhance the proper recognition of multiple sclerosis lesions, including a thorough definition and illustration of typical MRI features, as well as a discussion of red flags suggestive of alternative diagnoses. We also discuss the possible place of emerging qualitative features of lesions which may become important in the near future.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Center, National Institute for Health Research, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel S Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ahmed T Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, UK
| | - Anthony Traboulsee
- MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike P Wattjes
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Tarek A Yousry
- Division of Neuroradiology and Neurophysics, UCL Institute of Neurology, London, UK.,Lysholm Department of Neuroradiology, London, UK
| | - Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Catherine Lubetzki
- Sorbonne University, AP-HP Pitié-Salpétriére Hospital, Department of Neurology, 75013 Paris, France
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
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25
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London F, Zéphir H, Drumez E, Labreuche J, Hadhoum N, Lannoy J, Hodel J, Vermersch P, Pruvo JP, Leclerc X, Outteryck O. Optical coherence tomography: a window to the optic nerve in clinically isolated syndrome. Brain 2019; 142:903-915. [PMID: 30847470 DOI: 10.1093/brain/awz038] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 12/25/2022] Open
Abstract
In this study, we aimed to evaluate the association of asymptomatic optic nerve demyelinating lesion in patients presenting a clinically isolated syndrome with the asymptomatic retinal neuro-axonal loss previously reported at clinically isolated syndrome. We prospectively recruited 66 patients presenting a clinically isolated syndrome and 66 healthy control subjects matched according to age and gender. All patients underwent brain magnetic resonance imaging including 3D-double inversion recovery (DIR) sequence, optical coherence tomography examination and visual function evaluation, at 2.5-4.5 months after CIS. Evaluation criteria were presence and length of optic nerve DIR hypersignal, retinal layers (including ganglion cell inner plexiform layer and inner nuclear layer) thickness/volume, and low contrast monocular vision acuity (number of letters correctly identified). All clinically isolated syndrome eyes with past history of optic neuritis (CIS-ON) presented an optic nerve DIR hypersignal. We observed asymptomatic optic nerve DIR hypersignal in 22.2% of clinically isolated syndrome eyes without optic neuritis (CIS-NON). In comparison with healthy control, GCIPL volume (in mm3) was significantly lower in CIS-ON eyes [β (95% confidence interval, CI) = -0.121 (-0.168 to -0.074); P < 0.0001], and to a lesser extent in CIS-NON [β (95% CI) = -0.023 (-0.039 to -0.008); P = 0.004]. In comparison to healthy controls, eyes with asymptomatic optic nerve DIR hypersignal presented significantly lower macular ganglion cell inner plexiform layer volume [β (95% CI) = -0.043 (-0.068 to -0.019); P = 0.001], and eyes without did not [β (95% CI) = -0.016 (-0.034 to 0.003); P = 0.083]. Among CIS-NON, macular ganglion cell inner plexiform layer volume decrease was associated with asymptomatic optic nerve DIR hypersignal independently of optic radiations T2 lesions and primary visual cortex volumes (P = 0.012). Symptomatic optic nerve DIR hypersignal were significantly longer (13.8 ± 6.7 mm) than asymptomatic optic nerve hypersignal (10.0 ± 5.5 mm; P = 0.047). Length of optic nerve DIR hypersignal was significantly associated with thinner inner retinal layers (P ≤ 0.001), thicker inner nuclear layer (P = 0.017) and lower low contrast monocular vision acuity (P < 0.05). Compared to healthy control, low contrast monocular vision acuity was significantly lower in CIS-ON eyes (P < 0.0001) and CIS-NON eyes with (P = 0.03) or without asymptomatic optic nerve DIR hypersignal (P = 0.0005). Asymptomatic demyelinating optic nerve DIR hypersignal at the earliest clinical stage of multiple sclerosis is frequent and associated with asymptomatic retinal neuro-axonal loss reported at clinically isolated syndrome stage. Length of optic nerve DIR hypersignal is a biomarker of retinal neuro-axonal loss and visual disability at clinically isolated syndrome stage. Visual disability of clinically isolated syndrome eyes without clinical and subclinical optic nerve involvement might be due to missed optic nerve lesions on MRI. At the earliest clinical stage of multiple sclerosis, our results support considering optical coherence tomography as a window to the optic nerve rather than to the brain.
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Affiliation(s)
- Frédéric London
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Hélène Zéphir
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Elodie Drumez
- University of Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Julien Labreuche
- University of Lille, CHU Lille, EA 2694 - Santé publique : épidémiologie et qualité des soins, F-59000 Lille, France
| | - Nawal Hadhoum
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Julien Lannoy
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Jérôme Hodel
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France.,University of Paris Est Créteil, Department of Neuroradiology, Hopital Henri Mondor, Créteil, Paris, France
| | - Patrick Vermersch
- University of Lille (UMR995), Department of Neurology, Roger Salengro Hospital, Lille, France
| | - Jean-Pierre Pruvo
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France
| | - Xavier Leclerc
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France
| | - Olivier Outteryck
- University of Lille (UMR1171), Department of Neuroradiology, Roger Salengro Hospital, Lille, France
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Spectrally fat-suppressed coronal 2D TSE sequences may be more sensitive than 2D STIR for the detection of hyperintense optic nerve lesions. Eur Radiol 2019; 29:6266-6274. [DOI: 10.1007/s00330-019-06255-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/16/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
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Stunkel L, Sharma A, Parsons MS, Salter A, Van Stavern GP. Evaluating the Utility of a Postprocessing Algorithm for MRI Evaluation of Optic Neuritis. AJNR Am J Neuroradiol 2019; 40:1043-1048. [PMID: 31048299 DOI: 10.3174/ajnr.a6057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/31/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging is useful for the detection and/or confirmation of optic neuritis. The objective of this study was to determine whether a postprocessing algorithm selectively increases the contrast-to-noise ratio of abnormal optic nerves in optic neuritis, facilitating this diagnosis on MR imaging. MATERIALS AND METHODS In this retrospective case-control study, coronal FLAIR images and coronal contrast-enhanced T1WI from 44 patients (31 eyes with clinically confirmed optic neuritis and 28 control eyes) underwent processing using a proprietary postprocessing algorithm designed to detect and visually highlight regions of contiguous increases in signal intensity by increasing the signal intensities of regions that exceed a predetermined threshold. For quantitative evaluation of the effect on image processing, the contrast-to-noise ratio of equivalent ROIs and the contrast-to-noise ratio between optic nerves and normal-appearing white matter were measured on baseline and processed images. The effect of image-processing on diagnostic performance was evaluated by masked reviews of baseline and processed images by 6 readers with varying experience levels. RESULTS In abnormal nerves, processing resulted in an increase in the median contrast-to-noise ratio from 17.8 to 85.0 (P < .001) on FLAIR and from 19.4 to 93.7 (P < .001) on contrast-enhanced images. The contrast-to-noise ratio for control optic nerves was not affected by processing (P = 0.13). Image processing had a beneficial effect on radiologists' diagnostic performance, with an improvement in sensitivities for 5/6 readers and relatively unchanged specificities. Interobserver agreement improved following processing. CONCLUSIONS Processing resulted in a selective increase in the contrast-to-noise ratio for diseased nerves and corresponding improvement in the detection of optic neuritis on MR imaging by radiologists.
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Affiliation(s)
- L Stunkel
- From the Department of Neurology (L.S.)
| | - A Sharma
- Mallinckrodt Institute of Radiology (A. Sharma, M.S.P.)
| | - M S Parsons
- Mallinckrodt Institute of Radiology (A. Sharma, M.S.P.)
| | - A Salter
- Division of Biostatistics (A. Salter)
| | - G P Van Stavern
- Department of Ophthalmology and Visual Sciences (G.P.V.S.), Washington University in St. Louis School of Medicine, St. Louis, Missouri.
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London F, Zéphir H, Hadhoum N, Lannoy J, Vermersch P, Pruvo JP, Hodel J, Leclerc X, Outteryck O. Optic nerve double inversion recovery hypersignal in patients with clinically isolated syndrome is associated with asymptomatic gadolinium-enhanced lesion. Mult Scler 2018; 25:1888-1895. [DOI: 10.1177/1352458518815797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Optic nerve involvement is not considered in dissemination in space (DIS) or time (DIT) of multiple sclerosis (MS) lesions. Objectives: To evaluate frequency of optic nerve involvement using three-dimensional (3D)-double inversion recovery (DIR) sequence in clinically isolated syndrome (CIS) and to measure its relationship with DIS and DIT (2010 and 2017 McDonald criteria). Methods: From November 2013 to August 2016, 57 CIS patients underwent 3T-magnetic resonance imaging (3T-MRI) including 3D-DIR sequence and optical coherence tomography (OCT) at 3 months after CIS. We assessed signal abnormalities of the optic nerves on DIR sequence and collected data for DIS and DIT criteria according to 2010 and 2017 McDonald criteria. Results: Among the 57 recruited patients, the presence of ⩾1 DIR hypersignal in optic nerve was observed in 36 (63%; 48 optic nerves) including asymptomatic hypersignal in 22 (38.5%; 25 optic nerves). Optic nerve involvement was significantly associated with DIT ( p = 0.006) and MS according to 2010 criteria ( p = 0.01) but was not significantly associated with presence of DIS criteria according to 2010 and 2017 McDonald criteria. We identified a significant ( p < 0.001) temporal peripapillary retinal nerve fiber layer thinning on eyes with optic nerve involvement versus healthy controls. Conclusions: Optic nerve involvement is very frequent at the earliest clinical stage of MS. It is associated with the presence of asymptomatic gadolinium-enhancement and retinal axonal loss and may reflect the inflammatory disease activity level.
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Affiliation(s)
- Frédéric London
- Department of Neurology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | - Hélène Zéphir
- Department of Neurology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France/LIRIC UMR 995, CHU Lille, University of Lille, Lille, France
| | - Nawal Hadhoum
- Department of Neurology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | - Julien Lannoy
- Department of Neurology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France
| | - Patrick Vermersch
- Department of Neurology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France/LIRIC UMR 995, CHU Lille, University of Lille, Lille, France
| | - Jean-Pierre Pruvo
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France/UMR 1171, CHU Lille, University of Lille, Lille, France
| | - Jérôme Hodel
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France/UMR 1171, CHU Lille, University of Lille, Lille, France
| | - Xavier Leclerc
- Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France/UMR 1171, CHU Lille, University of Lille, Lille, France
| | - Olivier Outteryck
- Department of Neurology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France/Department of Neuroradiology, Roger Salengro Hospital, CHU Lille, University of Lille, Lille, France/UMR 1171, CHU Lille, University of Lille, Lille, France
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Riederer I, Mühlau M, Hoshi MM, Zimmer C, Kleine JF. Detecting optic nerve lesions in clinically isolated syndrome and multiple sclerosis: double-inversion recovery magnetic resonance imaging in comparison with visually evoked potentials. J Neurol 2018; 266:148-156. [DOI: 10.1007/s00415-018-9114-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 02/02/2023]
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Umino M, Maeda M, Ii Y, Tomimoto H, Sakuma H. 3D double inversion recovery MR imaging: Clinical applications and usefulness in a wide spectrum of central nervous system diseases. J Neuroradiol 2018; 46:107-116. [PMID: 30016704 DOI: 10.1016/j.neurad.2018.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/03/2018] [Accepted: 06/23/2018] [Indexed: 12/31/2022]
Abstract
Double inversion recovery (DIR) imaging provides two inversion pulses that attenuate signals from cerebrospinal fluid and normal white matter. This review was undertaken to describe the principle of the DIR sequence, the clinical applications of 3D DIR in various central nervous system diseases and the clinical benefits of the 3D DIR compared with those of other MR sequences. 3D DIR imaging provides better lesion conspicuity and topography than other MR techniques. It is particularly useful for diagnosing the following disease entities: cortical and subcortical abnormalities such as multiple sclerosis, cortical microinfarcts and cortical development anomalies; sulcal abnormalities such as meningitis and subacute/chronic subarachnoid hemorrhage; and optic neuritis caused by multiple sclerosis or neuromyelitis optica.
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Affiliation(s)
- Maki Umino
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan.
| | - Masayuki Maeda
- Department of Advanced Diagnostic Imaging, Mie University School of Medicine, Tsu, Mie, Japan
| | - Yuichiro Ii
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, 514-8507 Tsu, Mie, Japan
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Sartoretti T, Sartoretti E, Rauch S, Binkert C, Wyss M, Czell D, Sartoretti-Schefer S. How Common Is Signal-Intensity Increase in Optic Nerve Segments on 3D Double Inversion Recovery Sequences in Visually Asymptomatic Patients with Multiple Sclerosis? AJNR Am J Neuroradiol 2017; 38:1748-1753. [PMID: 28663263 DOI: 10.3174/ajnr.a5262] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/12/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In postmortem studies, subclinical optic nerve demyelination is very common in patients with MS but radiologic demonstration is difficult and mainly based on STIR T2WI. Our aim was to evaluate 3D double inversion recovery MR imaging for the detection of subclinical demyelinating lesions within optic nerve segments. MATERIALS AND METHODS The signal intensities in 4 different optic nerve segments (ie, retrobulbar, canalicular, prechiasmatic, and chiasm) were evaluated on 3D double inversion recovery MR imaging in 95 patients with MS without visual symptoms within the past 3 years and in 50 patients without optic nerve pathology. We compared the signal intensities with those of the adjacent lateral rectus muscle. The evaluation was performed by a student group and an expert neuroradiologist. Statistical evaluation (the Cohen κ test) was performed. RESULTS On the 3D double inversion recovery sequence, optic nerve segments in the comparison group were all hypointense, and an isointense nerve sheath surrounded the retrobulbar nerve segment. At least 1 optic nerve segment was isointense or hyperintense in 68 patients (72%) in the group with MS on the basis of the results of the expert neuroradiologist. Student raters were able to correctly identify optic nerve hypersignal in 97%. CONCLUSIONS A hypersignal in at least 1 optic nerve segment on the 3D double inversion recovery sequence compared with hyposignal in optic nerve segments in the comparison group was very common in visually asymptomatic patients with MS. The signal-intensity rating of optic nerve segments could also be performed by inexperienced student readers.
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Affiliation(s)
- T Sartoretti
- From the Institut für Radiologie (T.S., E.S., S.R., C.B., M.W., S.S.-S.)
| | - E Sartoretti
- From the Institut für Radiologie (T.S., E.S., S.R., C.B., M.W., S.S.-S.)
| | - S Rauch
- From the Institut für Radiologie (T.S., E.S., S.R., C.B., M.W., S.S.-S.)
| | - C Binkert
- From the Institut für Radiologie (T.S., E.S., S.R., C.B., M.W., S.S.-S.)
| | - M Wyss
- From the Institut für Radiologie (T.S., E.S., S.R., C.B., M.W., S.S.-S.)
| | - D Czell
- Klinik für Innere Medizin (D.C.), Abteilung für Neurologie, Kantonsspital Winterthur, Winterthur, Switzerland
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Puthenparampil M, Federle L, Poggiali D, Miante S, Signori A, Pilotto E, Rinaldi F, Perini P, Sormani MP, Midena E, Gallo P. Trans-synaptic degeneration in the optic pathway. A study in clinically isolated syndrome and early relapsing-remitting multiple sclerosis with or without optic neuritis. PLoS One 2017; 12:e0183957. [PMID: 28850630 PMCID: PMC5574611 DOI: 10.1371/journal.pone.0183957] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 08/15/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Increasing evidence suggest that neuronal damage is an early and diffuse feature of Multiple Sclerosis (MS) pathology. Analysis of the optic pathway may help to clarify the mechanisms involved in grey matter damage in MS. Purpose of our study was to investigate the relationship between inflammation and neurodegeneration and to achieve evidence of trans-synaptic degeneration in the optic pathway in MS at clinical onset. METHODS 50 clinically isolated syndromes/early relapse-onset MS (CIS/eRRMS) with mean disease duration of 4.0±3.5 months, 28 MRI healthy controls (HC) and 31 OCT-HC were studied. Ten patients had optic neuritis at presentation (MSON+), 40 presented with other symptoms (MSON-). MRI examination included 3D-T1, 3D-FLAIR and 3D-DIR sequences. Global cortical thickness (gCTh), pericalcarin CTh (pCTh) and white matter volume (WMV) were analysed by means of Freesurfer on 3D-T1 scans. Optic radiation morphology (OR) and volume (ORV) were reconstructed on the base of the Jülich's Atlas. White matter lesion volume (WMLV), OR-WMLV and percent WM damage (WMLV/WMV = WMLV% and OR-WMLV/ORV = ORWMLV%) were obtained by 3D-FLAIR image segmentation. 3D-DIR sequences were applied to identify inflammatory lesions of the optic nerve. Optic coherence tomography (OCT) protocol included the analysis of global peripapillary retinal nerve fiber layer (g-RNFL) and the 6 fundus oculi's sectors (temporal, T-RNFL; temporal superior, TS-RNFL; nasal superior, NS-RNFL; nasal, N-RNFL; nasal inferior, NI-RNFL, temporal inferior, TI-RNFL). The retina of both eyes was analyzed. The eyes of ON+ were further divided into affected (aON+) or not (naON+). RESULTS No difference in CTh was found between CIS/eRRMS and HC, and between MSON+ and MSON-. Moreover, MSON+ and MSON- did not differ for any WM lesion load parameter. The most significant correlations between RNFL thickness and optic radiation WM pathology were found in MSON+. In these patients, the temporal RNFL inversely correlated to ipsilateral optic radiation WM lesion load (T-RNFL: r -0.7, p<0.05; TS-RNFL: r -0.7, p<0.05), while nasal RNFL inversely correlated to contralateral optic radiation WM lesion load (NI: r -0.8, p<0.01; NS-RNFL: r -0.8, p<0.01). CONCLUSIONS Our findings suggest that in MSON+ the optic pathway is site of a diffuse pathological process that involves both directly and via trans-synaptic degeneration the RNFL.
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Affiliation(s)
- Marco Puthenparampil
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Lisa Federle
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Davide Poggiali
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Silvia Miante
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics–University of Genova, Genova, Italy
| | - Elisabetta Pilotto
- Ophthalmology Unit, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Francesca Rinaldi
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Paola Perini
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Maria Pia Sormani
- Department of Health Sciences, Section of Biostatistics–University of Genova, Genova, Italy
| | - Edoardo Midena
- Ophthalmology Unit, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital–Medical School, Padova, Italy
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Eichinger P, Wiestler H, Zhang H, Biberacher V, Kirschke JS, Zimmer C, Mühlau M, Wiestler B. A novel imaging technique for better detecting new lesions in multiple sclerosis. J Neurol 2017; 264:1909-1918. [PMID: 28756606 DOI: 10.1007/s00415-017-8576-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/24/2022]
Abstract
We developed a tool that performs longitudinal subtraction of 3D double inversion recovery (DIR) images in follow-up magnetic resonance (MR) examinations of patients with multiple sclerosis. As DIR sequences show a high lesion-to-parenchyma contrast, we hypothesized that such a tool might lead to increased sensitivity for new lesions as well as to speeding up the routine clinical work-up of follow-up MR imaging in multiple sclerosis by directly visualizing new lesions. DIR subtraction images of serial MR examinations were calculated in 106 patients with multiple sclerosis. Existence of new lesions was assessed in three different ways: by standard visual comparison, by FLAIR, and by DIR subtraction maps. A reference standard, to which the single modalities were compared, was defined by combining all information from all readouts and all readers. The presence and number of new lesions were determined and the time needed for analysis measured. Accuracy of detecting overall existence of new lesions using DIR subtraction maps was significantly higher than using visual comparison (96 vs. 86%, p = 0.013) or FLAIR subtraction maps (p < 0.001), with increased sensitivity and higher negative predictive value. Significantly more new lesions were detected when using DIR subtraction maps (p < 0.001). Analyzing subtraction maps took less than a third of the time needed for the standard visual comparison (p = 0.007). Thus, DIR subtraction maps improve the detection of new lesions in a clinical setting both in terms of accuracy and in terms of speed.
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Affiliation(s)
- Paul Eichinger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Hanni Wiestler
- Department of Psychiatry and Psychotherapy, Isar-Amper-Klinikum München-Ost, Vockestraße 72, 85540, Haar, Germany
| | - Haike Zhang
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Viola Biberacher
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-NIC, NeuroImaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany.,TUM-NIC, NeuroImaging Center, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
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Boegel KH, Tyan AE, Iyer VR, Rykken JB, McKinney AM. Utility of coronal contrast-enhanced fat-suppressed FLAIR in the evaluation of optic neuropathy and atrophy. Eur J Radiol Open 2017; 4:13-18. [PMID: 28275657 PMCID: PMC5331143 DOI: 10.1016/j.ejro.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Evaluating chronic sequelae of optic neuritis, such as optic neuropathy with or without optic nerve atrophy, can be challenging on whole brain MRI. This study evaluated the utility of dedicated coronal contrast-enhanced fat-suppressed FLAIR (CE-FS-FLAIR) MR imaging to detect optic neuropathy and optic nerve atrophy. Materials and methods Over 4.5 years, a 3 mm coronal CE-FS-FLAIR sequence at 1.5T was added to the routine brain MRIs of 124 consecutive patients, 102 of whom had suspected or known demyelinating disease. Retrospective record reviews confirmed that 28 of these 102 had documented onset of optic neuritis >4 weeks prior to the brain MRI. These 28 were compared to the other 22 (“controls”) of the 124 patients who lacked a history of demyelinating disease or visual symptoms. Using coronal CE-FS-FLAIR, two neuroradiologists separately graded each optic nerve (n = 50 patients, 100 total nerves) as either negative, equivocal, or positive for optic neuropathy or atrophy. The scoring was later repeated. Results The mean time from acute optic neuritis onset to MRI was 4.1 ± 4.6 years (range 34 days-17.4 years). Per individual nerve grading, the range of sensitivity, specificity, and accuracy of coronal CE-FS-FLAIR in detecting optic neuropathy was 71.4–77.1%, 93.8–95.4%, and 85.5–89.0%, respectively, with strong interobserver (k = 0.667 − 0.678, p < 0.0001), and intraobserver (k = 0.706 − 0.763, p < 0.0001) agreement. For optic atrophy, interobserver agreement was moderate (k = 0.437 − 0.484, p < 0.0001), while intraobserver agreement was moderate-strong (k = 0.491 − 0.596, p < 0.0001). Conclusion Coronal CE-FS-FLAIR is quite specific in detecting optic neuropathy years after the onset of acute optic neuritis, but is less useful in detecting optic nerve atrophy.
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Wang Y, Yan H, Ding Q, Mao C, Shen Y, Wang G. 3D-DIR for early differential diagnostic and prognostic evaluation of NMO. Exp Ther Med 2016; 12:1464-1468. [PMID: 27588068 PMCID: PMC4998000 DOI: 10.3892/etm.2016.3474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/23/2016] [Indexed: 01/04/2023] Open
Abstract
Neuromyelitis optica (NMO) is an acute or subacute lesion of demyelinating disease involving the optic nerve and spinal cord, and imaging techniques and their effects have been the focus of investigations. The aim of the present study was to examine the value of three-dimensional double inversion recovery (3D-DIR) in the early differential diagnostic and prognostic evaluation of NMO. Forty-eight patients with suspicious NMO were included into the study and underwent a combination of serum NMO-IgG quantitative detection and 3D-DIR examination. Forty cases (83.3%) of the suspicious cases were confirmed with NMO. The average time from onset to definite diagnosis was 3.5±0.6 days. The brain showed high T2W and fluid-attenuated inversion recovery (FLAIR) signals, involving 5.8±1.2 sites on average, distributed in the peripheral lateral ventricle, medulla, cerebral white matter, the third ventricle, peripheral aqueduct of sylvius, pons and diencephalon. The average T2W signal strength was 2.73±0.12. The signal intensity of DIR was significantly higher than that of T2W and FLAIR, and the difference was statistically significant. The optic nerve and chiasma showed a high FLAIR signal, with an average signal intensity of 2.13±0.14. The spinal cord showed swelling, necrosis and cavity lesion, involving the gray and white matter of the central site, transversely, with an average lesion length of 4.7±0.6 centrum. The relative signal intensity of DIR was significantly higher than that of T2W and FLAIR. Following treatment, the signal intensity of the brain, optic nerve, optic chiasma and spinal cord decreased significantly (P<0.05). In conclusion, 3D-DIR has great application value in the early differential diagnostic and prognostic evaluation of NMO.
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Affiliation(s)
- Yanbing Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, P.R. China; Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong 276826, P.R. China
| | - Hong Yan
- Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong 276826, P.R. China
| | - Qixing Ding
- Department of Radiology, Rizhao People's Hospital, Rizhao, Shandong 276826, P.R. China
| | - Cunhua Mao
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250012, P.R. China
| | - Yelong Shen
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, P.R. China
| | - Guangbin Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, P.R. China
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Hodel J, Badr S, Outteryck O, Lebert P, Chechin D, Benadjaoud MA, Pruvo JP, Vermersch P, Leclerc X. Altered signal intensity of active enhancing inflammatory lesions using post-contrast double inversion recovery MR sequence. Eur Radiol 2016; 27:637-641. [PMID: 27229340 DOI: 10.1007/s00330-016-4416-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 05/09/2016] [Accepted: 05/13/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed at establishing the impact upon gadolinium administration on the conspicuity of active enhancing multiple sclerosis (MS) lesions using double inversion recovery (DIR) at 3T. METHODS 15 consecutive patients with MS (n=8) or a clinically isolated syndrome (n=7) underwent pre and post-contrast DIR in addition to T2-weighted, FLAIR, pre and post-contrast T1-weighted sequences. First, two neuroradiologists located and marked all the enhancing MS lesions visible in consensus. Second, two other neuroradiologists, blinded to other sequences than DIR, independently assessed the SI changes from pre to post-contrast DIR images for each enhancing lesion, according to a 4-point-scale: increased SI (grade 1), absence of change (grade 2), lesion being partially (grade 3) or completely masked on post-contrast DIR images (grade 4). RESULTS 246 MS lesions were detected including 26 enhancing on post-contrast T1-weighted images in 9 patients. The two blinded readers concluded to a decreased signal-intensity on post-contrast DIR images for all the 26 enhancing MS lesions (14 of grade 3 and 12 of grade 4). Inter-observer agreement was excellent, Kappa=0.85 (0.75 - 0.94). Using DIR post-contrast leads to altered signal-intensity of enhancing active MS lesions, ranging from partial to complete signal-loss. CONCLUSION Our study strongly suggests the use of DIR before gadolinium administration. KEY POINTS • DIR has gained widespread use in MS. • MRI protocols for MS patients usually contain several post-contrast sequences. • Signal-intensity of enhancing MS lesions is altered using DIR post-contrast. • Our study strongly suggests the use of DIR before gadolinium administration.
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Affiliation(s)
- Jérôme Hodel
- Departments of Neuroradiology, AP-HP, Hôpitaux Universitaires Henri Mondor, Créteil, France.
- Faculty of Medicine, Université Paris Est Créteil, Créteil, France.
- CHU Lille, Department of Neuroradiology, F-59000, Lille, France.
| | - Sammy Badr
- CHU Lille, Department of Neuroradiology, F-59000, Lille, France
| | - Olivier Outteryck
- Uniersity of Lille, CHU Lille, LIRIC - INSERM U995, FHU Imminent, F-59000, Lille, France
| | - Paul Lebert
- CHU Lille, Department of Neuroradiology, F-59000, Lille, France
| | | | | | - Jean-Pierre Pruvo
- University of Lille, CHU Lille, INSERM U1171, FHU VasCog, F-59000, Lille, France
| | - Patrick Vermersch
- Uniersity of Lille, CHU Lille, LIRIC - INSERM U995, FHU Imminent, F-59000, Lille, France
| | - Xavier Leclerc
- University of Lille, CHU Lille, INSERM U1171, FHU VasCog, F-59000, Lille, France
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Hadhoum N, Hodel J, Defoort-Dhellemmes S, Duhamel A, Drumez E, Zéphir H, Pruvo JP, Leclerc X, Vermersch P, Outteryck O. Length of optic nerve double inversion recovery hypersignal is associated with retinal axonal loss. Mult Scler 2015; 22:649-58. [PMID: 26227005 DOI: 10.1177/1352458515598021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/07/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the association between optic nerve double inversion recovery (DIR) hypersignal length and retinal axonal loss in neuroinflammatory diseases affecting optic nerves. METHODS We recruited patients previously affected (> 6 months) by a clinical episode of optic neuritis (ON). We had 25 multiple sclerosis (MS) patients, eight neuromyelitis optica spectrum disorder (NMOSD) patients and two patients suffering from idiopathic caused ON undergo brain magnetic resonance imaging (MRI); including a 3-dimensional (3D) DIR sequence, optical coherence tomography (OCT) examination and visual disability evaluation. Evaluation criteria were retinal thickness/volume, optic nerve DIR hypersignal length and high/low contrast vision acuity. RESULTS In the whole cohort, we found good associations (< 0.0001) between optic nerve DIR hypersignal length, peripapillary retinal nerve fiber layer thickness, inner macular layers volumes, and visual disability. We found subclinical radiological optic nerve involvement in 38.5% of non-ON MS eyes. CONCLUSIONS Optic nerve DIR hypersignal length may be a biomarker for retinal axonal loss, easily applicable in routine and research on new anti-inflammatory or neuroprotective drug evaluation. Detection of subclinical ON with 3D-DIR in a non-negligible proportion of MS patients argues in favor of optic nerve imaging in future OCT MS studies, in order to achieve a better understanding of retinal axonal loss in non-ON eyes.
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Affiliation(s)
- N Hadhoum
- Roger Salengro Hospital, University of Lille, Lille, France
| | - J Hodel
- Roger Salengro Hospital, University of Lille, Lille, France
| | | | - A Duhamel
- Department of Biostatistics, Centre d'Etudes et de Recherche en Informatique Médicale, Lille, France
| | - E Drumez
- Department of Biostatistics, Centre d'Etudes et de Recherche en Informatique Médicale, Lille, France
| | - H Zéphir
- Roger Salengro Hospital, University of Lille, Lille, France
| | - J P Pruvo
- Roger Salengro Hospital, University of Lille, Lille, France
| | - X Leclerc
- Roger Salengro Hospital, University of Lille, Lille, France
| | - P Vermersch
- Roger Salengro Hospital, University of Lille, Lille, France
| | - O Outteryck
- Roger Salengro Hospital, University of Lille, Lille, France
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