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Barreiro-González A, Sanz MT, Carratalà-Boscà S, Pérez-Miralles F, Alcalá C, Carreres-Polo J, España-Gregori E, Casanova B. Design and Validation of an Expanded Disability Status Scale Model in Multiple Sclerosis. Eur Neurol 2021; 85:112-121. [PMID: 34788755 DOI: 10.1159/000519772] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to develop and validate an Expanded Disability Status Scale (EDSS) model through clinical, optical coherence tomography (OCT), and magnetic resonance imaging (MRI) measures. METHODS Sixty-four multiple sclerosis (MS) patients underwent peripapillary retinal nerve fiber layer and segmented macular layers evaluation through OCT (Spectralis, Heidelberg Engineering). Brain parenchymal fraction was quantified through Freesurfer, while cervical spinal cord (SC) volume was assessed manually guided by Spinal Cord Toolbox software analysis. EDSS, neuroradiological, and OCT assessment were carried out within 3 months. OCT parameters were calculated as the average of both nonoptic neuritis (ON) eyes, and in case the patient had previous ON, the value of the fellow non-ON eye was taken. Brain lesion volume, sex, age, disease duration, and history of disease-modifying treatment (1st or 2nd line disease-modifying treatments) were tested as covariables of the EDSS score. RESULTS EDSS values correlated with patient's age (r = 0.543, p = 0.001), SC volume (r = -0.301, p = 0.034), and ganglion cell layer (GCL, r = -0.354, p = 0.012). Using these correlations, an ordinal regression model to express probability of diverse EDSS scores were designed, the highest of which was the most probable (Nagelkerke R2 = 43.3%). Using EDSS cutoff point of 4.0 in a dichotomous model, compared to a cutoff of 2.0, permits the inclusion of GCL as a disability predictor, in addition to age and SC. CONCLUSIONS MS disability measured through EDSS is an age-dependent magnitude that is partly conditioned by SC and GCL. Further studies assessing paraclinical disability predictors are needed.
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Affiliation(s)
| | - Maria T Sanz
- Department of Mathematics Teaching, University of Valencia, Valencia, Spain
| | - Sara Carratalà-Boscà
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | | | - Carmen Alcalá
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Joan Carreres-Polo
- Radiology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Enrique España-Gregori
- Opthalmology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Surgery Department, University of Valencia, Valencia, Spain
| | - Bonaventura Casanova
- Neurology Department, University and Polytechnic Hospital La Fe, Valencia, Spain.,Medicine Department, University of Valencia, Valencia, Spain
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A matter of atrophy: differential impact of brain and spine damage on disability worsening in multiple sclerosis. J Neurol 2021; 268:4698-4706. [PMID: 33942160 PMCID: PMC8563557 DOI: 10.1007/s00415-021-10576-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
As atrophy represents the most relevant driver of progression in multiple sclerosis (MS), we investigated the impact of different patterns of brain and spinal cord atrophy on disability worsening in MS. We acquired clinical and MRI data from 90 patients with relapsing–remitting MS and 24 healthy controls (HC). Clinical progression at follow-up (mean 3.7 years) was defined according to the Expanded Disability Status Scale-Plus. Brain and spinal cord volumes were computed on MRI brain scans. After normalizing each participants’ brain and spine volume to the mean of the HC, z-score cut-offs were applied to separate pathologically atrophic from normal brain and spine volumes (accepting a 2.5% error probability). Accordingly, MS patients were classified into four groups (Group I: no brain or spinal cord atrophy N = 40, Group II: brain atrophy/no spinal cord atrophy N = 11, Group III: no brain atrophy/ spinal cord atrophy N = 32, Group IV: both brain and spinal cord atrophy N = 7). All patients’ groups showed significantly lower brain volume than HC (p < 0.0001). Group III and IV showed lower spine volume than HC (p < 0.0001 for both). Higher brain lesion load was identified in Group II (p = 0.049) and Group IV (p = 0.023) vs Group I, and in Group IV (p = 0.048) vs Group III. Spinal cord atrophy (OR = 3.75, p = 0.018) and brain + spinal cord atrophy (OR = 5.71, p = 0.046) were significant predictors of disability progression. The presence of concomitant brain and spinal cord atrophy is the strongest correlate of progression over time. Isolated spinal cord atrophy exerts a similar effect, confirming the leading role of spinal cord atrophy in the determination of motor disability.
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Jeong K, Shah LM, Lee YJ, Thapa B, Sapkota N, Bisson E, Carlson NG, Jeong EK, Rose JW. High-b diffusivity of MS lesions in cervical spinal cord using ultrahigh-b DWI (UHb-DWI). Neuroimage Clin 2021; 30:102610. [PMID: 33752076 PMCID: PMC7985401 DOI: 10.1016/j.nicl.2021.102610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate UHb-rDWI signal in white matter tracts of the cervical spinal cord (CSC) and compare quantitative values between healthy control WM with both MS NAWM and MS WM lesions. METHODS UHb-rDWI experiments were performed on (a) 7 MS patients with recently active or chronic lesions in CSC and on (b) 7 healthy control of similar age range and gender distribution to MS subjects. All MRI data were acquired using clinical 3T MRI system. Axial high-b diffusion images were acquired using 2D single-shot DW stimulated EPI with reduced FOV and a CSC-dedicated 8 channel array coil. High-b diffusion coefficient DH was estimated by fitting the signal-b curve to a double or single-exponential function. RESULTS The high-b diffusivity DH values were measured as (0.767 ± 0.297) × 10-3 mm2/s in the posterior column lesions, averaged over 6 MS patients, and 0.587 × 10-3 mm2/s in the corticospinal tract for another patient. The averaged DH values of the 7 healthy volunteers from the posterior and lateral column were (0.0312 ± 0.0306) × 10-3 and (0.0505 ± 0.0205) × 10-3 mm2/s, respectively. UHb-rDWI signal-b curves of the MS patients revealed to noticeably behave differently to that of the healthy controls. The patient signal-b curves decayed with greater high-b decay constants to reach lower signal intensities relative to signal-b curves of the healthy controls. CONCLUSION UHb-DWI of the CSC reveals a marked difference in signal-b-curves and DH values in MS lesions compared to NAWM and healthy control WM. Based on physical principles, we interpret these altered observations of quantitative diffusion values to be indicative of demyelination. Further studies in animal models will be required to fully interpret UHb-DWI quantitative diffusion values during demyelination and remyelination.
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Affiliation(s)
- Kyle Jeong
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Lubdha M Shah
- Department of Radiology and Imaging Sciences, University of Utah, Utah, USA
| | - You-Jung Lee
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Bijaya Thapa
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Nabraj Sapkota
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA
| | - Erica Bisson
- Department of Neurosurgery, University of Utah, Utah, USA
| | - Noel G Carlson
- Neuroimmunology and Neurovirology Division, Department of Neurology, University of Utah, Utah, USA; GRECC, VA Salt Lake City Health Care System, Utah, USA; Department of Neurobiology, University of Utah, Utah, USA
| | - E K Jeong
- Utah Center for Advanced Imaging Research, University of Utah, Utah, USA; Department of Radiology and Imaging Sciences, University of Utah, Utah, USA
| | - John W Rose
- Neuroimmunology and Neurovirology Division, Department of Neurology, University of Utah, Utah, USA; Neurology Service, VA Salt Lake City Health Care System, Utah, USA.
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Spinal cord atrophy in a primary progressive multiple sclerosis trial: Improved sample size using GBSI. NEUROIMAGE-CLINICAL 2020; 28:102418. [PMID: 32961403 PMCID: PMC7509079 DOI: 10.1016/j.nicl.2020.102418] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 01/18/2023]
Abstract
The GBSI provided clinically meaningful measurements of spinal cord atrophy, with low sample size. Deriving spinal cord atrophy from brain MRI using the GBSI is easier than spinal cord MRI. Spinal cord atrophy on GBSI could be used as a secondary outcome measure.
Background We aimed to evaluate the implications for clinical trial design of the generalised boundary-shift integral (GBSI) for spinal cord atrophy measurement. Methods We included 220 primary-progressive multiple sclerosis patients from a phase 2 clinical trial, with baseline and week-48 3DT1-weighted MRI of the brain and spinal cord (1 × 1 × 1 mm3), acquired separately. We obtained segmentation-based cross-sectional spinal cord area (CSA) at C1-2 (from both brain and spinal cord MRI) and C2-5 levels (from spinal cord MRI) using DeepSeg, and, then, we computed corresponding GBSI. Results Depending on the spinal cord segment, we included 67.4–98.1% patients for CSA measurements, and 66.9–84.2% for GBSI. Spinal cord atrophy measurements obtained with GBSI had lower measurement variability, than corresponding CSA. Looking at the image noise floor, the lowest median standard deviation of the MRI signal within the cerebrospinal fluid surrounding the spinal cord was found on brain MRI at the C1-2 level. Spinal cord atrophy derived from brain MRI was related to the corresponding measures from dedicated spinal cord MRI, more strongly for GBSI than CSA. Spinal cord atrophy measurements using GBSI, but not CSA, were associated with upper and lower limb motor progression. Discussion Notwithstanding the reduced measurement variability, the clinical correlates, and the possibility of using brain acquisitions, spinal cord atrophy using GBSI should remain a secondary outcome measure in MS studies, until further advancements increase the quality of acquisition and reliability of processing.
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Standardizing Magnetic Resonance Imaging Protocols, Requisitions, and Reports in Multiple Sclerosis: An Update for Radiologist Based on 2017 Magnetic Resonance Imaging in Multiple Sclerosis and 2018 Consortium of Multiple Sclerosis Centers Consensus Guidelines. J Comput Assist Tomogr 2019; 43:1-12. [PMID: 30015803 DOI: 10.1097/rct.0000000000000767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The advent of magnetic resonance imaging has improved our understanding of the pathophysiology and natural course of multiple sclerosis (MS). The ability of magnetic resonance imaging to show the evolution of MS lesions on sequential scans has brought it to be one of the endpoints in clinical trials for disease-modifying therapies. Based on the most updated consensus guidelines from the American (Consortium of MS Centers) and European (Magnetic Resonance Imaging in MS) boards of experts in MS, this document shows the most relevant landmarks related to imaging findings, diagnostic criteria, indications to obtain a magnetic resonance, scan protocols and sequence options for patients with MS. Although incorporating the knowledge derived from the research arena into the daily clinical practice is always challenging, in this article, the authors provide useful recommendations to improve the information contained in the magnetic resonance report oriented to facilitate communication between radiologists and specialized medical teams involved in MS patients' multidisciplinary care.
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Petracca M, Margoni M, Bommarito G, Inglese M. Monitoring Progressive Multiple Sclerosis with Novel Imaging Techniques. Neurol Ther 2018; 7:265-285. [PMID: 29956263 PMCID: PMC6283788 DOI: 10.1007/s40120-018-0103-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/04/2023] Open
Abstract
Imaging markers for monitoring disease progression in progressive multiple sclerosis (PMS) are scarce, thereby limiting the possibility to monitor disease evolution and to test effective treatments in clinical trials. Advanced imaging techniques that have the advantage of metrics with increased sensitivity to short-term tissue changes and increased specificity to the structural abnormalities characteristic of PMS have recently been applied in clinical trials of PMS. In this review, we (1) provide an overview of the pathological features of PMS, (2) summarize the findings of research and clinical trials conducted in PMS which have applied conventional and advanced magnetic resonance imaging techniques and (3) discuss recent advancements and future perspectives in monitoring PMS with imaging techniques.
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Affiliation(s)
- Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Margoni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Multiple Sclerosis Centre, Department of Neurosciences DNS, University Hospital, University of Padua, Padua, Italy
| | - Giulia Bommarito
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Genetics and Maternal and Perinatal Sciences, University of Genoa, Genoa, Italy.
- Departments of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Zeydan B, Gu X, Atkinson EJ, Keegan BM, Weinshenker BG, Tillema JM, Pelletier D, Azevedo CJ, Lebrun-Frenay C, Siva A, Okuda DT, Kantarci K, Kantarci OH. Cervical spinal cord atrophy: An early marker of progressive MS onset. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e435. [PMID: 29435472 PMCID: PMC5795903 DOI: 10.1212/nxi.0000000000000435] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/28/2017] [Indexed: 11/15/2022]
Abstract
Objective To assess whether cervical spinal cord atrophy heralds the onset of progressive MS. Methods We studied 34 individuals with radiologically isolated syndrome (RIS) and 31 patients with relapsing-remitting MS (RRMS) age matched to 25 patients within a year of onset of secondary progressive MS (SPMS). Two raters independently measured (twice per rater) the cervical spinal cord average segmental area (CASA) (mm2) of axial T2-weighted images between C2 and C7 landmarks. The midsagittal T2-weighted image from the end of C2 to the end of C7 vertebra was used to measure the cervical spine (c-spine) length (mm). Sex, age at cervical MRI, number and location of cervical spinal cord lesions, c-spine length, and diagnoses were analyzed against the outcome measures of CASA and C2 and C7 slice segmental areas. Results Intrarater and interrater agreement was excellent (intraclass correlation coefficient >0.97). The CASA area (p = 0.03) and C7 area (p = 0.002) were smaller in SPMS compared with RRMS. The C2 area (p = 0.027), CASA (p = 0.004), and C7 area (p = 0.003) were smaller in SPMS compared with RIS. The C2 area did not differ between SPMS and RRMS (p = 0.09). The C2 area (p = 0.349), CASA (p = 0.136), and C7 area (p = 0.228) did not differ between RIS and MS (SPMS and RRMS combined). In the multivariable model, ≥2 cervical spinal cord lesions were associated with the C2 area (p = 0.008), CASA (p = 0.009), and C7 area independent of disease course (p = 0.017). Progressive disease course was associated with the C7 area independent of the cervical spinal cord lesion number (p = 0.004). Conclusion Cervical spinal cord atrophy is evident at the onset of progressive MS and seems partially independent of the number of cervical spinal cord lesions. Classification of evidence This study provides Class III evidence that MRI cervical spinal cord atrophy distinguishes patients at the onset of progressive MS from those with RIS and RRMS.
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Affiliation(s)
- Burcu Zeydan
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Xinyi Gu
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Elizabeth J Atkinson
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - B Mark Keegan
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Brian G Weinshenker
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Jan-Mendelt Tillema
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Daniel Pelletier
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Christina J Azevedo
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Christine Lebrun-Frenay
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Aksel Siva
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Darin T Okuda
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Kejal Kantarci
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
| | - Orhun H Kantarci
- Department of Neurology (B.Z., X.G., B.M.K., B.G.W., J.-M.T., O.H.K.), Department of Radiology (B.Z., K.K.), and Department of Health Sciences Research (E.J.A.), Mayo Clinic College of Medicine, Rochester, MN; Department of Neurology (X.G.), The affiliated ZhongShan Hospital of DaLian University, LiaoNing, China; Multiple Sclerosis Center (D.P., C.J.A.), Keck School of Medicine, University of Southern California, Los Angeles; Department of Neurology (C.L.-F.), Hopital Pasteur, Nice, France; Cerrahpasa School of Medicine (A.S.), Istanbul University, Turkey; and Department of Neurology & Neurotherapeutics (D.T.O.), Clinical Center for Multiple Sclerosis, University of Texas Southwestern Medical Center, Dallas
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Aymerich FX, Auger C, Alonso J, Alberich M, Sastre-Garriga J, Tintoré M, Montalban X, Rovira A. Cervical Cord Atrophy and Long-Term Disease Progression in Patients with Primary-Progressive Multiple Sclerosis. AJNR Am J Neuroradiol 2017; 39:399-404. [PMID: 29284602 DOI: 10.3174/ajnr.a5495] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/16/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cervical cord atrophy has been associated with clinical disability in multiple sclerosis and is proposed as an outcome measure of neurodegeneration. The aim of this study was to quantify the development of cervical cord atrophy and to evaluate its association with disability progression in patients with primary-progressive multiple sclerosis. MATERIALS AND METHODS Thirty-one patients with primary-progressive multiple sclerosis underwent 1.5T brain and spinal cord MR imaging at baseline and 6-7 years later. The cervical spinal cord from C1 to C5 was segmented to evaluate the normalized overall cross-sectional area and the cross-sectional area of C2-C3, C3-C4, and C4-C5. The annualized rates of normalized cross-sectional area loss were also evaluated. To estimate clinical progression, we determined the Expanded Disability Status Scale score at baseline and at 2 and 14 years after baseline to compute the normalized area under the curve of the Expanded Disability Status Scale and the Expanded Disability Status Scale changes from baseline to the follow-up time points. Associations between the cord cross-sectional area and brain MR imaging and clinical measures were also investigated. Finally, the value of all these measures for predicting long-term disability was evaluated. RESULTS Some normalized cross-sectional area measurements showed moderate correlations with the normalized area under the curve of the Expanded Disability Status Scale, ranging from -0.439 to -0.359 (P < .05). Moreover, the annualized rate of the normalized mean cross-sectional area loss and the baseline Expanded Disability Status Scale were independent predictors of long-term disability progression. CONCLUSIONS These data indicate that development of cervical cord atrophy is associated with progression of disability and is predictive of this event in patients with primary-progressive MS.
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Affiliation(s)
- F X Aymerich
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology .,Department of Automatic Control (F.X.A.), Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | - C Auger
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
| | - J Alonso
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
| | - M Alberich
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
| | - J Sastre-Garriga
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Tintoré
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Rovira
- From the Magnetic Resonance Unit (F.X.A., C.A., J.A., M.A., A.R.), Department of Radiology
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9
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Moccia M, de Stefano N, Barkhof F. Imaging outcome measures for progressive multiple sclerosis trials. Mult Scler 2017; 23:1614-1626. [PMID: 29041865 PMCID: PMC5650056 DOI: 10.1177/1352458517729456] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
Abstract
Imaging markers that are reliable, reproducible and sensitive to neurodegenerative changes in progressive multiple sclerosis (MS) can enhance the development of new medications with a neuroprotective mode-of-action. Accordingly, in recent years, a considerable number of imaging biomarkers have been included in phase 2 and 3 clinical trials in primary and secondary progressive MS. Brain lesion count and volume are markers of inflammation and demyelination and are important outcomes even in progressive MS trials. Brain and, more recently, spinal cord atrophy are gaining relevance, considering their strong association with disability accrual; ongoing improvements in analysis methods will enhance their applicability in clinical trials, especially for cord atrophy. Advanced magnetic resonance imaging (MRI) techniques (e.g. magnetization transfer ratio (MTR), diffusion tensor imaging (DTI), spectroscopy) have been included in few trials so far and hold promise for the future, as they can reflect specific pathological changes targeted by neuroprotective treatments. Positron emission tomography (PET) and optical coherence tomography have yet to be included. Applications, limitations and future perspectives of these techniques in clinical trials in progressive MS are discussed, with emphasis on measurement sensitivity, reliability and sample size calculation.
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Affiliation(s)
- Marcello Moccia
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, University College London, London, UK; Multiple Sclerosis Clinical Care and Research Centre, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Nicola de Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Frederik Barkhof
- NMR Research Unit, Queen Square MS Centre, UCL Institute of Neurology, University College London, London, UK; Translational Imaging Group, UCL Institute of Healthcare Engineering, University College London, London, UK; Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
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10
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Rocca MA, Comi G, Filippi M. The Role of T1-Weighted Derived Measures of Neurodegeneration for Assessing Disability Progression in Multiple Sclerosis. Front Neurol 2017; 8:433. [PMID: 28928705 PMCID: PMC5591328 DOI: 10.3389/fneur.2017.00433] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is characterised by the accumulation of permanent neurological disability secondary to irreversible tissue loss (neurodegeneration) in the brain and spinal cord. MRI measures derived from T1-weighted image analysis (i.e., black holes and atrophy) are correlated with pathological measures of irreversible tissue loss. Quantifying the degree of neurodegeneration in vivo using MRI may offer a surrogate marker with which to predict disability progression and the effect of treatment. This review evaluates the literature examining the association between MRI measures of neurodegeneration derived from T1-weighted images and disability in MS patients. Methods A systematic PubMed search was conducted in January 2017 to identify MRI studies in MS patients investigating the relationship between “black holes” and/or atrophy in the brain and spinal cord, and disability. Results were limited to human studies published in English in the previous 10 years. Results A large number of studies have evaluated the association between the previous MRI measures and disability. These vary considerably in terms of study design, duration of follow-up, size, and phenotype of the patient population. Most, although not all, have shown that there is a significant correlation between disability and black holes in the brain, as well as atrophy of the whole brain and grey matter. The results for brain white matter atrophy are less consistently positive, whereas studies evaluating spinal cord atrophy consistently showed a significant correlation with disability. Newer ways of measuring atrophy, thanks to the development of segmentation and voxel-wise methods, have allowed us to assess the involvement of strategic regions of the CNS (e.g., thalamus) and to map the regional distribution of damage. This has resulted in better correlations between MRI measures and disability and in the identification of the critical role played by some CNS structures for MS clinical manifestations. Conclusion The evaluation of MRI measures of atrophy as predictive markers of disability in MS is a highly active area of research. At present, measurement of atrophy remains within the realm of clinical studies, but its utility in clinical practice has been recognized and barriers to its implementation are starting to be addressed.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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11
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Relevance of early cervical cord volume loss in the disease evolution of clinically isolated syndrome and early multiple sclerosis: a 2-year follow-up study. J Neurol 2017; 264:1402-1412. [PMID: 28600596 DOI: 10.1007/s00415-017-8537-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
Upper cervical cord area (UCCA) atrophy is a prognostic marker for clinical progression in longstanding multiple sclerosis (MS). The objectives of the study were to quantify UCCA atrophy and evaluate its impact in clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS); to compare converting CIS patients with stable CIS, and to study changes of UCCA and brain white matter (WM) and grey matter (GM) at 2-year follow-up. 110 therapy-naive patients including 53 CIS [6 ± 6 months after symptom onset (SO)] and 57 early RRMS (SO: 12 ± 9 months) underwent sagittal 3D-T1w brain MR (3T). Mean UCCA (C1-C3 level), WM and GM, disability status (EDSS), pyramidal and sensory functional scores, motoric fatigue were assessed at baseline (BL), 12 and 24 months. Volumes were compared with 34 age- and gender-matched healthy controls to assess atrophy. RRMS (78.1 ± 8.7 mm2, p = 0.011) and converting CIS (77.3 ± 8.0 mm2, p = 0.046) presented with baseline UCCA atrophy, when compared with controls (82.7 ± 5.2 mm2), but not stable CIS (82.6 ± 7.4 mm2, p = 0.998). Baseline WM was reduced in RRMS (509.3 ± 25.7 ml vs. CONTROLS 528.4 ± 24.1 ml, p = 0.032). Baseline UCCA correlated negative with muscular weakness and fatigability in all patients and RRMS. EDSS exceeding 3 was associated with lower baseline UCCA. Longitudinal atrophy rates were higher in UCCA than in brain volumes. Early cervical cord atrophy in CIS and RRMS was confirmed and may represent a potential new risk marker for conversion from CIS to MS. Baseline atrophy and atrophy change rates were higher in UCCA compared to WM and GM, suggesting that cervical cord volumetry might become an additional MRI marker relevant in future clinical studies in CIS and early MS.
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12
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Klein JP. Imaging of noninfectious inflammatory disorders of the spinal cord. HANDBOOK OF CLINICAL NEUROLOGY 2017; 136:733-46. [PMID: 27430439 DOI: 10.1016/b978-0-444-53486-6.00036-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Myelitis, or inflammation of the spinal cord, produces a characteristic clinical syndrome. Among the many causes of myelitis are the prototypical demyelinating diseases multiple sclerosis and neuromyelitis optica, each of which has distinct clinical, pathologic, and radiographic features. Less distinct are the myelitides associated with systemic autoimmune conditions like sarcoidosis and lupus. Nondemyelinating conditions such as arachnoiditis, dural arteriovenous fistula, and tumor infiltration may also produce inflammation of the spinal cord. The objective of this review is to aid the clinician in the radiographic diagnosis of noninfectious inflammatory diseases of the spinal cord.
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Affiliation(s)
- Joshua P Klein
- Departments of Neurology and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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13
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Keshavan A, Paul F, Beyer MK, Zhu AH, Papinutto N, Shinohara RT, Stern W, Amann M, Bakshi R, Bischof A, Carriero A, Comabella M, Crane JC, D'Alfonso S, Demaerel P, Dubois B, Filippi M, Fleischer V, Fontaine B, Gaetano L, Goris A, Graetz C, Gröger A, Groppa S, Hafler DA, Harbo HF, Hemmer B, Jordan K, Kappos L, Kirkish G, Llufriu S, Magon S, Martinelli-Boneschi F, McCauley JL, Montalban X, Mühlau M, Pelletier D, Pattany PM, Pericak-Vance M, Cournu-Rebeix I, Rocca MA, Rovira A, Schlaeger R, Saiz A, Sprenger T, Stecco A, Uitdehaag BMJ, Villoslada P, Wattjes MP, Weiner H, Wuerfel J, Zimmer C, Zipp F, Hauser SL, Oksenberg JR, Henry RG. Power estimation for non-standardized multisite studies. Neuroimage 2016; 134:281-294. [PMID: 27039700 PMCID: PMC5656257 DOI: 10.1016/j.neuroimage.2016.03.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022] Open
Abstract
A concern for researchers planning multisite studies is that scanner and T1-weighted sequence-related biases on regional volumes could overshadow true effects, especially for studies with a heterogeneous set of scanners and sequences. Current approaches attempt to harmonize data by standardizing hardware, pulse sequences, and protocols, or by calibrating across sites using phantom-based corrections to ensure the same raw image intensities. We propose to avoid harmonization and phantom-based correction entirely. We hypothesized that the bias of estimated regional volumes is scaled between sites due to the contrast and gradient distortion differences between scanners and sequences. Given this assumption, we provide a new statistical framework and derive a power equation to define inclusion criteria for a set of sites based on the variability of their scaling factors. We estimated the scaling factors of 20 scanners with heterogeneous hardware and sequence parameters by scanning a single set of 12 subjects at sites across the United States and Europe. Regional volumes and their scaling factors were estimated for each site using Freesurfer's segmentation algorithm and ordinary least squares, respectively. The scaling factors were validated by comparing the theoretical and simulated power curves, performing a leave-one-out calibration of regional volumes, and evaluating the absolute agreement of all regional volumes between sites before and after calibration. Using our derived power equation, we were able to define the conditions under which harmonization is not necessary to achieve 80% power. This approach can inform choice of processing pipelines and outcome metrics for multisite studies based on scaling factor variability across sites, enabling collaboration between clinical and research institutions.
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Affiliation(s)
- Anisha Keshavan
- Department of Neurology, University of California, San Francisco, CA, USA; UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA, USA.
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité University Medicine Berlin, Berlin, Germany.
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway.
| | - Alyssa H Zhu
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Nico Papinutto
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
| | - William Stern
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Michael Amann
- Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.
| | - Rohit Bakshi
- Brigham and Women's Hospital, MA, United States.
| | - Antje Bischof
- Department of Neurology, University of California, San Francisco, CA, USA; Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland; Clinical Immunology, University Hospital Basel,University of Basel, Basel, Switzerland.
| | - Alessandro Carriero
- Department of Translational Medicine, Department of Radiology, UPO University, Via Solaroli 17, 28100 Novara, Italy.
| | | | - Jason C Crane
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | | | - Philippe Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
| | - Benedicte Dubois
- KU Leuven-University of Leuven, Department of Neurosciences, Leuven, Belgium.
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Germany.
| | - Bertrand Fontaine
- Hôpital Pitié-Salpêtrière, ICM, UPMC 06 UM 75, INSERM U 1127, CNRS UMR 7225, IHU-A-ICM, AP-HP: Pôle des maladies du système nerveux, 47 boulevard de l'Hôpital, 75013 Paris, France.
| | - Laura Gaetano
- Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland; Medical Image Analysis Center (MIAC AG), Basel, Switzerland.
| | - An Goris
- KU Leuven-University of Leuven, Department of Neurosciences, Leuven, Belgium.
| | - Christiane Graetz
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Germany.
| | - Adriane Gröger
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Germany.
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Germany.
| | - David A Hafler
- Departments of Neurology and Immunobiology, Yale School of Medicine, CT, USA.
| | - Hanne F Harbo
- Department of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway.
| | - Bernhard Hemmer
- Dept. Neurology of the Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster of Systems Neurology (SyNery), Germany.
| | - Kesshi Jordan
- Department of Neurology, University of California, San Francisco, CA, USA; UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA, USA.
| | - Ludwig Kappos
- Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.
| | - Gina Kirkish
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
| | - Sara Llufriu
- Center for Neuroimmunology, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain.
| | - Stefano Magon
- Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.
| | - Filippo Martinelli-Boneschi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics and the Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miami, USA.
| | | | - Mark Mühlau
- Dept. Neurology of the Klinikum rechts der Isar, Technische Universität München, Munich, Germany; TUM-Neuroimaging Center, Technische Universität München, Munich, Germany.
| | - Daniel Pelletier
- Departments of Neurology and Immunobiology, Yale School of Medicine, CT, USA.
| | - Pradip M Pattany
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Margaret Pericak-Vance
- John P. Hussman Institute for Human Genomics and the Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miami, USA.
| | - Isabelle Cournu-Rebeix
- Hôpital Pitié-Salpêtrière, ICM, UPMC 06 UM 75, INSERM U 1127, CNRS UMR 7225, IHU-A-ICM, AP-HP: Pôle des maladies du système nerveux, 47 boulevard de l'Hôpital, 75013 Paris, France.
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alex Rovira
- Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - Regina Schlaeger
- Department of Neurology, University of California, San Francisco, CA, USA; Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland; Clinical Immunology, University Hospital Basel,University of Basel, Basel, Switzerland.
| | - Albert Saiz
- Center for Neuroimmunology, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain.
| | - Till Sprenger
- Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland; DKD Helios Klinik Wiesbaden, Wiesbaden, Germany.
| | - Alessandro Stecco
- Section of Neuroradiology, Department of Radiology, Maggiore Hospital, Corso Mazzini 18, 28100, Novara, Italy.
| | | | - Pablo Villoslada
- Center for Neuroimmunology, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain.
| | - Mike P Wattjes
- MS Center Amsterdam, VU University Medical Center Amsterdam, The Netherlands.
| | | | - Jens Wuerfel
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; Medical Image Analysis Center, Basel, Switzerland.
| | - Claus Zimmer
- Dept. Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn2), University Medical Centre of the Johannes Gutenberg University Mainz, Germany.
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Jorge R Oksenberg
- Department of Neurology, University of California, San Francisco, CA, USA.
| | - Roland G Henry
- Department of Neurology, University of California, San Francisco, CA, USA; UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA, USA; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
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14
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Brown JWL, Chard DT. The role of MRI in the evaluation of secondary progressive multiple sclerosis. Expert Rev Neurother 2016; 16:157-71. [PMID: 26692498 DOI: 10.1586/14737175.2016.1134323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging already has an established role in the diagnosis of multiple sclerosis, but it also has the potential to provide prognostic information, and to monitor [corrected] disease progression in clinical trials and practice. Magnetic resonance imaging measures are increasingly being used as the primary outcome in early phase clinical trials of immunomodulatory therapies (for example brain white matter lesion counts or volumes, and gadolinium contrast enhancing lesions) and putatively neuroprotective agents (for example measures of whole brain atrophy), and trials of agents that promote remyelination are also likely to follow suit. In this review we consider the use of magnetic resonance imaging measures as predictors and markers of disease progression in multiple sclerosis, and explore possible future directions in this rapidly developing field.
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Affiliation(s)
- J William L Brown
- a Department of Clinical Neurosciences , University of Cambridge , Cambridge , UK.,b NMR Research Unit, Queen Square Multiple Sclerosis Centre, Institute of Neurology , University College London (UCL) , London , UK
| | - Declan T Chard
- b NMR Research Unit, Queen Square Multiple Sclerosis Centre, Institute of Neurology , University College London (UCL) , London , UK.,c Biomedical Research Centre, National Institute for Health Research (NIHR) , University College London Hospitals (UCLH) , London , UK
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15
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Sellebjerg F, Cadavid D, Steiner D, Villar LM, Reynolds R, Mikol D. Exploring potential mechanisms of action of natalizumab in secondary progressive multiple sclerosis. Ther Adv Neurol Disord 2016; 9:31-43. [PMID: 26788129 DOI: 10.1177/1756285615615257] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multiple sclerosis (MS) is a common and chronic central nervous system (CNS) demyelinating disease and a leading cause of permanent disability. Patients most often present with a relapsing-remitting disease course, typically progressing over time to a phase of relentless advancement in secondary progressive MS (SPMS), for which approved disease-modifying therapies are limited. In this review, we summarize the pathophysiological mechanisms involved in the development of SPMS and the rationale and clinical potential for natalizumab, which is currently approved for the treatment of relapsing forms of MS, to exert beneficial effects in reducing disease progression unrelated to relapses in SPMS. In both forms of MS, active brain-tissue injury is associated with inflammation; but in SPMS, the inflammatory response occurs at least partly behind the blood-brain barrier and is followed by a cascade of events, including persistent microglial activation that may lead to chronic demyelination and neurodegeneration associated with irreversible disability. In patients with relapsing forms of MS, natalizumab therapy is known to significantly reduce intrathecal inflammatory responses which results in reductions in brain lesions and brain atrophy as well as beneficial effects on clinical measures, such as reduced frequency and severity of relapse and reduced accumulation of disability. Natalizumab treatment also reduces levels of cerebrospinal fluid chemokines and other biomarkers of intrathecal inflammation, axonal damage and demyelination, and has demonstrated the ability to reduce innate immune activation and intrathecal immunoglobulin synthesis in patients with MS. The efficacy of natalizumab therapy in SPMS is currently being investigated in a randomized, double-blind, placebo-controlled trial.
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Affiliation(s)
- Finn Sellebjerg
- Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Luisa Maria Villar
- Department of Immunology, Ramón y Cajal University Hospital, Institute Ramón y Cajal for Biomedical Research, Madrid, Spain
| | - Richard Reynolds
- Division of Brain Sciences, Imperial College London, Hammersmith Hospital Campus, London, UK
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16
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Vollmer T, Huynh L, Kelley C, Galebach P, Signorovitch J, DiBernardo A, Sasane R. Relationship between brain volume loss and cognitive outcomes among patients with multiple sclerosis: a systematic literature review. Neurol Sci 2015; 37:165-79. [PMID: 26537494 DOI: 10.1007/s10072-015-2400-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022]
Abstract
Patients with multiple sclerosis (MS) experience varying rates of brain volume (BV) loss ranging from 0.5 to 1.5 % per year. In addition, 66 % of patients with MS experience cognitive impairment, resulting in impact on daily activities. A systematic literature review (2003-2013) was conducted to identify all studies reporting a relationship between whole BV measures and selected patient outcomes measuring cognition, including the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT) and MS Functional Composite (MSFC) scores. We identified 18 studies reporting associations between whole BV and cognitive outcomes. Six studies (33 %) examined the association between BV and SDMT; all six studies reported that BV loss (BVL) was significantly associated with a decline in SDMT scores (all p < 0.05). Among 14 studies (78 %) that examined the association between BV and PASAT scores, 12 (86 %) found a significant relationship between BVL and lower PASAT scores (all p < 0.05). Of the seven studies (39 %) that looked at BV and MSFC, six studies (86 %) found BVL significantly associated with lower MSFC scores (all p < 0.05). Our study demonstrated that BVL is associated with declines in cognition in MS patients across several cognition measures. The results of this study suggest that BV is a critical component of disease activity and progression in MS and has implications for treatment decisions to minimize BVL and preserve cognitive functioning.
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Affiliation(s)
- Timothy Vollmer
- Department of Neurology, University of Colorado Denver, 12631 East 17th Avenue, Aurora, CO, 80045, USA
| | - Lynn Huynh
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA
| | - Caroline Kelley
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA
| | - Philip Galebach
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA
| | - James Signorovitch
- Analysis Group, Inc., 111 Huntington Avenue, 10th floor, Boston, MA, 02199, USA.
| | - Allitia DiBernardo
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hannover, NJ, 07936, USA
| | - Rahul Sasane
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hannover, NJ, 07936, USA
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17
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The natural history of brain volume loss among patients with multiple sclerosis: A systematic literature review and meta-analysis. J Neurol Sci 2015; 357:8-18. [DOI: 10.1016/j.jns.2015.07.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 06/15/2015] [Accepted: 07/09/2015] [Indexed: 11/21/2022]
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18
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Kruszewski AM, Rao G, Tatomir A, Hewes D, Tegla CA, Cudrici CD, Nguyen V, Royal W, Bever CT, Rus V, Rus H. RGC-32 as a potential biomarker of relapse and response to treatment with glatiramer acetate in multiple sclerosis. Exp Mol Pathol 2015; 99:498-505. [PMID: 26407760 DOI: 10.1016/j.yexmp.2015.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/18/2015] [Indexed: 02/06/2023]
Abstract
Currently there is critical need for the identification of reliable biomarkers to help guide clinical management of multiple sclerosis (MS) patients. We investigated the combined roles of Response Gene to Complement 32 (RGC-32), FasL, CDC2, AKT, and IL-21 as possible biomarkers of relapse and response to glatiramer acetate (GA) treatment in relapsing-remitting MS (RRMS) patients. Over the course of 2 years, a cohort of 15 GA-treated RRMS patients was clinically monitored and peripheral blood mononuclear cells (PBMCs) were collected at 0, 3, 6, and 12 months. Target gene mRNA expression was measured in patients' isolated PBMCs by real-time qRT-PCR. Compared to stable MS patients, those with acute relapses exhibited decreased expression of RGC-32 (p<0.0001) and FasL (p<0.0001), increased expression of IL-21 (p=0.04), but no change in CDC2 or AKT. Compared to non-responders, responders to GA treatment showed increased expression of RGC-32 (p<0.0001) and FasL (p<0.0001), and decreased expression of IL-21 (p=0.02). Receiver operating characteristic (ROC) analysis was used to assess the predictive accuracy of each putative biomarker. The probability of accurately detecting relapse was 90% for RGC-32, 88% for FasL, and 75% for IL-21. The probability of accurately detecting response to GA was 85% for RGC-32, 90% for FasL, and 85% for IL-21. Our data suggest that RGC-32, FasL, and IL-21 could serve as potential biomarkers for the detection of MS relapse and response to GA therapy.
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Affiliation(s)
- Adam M Kruszewski
- Department of Neurology, University of Maryland, School of Medicine, United States
| | - Gautam Rao
- Department of Neurology, University of Maryland, School of Medicine, United States
| | - Alexandru Tatomir
- Department of Neurology, University of Maryland, School of Medicine, United States
| | - Daniel Hewes
- Department of Neurology, University of Maryland, School of Medicine, United States
| | - Cosmin A Tegla
- Department of Neurology, University of Maryland, School of Medicine, United States; Research Service, Veterans Administration Maryland Health Care System, United States
| | - Cornelia D Cudrici
- Department of Neurology, University of Maryland, School of Medicine, United States
| | - Vingh Nguyen
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland, School of Medicine, United States
| | - Walter Royal
- Department of Neurology, University of Maryland, School of Medicine, United States; Veterans Administration Multiple Sclerosis Center of Excellence East, Baltimore, MD, USA
| | - Christopher T Bever
- Department of Neurology, University of Maryland, School of Medicine, United States; Research Service, Veterans Administration Maryland Health Care System, United States; Veterans Administration Multiple Sclerosis Center of Excellence East, Baltimore, MD, USA
| | - Violeta Rus
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland, School of Medicine, United States
| | - Horea Rus
- Department of Neurology, University of Maryland, School of Medicine, United States; Research Service, Veterans Administration Maryland Health Care System, United States; Veterans Administration Multiple Sclerosis Center of Excellence East, Baltimore, MD, USA.
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Tauhid S, Chu R, Sasane R, Glanz BI, Neema M, Miller JR, Kim G, Signorovitch JE, Healy BC, Chitnis T, Weiner HL, Bakshi R. Brain MRI lesions and atrophy are associated with employment status in patients with multiple sclerosis. J Neurol 2015. [PMID: 26205635 PMCID: PMC4639581 DOI: 10.1007/s00415-015-7853-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiple sclerosis (MS) commonly
affects occupational function. We investigated the link between brain MRI and employment status. Patients with MS (n = 100) completed a Work Productivity and Activity Impairment (WPAI) (general health version) survey measuring employment status, absenteeism, presenteeism, and overall work and daily activity impairment. Patients “working for pay” were considered employed; “temporarily not working but looking for work,” “not working or looking for work due to age,” and “not working or looking for work due to disability” were considered not employed. Brain MRI T1 hypointense (T1LV) and T2 hyperintense (T2LV) lesion volumes were quantified. To assess lesional destructive capability, we calculated each subject’s ratio of T1LV to T2LV (T1/T2). Normalized brain parenchymal volume (BPV) assessed brain atrophy. The mean (SD) age was 45.5 (9.7) years; disease duration was 12.1 (8.1) years; 75 % were women, 76 % were relapsing-remitting, and 76 % were employed. T1LV, T1/T2, Expanded Disability Status Scale (EDSS) scores, and activity impairment were lower and BPV was higher in the employed vs. not employed group (Wilcoxon tests, p < 0.05). Age, disease duration, MS clinical subtype, and T2LV did not differ between groups (p > 0.05). In multivariable logistic regression modeling, adjusting for age, sex, and disease duration, higher T1LV predicted a lower chance of employment (p < 0.05). Pearson correlations showed that EDSS was associated with activity impairment (p < 0.05). Disease duration, age, and MRI measures were not correlated with activity impairment or other WPAI outcomes (p > 0.05). We report a link between brain atrophy and lesions, particularly lesions with destructive potential, to MS employment status.
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Affiliation(s)
- Shahamat Tauhid
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Renxin Chu
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Bonnie I Glanz
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Mohit Neema
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Jennifer R Miller
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Gloria Kim
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Brian C Healy
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Howard L Weiner
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Department of Neurology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, Department of Radiology, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. .,Laboratory for Neuroimaging Research, One Brookline Place, Brookline, MA, 02445, USA.
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20
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Valsasina P, Rocca MA, Horsfield MA, Copetti M, Filippi M. A longitudinal MRI study of cervical cord atrophy in multiple sclerosis. J Neurol 2015; 262:1622-8. [DOI: 10.1007/s00415-015-7754-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
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21
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Lukas C, Knol DL, Sombekke MH, Bellenberg B, Hahn HK, Popescu V, Weier K, Radue EW, Gass A, Kappos L, Naegelin Y, Uitdehaag BMJ, Geurts JJG, Barkhof F, Vrenken H. Cervical spinal cord volume loss is related to clinical disability progression in multiple sclerosis. J Neurol Neurosurg Psychiatry 2015; 86:410-8. [PMID: 24973341 DOI: 10.1136/jnnp-2014-308021] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the temporal evolution of spinal cord (SC) atrophy in multiple sclerosis (MS), and its association with clinical progression in a large MS cohort. METHODS A total of 352 patients from two centres with MS (relapsing remitting MS (RRMS): 256, secondary progressive MS (SPMS): 73, primary progressive MS (PPMS): 23) were included. Clinical and MRI parameters were obtained at baseline, after 12 months and 24 months of follow-up. In addition to conventional brain and SC MRI parameters, the annualised percentage brain volume change and the annualised percentage upper cervical cord cross-sectional area change (aUCCA) were quantified. Main outcome measure was disease progression, defined by expanded disability status scale increase after 24 months. RESULTS UCCA was lower in SPMS and PPMS compared with RRMS for all time points. aUCCA over 24 months was highest in patients with SPMS (-2.2% per year) and was significantly higher in patients with disease progression (-2.3% per year) than in stable patients (-1.2% per year; p=0.003), while annualised percentage brain volume change did not differ between subtypes (RRMS: -0.42% per year; SPMS -0.6% per year; PPMS: -0.46% per year) nor between progressive and stable patients (p=0.055). Baseline UCCA and aUCCA over 24 months were found to be relevant contributors of expanded disability status scale at month-24, while baseline UCCA as well as number of SC segments involved by lesions at baseline but not aUCCA were relevant contributors of disease progression. CONCLUSIONS SC MRI parameters including baseline UCCA and SC lesions were significant MRI predictors of disease progression. Progressive 24-month upper SC atrophy occurred in all MS subtypes, and was faster in patients exhibiting disease progression at month-24.
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Affiliation(s)
- Carsten Lukas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Dirk L Knol
- Department of Epidemiology and Biostatistics, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Madeleine H Sombekke
- Department of Neurology, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Barbara Bellenberg
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Horst K Hahn
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Veronica Popescu
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Katrin Weier
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ernst W Radue
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Achim Gass
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Medical Image Analysis Center (MIAC), University Hospital Basel, Basel, Switzerland
| | - Bernard M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands. Department of Anatomy and Neurosciences, section of Clinical Neuroscience, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands
| | - Hugo Vrenken
- Department of Radiology, Nuclear Medicine and PET Research, MS Center Amsterdam, VU University Medical Center & Neuroscience Campus Amsterdam, Amsterdam, The Netherlands. Department of Physics and Medical Technology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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22
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Gass A, Rocca MA, Agosta F, Ciccarelli O, Chard D, Valsasina P, Brooks JCW, Bischof A, Eisele P, Kappos L, Barkhof F, Filippi M. MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis. Lancet Neurol 2015; 14:443-54. [PMID: 25748099 DOI: 10.1016/s1474-4422(14)70294-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The spinal cord is a clinically important site that is affected by pathological changes in most patients with multiple sclerosis; however, imaging of the spinal cord with conventional MRI can be difficult. Improvements in MRI provide a major advantage for spinal cord imaging, with better signal-to-noise ratio and improved spatial resolution. Through the use of multiplanar MRI, identification of diffuse and focal changes in the whole spinal cord is now routinely possible. Corroborated by related histopathological analyses, several new techniques, such as magnetisation transfer, diffusion tension imaging, functional MRI, and proton magnetic resonance spectroscopy, can detect non-focal, spinal cord pathological changes in patients with multiple sclerosis. Additionally, functional MRI can reveal changes in the response pattern to sensory stimulation in patients with multiple sclerosis. Through use of these techniques, findings of cord atrophy, intrinsic cord damage, and adaptation are shown to occur largely independently of focal spinal cord lesion load, which emphasises their relevance in depiction of the true burden of disease. Combinations of magnetisation transfer ratio or diffusion tension imaging indices with cord atrophy markers seem to be the most robust and meaningful biomarkers to monitor disease evolution in early multiple sclerosis.
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Affiliation(s)
- Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany.
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Olga Ciccarelli
- Department of Brain Repair and Rehabilitation, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Antje Bischof
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Philipp Eisele
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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23
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Biberacher V, Boucard CC, Schmidt P, Engl C, Buck D, Berthele A, Hoshi MM, Zimmer C, Hemmer B, Mühlau M. Atrophy and structural variability of the upper cervical cord in early multiple sclerosis. Mult Scler 2014; 21:875-84. [PMID: 25139943 DOI: 10.1177/1352458514546514] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 07/21/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite agreement about spinal cord atrophy in progressive forms of multiple sclerosis (MS), data on clinically isolated syndrome (CIS) and relapsing-remitting MS (RRMS) are conflicting. OBJECTIVE To determine the onset of spinal cord atrophy in the disease course of MS. METHODS Structural brain magnetic resonance imaging (MRI) was acquired from 267 patients with CIS (85) or RRMS (182) and 64 healthy controls (HCs). The upper cervical cord cross-sectional area (UCCA) was determined at the level of C2/C3 by a segmentation tool and adjusted for focal MS lesions. The coefficient of variation (CV) was calculated from all measurements between C2/C3 and 13 mm above as a measure of structural variability. RESULTS Compared to HCs (76.1±6.9 mm(2)), UCCA was significantly reduced in CIS patients (73.5±5.8 mm(2), p=0.018) and RRMS patients (72.4±7.0 mm(2), p<0.001). Structural variability was higher in patients than in HCs, particularly but not exclusively in case of focal lesions (mean CV HCs/patients without/with lesions: 2.13%/2.55%/3.32%, all p-values<0.007). UCCA and CV correlated with Expanded Disability Status Scale (EDSS) scores (r =-0.131/0.192, p=0.044/<0.001) and disease duration (r=-0.134/0.300, p=0.039/< 0.001). CV additionally correlated with hand and arm function (r=0.180, p=0.014). CONCLUSION In MS, cervical cord atrophy already occurs in CIS. In early stages, structural variability may be a more meaningful marker of spinal cord pathology than atrophy.
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Affiliation(s)
- Viola Biberacher
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany
| | - Christine C Boucard
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany
| | - Paul Schmidt
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany/Ludwig-Maximilians-University München, Germany
| | - Christina Engl
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany
| | - Dorothea Buck
- Department of Neurology, Technische Universität München, Germany
| | - Achim Berthele
- Department of Neurology, Technische Universität München, Germany
| | | | | | - Bernhard Hemmer
- Technische Universität München, Germany/Munich Cluster for Systems Neurology (SyNergy), Germany
| | - Mark Mühlau
- Technische Universität München, Germany/TUM-Neuroimaging Center, Technische Universität München, Germany/Munich Cluster for Systems Neurology (SyNergy), Germany
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24
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Dehydration affects spinal cord cross-sectional area measurement on MRI in healthy subjects. Spinal Cord 2014; 52:616-20. [PMID: 24777158 DOI: 10.1038/sc.2014.66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/27/2014] [Accepted: 04/01/2014] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN This was a prospective cohort observational study. OBJECTIVE To determine the effect of dehydration and rehydration on spinal cord cross-sectional area (CSA) measurement on magnetic resonance imaging (MRI). SETTING MRI Research Centre, University of British Columbia, Canada. METHODS Ten healthy subjects (aged 21-32 years) were scanned on a 3T MRI scanner at four time points: (1) baseline, (2) rescan after 1 h, (3) the next day after fasting for a minimum of 14 h and (4) after rehydration with 1.5 l of water over the course of 1 h. Two independent, established semi-automatic CSA measurement techniques (one based on two-dimensional (2D) edge detection, the other on three-dimensional (3D) surface fitting) were applied to a 3D T1-weighted scan of each subject at each time point, with the operator blinded to scan order. The percentage change in CSA from baseline to each subsequent time point was calculated. One-tailed paired t-tests were used to assess the significance of the changes from baseline. RESULTS A decrease in CSA following dehydration was detected by both measurement methods, with a mean change of -0.654% (s.d.=0.778, P<0.05) and -0.650% (s.d.=1.071, P<0.05) for the first and second methods, respectively. CONCLUSION Dehydration can confound CSA measurements on MRI. The magnitude of the effect is significant relative to short-term pathological changes that have been observed in diseases such as multiple sclerosis.
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25
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Jones BC, Nair G, Shea CD, Crainiceanu CM, Cortese ICM, Reich DS. Quantification of multiple-sclerosis-related brain atrophy in two heterogeneous MRI datasets using mixed-effects modeling. NEUROIMAGE-CLINICAL 2013; 3:171-9. [PMID: 24179861 PMCID: PMC3791279 DOI: 10.1016/j.nicl.2013.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 07/31/2013] [Accepted: 08/01/2013] [Indexed: 11/24/2022]
Abstract
Brain atrophy, measured by MRI, has been proposed as a useful surrogate marker for disease progression in multiple sclerosis (MS). However, it is conventionally assumed that the accurate quantification of brain atrophy is made difficult, if not impossible, by changes in the parameters of the MRI acquisition, which are almost inevitable over the course of a longitudinal study since MRI technology changes rapidly. This state of affairs can negatively affect clinical trial design and limit the use of historical data. Here, we investigate whether we can coherently estimate brain atrophy rates in a heterogeneous MS sample via linear mixed-effects multivariable regression, incorporating three critical assumptions: (1) using age at time of scanning, rather than time since baseline, as the regressor of interest; (2) scanning individuals with a variety of techniques; and (3) introducing a simple additive correction for major differences in MRI protocol. We fit the model to several measures of brain volume as the outcome in two MS populations: 1123 scans from 195 cases acquired for over approximately 7 years in two natural history protocols (Cohort 1), and 1331 scans from 69 cases seen for over 11 years who were primarily treated with two specific MS disease-modifying therapies (Cohort 2). We compared the mixed-effects model with additive correction for MRI acquisition parameters to a model fit without this correction and performed sample-size calculations to provide an estimate of the number of participants in an MS clinical trial that might be required to see a therapeutic effect of treatment using the approach described here. The results show that without the additive correction for T1-weighted protocol parameters, atrophy was underestimated and subject-specific estimates were more narrowly distributed about the population mean. Ventricular CSF is the most consistently estimated brain volume, with a mean of 2.8%/year increase in Cohort 1 and 4.4%/year increase in Cohort 2. An interesting observation was that gray matter volume decreased and white matter volume remained essentially unchanged in both cohorts, suggesting that changes in ventricular CSF volume are a surrogate for changes in gray matter volume. In conclusion, the mixed-effects modeling framework presented here allows effective use of heterogeneously acquired and historical data in the study of brain atrophy in MS, potentially simplifying the design of future single- and multi-site clinical trials and natural history studies. We model brain atrophy in two heterogeneously acquired MS MRI datasets. Mixed-effects regression effectively adjusts for major MRI differences. Ventricular CSF tracks with gray matter but is more reliably estimated. The method would allow reasonable sample sizes in MS therapeutic trials.
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Affiliation(s)
- Blake C Jones
- Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke, NIH, 10 Center Drive MSC 1400, Building 10 Room 5C103, Bethesda, MD 20892, USA ; Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH 44106, USA
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Kearney H, Rocca MA, Valsasina P, Balk L, Sastre-Garriga J, Reinhardt J, Ruggieri S, Rovira A, Stippich C, Kappos L, Sprenger T, Tortorella P, Rovaris M, Gasperini C, Montalban X, Geurts JJG, Polman CH, Barkhof F, Filippi M, Altmann DR, Ciccarelli O, Miller DH, Chard DT. Magnetic resonance imaging correlates of physical disability in relapse onset multiple sclerosis of long disease duration. Mult Scler 2013; 20:72-80. [PMID: 23812283 PMCID: PMC4107776 DOI: 10.1177/1352458513492245] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Understanding long-term disability in multiple sclerosis (MS) is a key goal of
research; it is relevant to how we monitor and treat the disease. Objectives: The Magnetic Imaging in MS (MAGNIMS) collaborative group sought to determine the
relationship of brain lesion load, and brain and spinal cord atrophy, with physical
disability in patients with long-established MS. Methods: Patients had a magnetic resonance imaging (MRI) scan of their brain and spinal cord,
from which we determined brain grey (GMF) and white matter (WMF) fractional volumes,
upper cervical spinal cord cross-sectional area (UCCA) and brain T2-lesion volume
(T2LV). We assessed patient disability using the Expanded Disability Status Scale
(EDSS). We analysed associations between EDSS and MRI measures, using two regression
models (dividing cohort by EDSS into two and four sub-groups). Results: In the binary model, UCCA (p < 0.01) and T2LV (p =
0.02) were independently associated with the requirement of a walking aid. In the
four-category model UCCA (p < 0.01), T2LV (p =
0.02) and GMF (p = 0.04) were independently associated with
disability. Conclusions: Long-term physical disability was independently linked with atrophy of the spinal cord
and brain T2 lesion load, and less consistently, with brain grey matter atrophy.
Combinations of spinal cord and brain MRI measures may be required to capture
clinically-relevant information in people with MS of long disease duration.
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Affiliation(s)
- H Kearney
- Institute of Neurology, University College London, UK
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Filli L, Hofstetter L, Kuster P, Traud S, Mueller-Lenke N, Naegelin Y, Kappos L, Gass A, Sprenger T, Nichols TE, Vrenken H, Barkhof F, Polman C, Radue EW, Borgwardt SJ, Bendfeldt K. Spatiotemporal distribution of white matter lesions in relapsing-remitting and secondary progressive multiple sclerosis. Mult Scler 2012; 18:1577-84. [PMID: 22495945 DOI: 10.1177/1352458512442756] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system. MS lesions show a typical distribution pattern and primarily affect the white matter (WM) in the periventricular zone and in the centrum semiovale. OBJECTIVE To track lesion development during disease progression, we compared the spatiotemporal distribution patterns of lesions in relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS). METHODS We used T1 and T2 weighted MR images of 209 RRMS and 62 SPMS patients acquired on two different 1.5 Tesla MR scanners in two clinical centers followed up for 25 (± 1.7) months. Both cross-sectional and longitudinal differences in lesion distribution between RRMS and SPMS patients were analyzed with lesion probability maps (LPMs) and permutation-based inference. RESULTS MS lesions clustered around the lateral ventricles and in the centrum semiovale. Cross-sectionally, compared to RRMS patients, the SPMS patients showed a significantly higher regional probability of T1 hypointense lesions (p ≤ 0.03) in the callosal body, the corticospinal tract, and other tracts adjacent to the lateral ventricles, but not of T2 lesions (peak probabilities were RRMS: T1 9%, T2 18%; SPMS: T1 21%, T2 27%). No longitudinal changes of regional T1 and T2 lesion volumes between baseline and follow-up scan were found. CONCLUSION The results suggest a particular vulnerability to neurodegeneration during disease progression in a number of WM tracts.
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Affiliation(s)
- Lukas Filli
- Medical Image Analysis Center, University Hospital Basel, Basel, Switzerland
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28
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Advances in imaging to support the development of novel therapies for multiple sclerosis. Clin Pharmacol Ther 2012; 91:621-34. [PMID: 22398971 DOI: 10.1038/clpt.2011.349] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Multiple sclerosis (MS) is a common neurological disease in North America and Europe. Although most patients develop major locomotor disability over the course of 15-20 years, in approximately one-third of patients the long-term course is favorable, with minimal disability. Although current disease-modifying treatments reduce the relapse rate, their long-term effects are uncertain. MS treatment trials are challenging because of the variable clinical course and typically slow evolution of the disease. Magnetic resonance imaging (MRI) is sensitive in monitoring MS pathology and facilitates evaluation of potential new treatments. MRI measurements of lesion activity have identified new immunomodulatory treatments for preventing relapse. Quantitative measurements of tissue volume and structural integrity, capable of detecting neuroprotection and repair, should facilitate new treatments designed to prevent irreversible disability. Higher-field MR scanners and new positron emission tomography (PET) radioligands are providing new insights into cellular and pathophysiological abnormalities, and should be valuable in future therapeutic trials. Retinal axonal loss measured using optical coherence tomography (OCT) can assess acute neuroprotection in optic neuritis.
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Ingram G, Hakobyan S, Hirst CL, Harris CL, Loveless S, Mitchell JP, Pickersgill TP, Robertson NP, Morgan BP. Systemic complement profiling in multiple sclerosis as a biomarker of disease state. Mult Scler 2012; 18:1401-11. [PMID: 22354735 PMCID: PMC3697901 DOI: 10.1177/1352458512438238] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is increasing evidence of significant and dynamic systemic activation and upregulation of complement in multiple sclerosis (MS), which may contribute to disease pathogenesis. OBJECTIVE We aimed to investigate the pathological role of complement in MS and the potential role for complement profiling as a biomarker of MS disease state. METHODS Key components of the classical, alternative and terminal pathways of complement were measured in plasma and cerebrospinal fluid (CSF) of patients with MS in different clinical phases of disease and in matched controls. RESULTS Increased plasma levels of C3 (p<0.003), C4 (p<0.001), C4a (p<0.001), C1 inhibitor (p<0.001), and factor H (p<0.001), and reduced levels of C9 (p<0.001) were observed in MS patients compared with controls. Combined profiling of these analytes produced a statistical model with a predictive value of 97% for MS and 73% for clinical relapse when combined with selected demographic data. CSF-plasma correlations suggested that source of synthesis of these components was both systemic and central. CONCLUSION These data provide further evidence of alterations in both local and systemic expression and activation of complement in MS and suggest that complement profiling may be informative as a biomarker of MS disease, although further work is needed to determine its use in distinguishing MS from its differential.
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Affiliation(s)
- G Ingram
- Department of Neurology, University Hospital of Wales, Cardiff, UK
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Current world literature. Curr Opin Ophthalmol 2011; 22:523-9. [PMID: 22005482 DOI: 10.1097/icu.0b013e32834cb7d7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hayton T, Furby J, Smith KJ, Altmann DR, Brenner R, Chataway J, Hunter K, Tozer DJ, Miller DH, Kapoor R. Longitudinal changes in magnetisation transfer ratio in secondary progressive multiple sclerosis: data from a randomised placebo controlled trial of lamotrigine. J Neurol 2011; 259:505-14. [PMID: 21904901 DOI: 10.1007/s00415-011-6212-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Revised: 07/28/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022]
Abstract
Sodium blockade with lamotrigine is neuroprotective in animal models of central nervous system demyelination. This study evaluated the effect of lamotrigine on magnetisation transfer ratio (MTR), a putative magnetic resonance imaging measure of intact brain tissue, in a group of subjects with secondary progressive multiple sclerosis (MS). In addition, the utility of MTR measures for detecting change in clinically relevant pathology was evaluated. One hundred seventeen people attending the National Hospital for Neurology and Neurosurgery or the Royal Free Hospital, London, UK, were recruited into a double-blind, parallel-group trial. Subjects were randomly assigned by minimisation to receive lamotrigine (target dose 400 mg/day) or placebo for 2 years. Treating and assessing physicians and patients were masked to treatment allocation. Results of the primary endpoint, central cerebral volume, have been published elsewhere. Significant differences between the verum and placebo arms were seen in only two measures [normal appearing grey matter (NAGM) p = 0.036 and lesion peak height (PH) p = 0.004], and in both cases there was a greater reduction in MTR in the verum arm. Significant correlations were found of change in MS functional composite with all MTR measures except lesion and normal appearing white matter (NAWM) PH. However, the change in MTR measures over 2 years were small, with only NAGM mean (p = 0.001), lesion peak location (p = 0.11) and mean (p < 0.0001) changing significantly from baseline. These data did not show that lamotrigine was neuroprotective. The clinical correlation of MTR measures was consistent, but the responsiveness to change was limited.
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Affiliation(s)
- T Hayton
- Department of Neuroinflammation, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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Hayton T, Furby J, Smith KJ, Altmann DR, Brenner R, Chataway J, Hunter K, Tozer DJ, Miller DH, Kapoor R. Clinical and imaging correlates of the multiple sclerosis impact scale in secondary progressive multiple sclerosis. J Neurol 2011; 259:237-45. [DOI: 10.1007/s00415-011-6151-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 06/15/2011] [Indexed: 10/17/2022]
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