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Hansen CE, Kamermans A, Mol K, Berve K, Rodriguez-Mogeda C, Fung WK, van Het Hof B, Fontijn RD, van der Pol SMA, Michalick L, Kuebler WM, Kenkhuis B, van Roon-Mom W, Liedtke W, Engelhardt B, Kooij G, Witte ME, de Vries HE. Inflammation-induced TRPV4 channels exacerbate blood-brain barrier dysfunction in multiple sclerosis. J Neuroinflammation 2024; 21:72. [PMID: 38521959 PMCID: PMC10960997 DOI: 10.1186/s12974-024-03069-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Blood-brain barrier (BBB) dysfunction and immune cell migration into the central nervous system (CNS) are pathogenic drivers of multiple sclerosis (MS). Ways to reinstate BBB function and subsequently limit neuroinflammation present promising strategies to restrict disease progression. However, to date, the molecular players directing BBB impairment in MS remain poorly understood. One suggested candidate to impact BBB function is the transient receptor potential vanilloid-type 4 ion channel (TRPV4), but its specific role in MS pathogenesis remains unclear. Here, we investigated the role of TRPV4 in BBB dysfunction in MS. MAIN TEXT In human post-mortem MS brain tissue, we observed a region-specific increase in endothelial TRPV4 expression around mixed active/inactive lesions, which coincided with perivascular microglia enrichment in the same area. Using in vitro models, we identified that microglia-derived tumor necrosis factor-α (TNFα) induced brain endothelial TRPV4 expression. Also, we found that TRPV4 levels influenced brain endothelial barrier formation via expression of the brain endothelial tight junction molecule claudin-5. In contrast, during an inflammatory insult, TRPV4 promoted a pathological endothelial molecular signature, as evidenced by enhanced expression of inflammatory mediators and cell adhesion molecules. Moreover, TRPV4 activity mediated T cell extravasation across the brain endothelium. CONCLUSION Collectively, our findings suggest a novel role for endothelial TRPV4 in MS, in which enhanced expression contributes to MS pathogenesis by driving BBB dysfunction and immune cell migration.
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Grants
- 813294 European Union´s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant (ENTRAIN)
- 813294 European Union´s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant (ENTRAIN)
- 813294 European Union´s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant (ENTRAIN)
- 813294 European Union´s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant (ENTRAIN)
- 91719305 Dutch Research Council, NWO, Vidi grant
- 91719305 Dutch Research Council, NWO, Vidi grant
- 91719305 Dutch Research Council, NWO, Vidi grant
- 18-1023MS Stichting MS Research
- 20-1106MS Stichting MS Research
- 20-1106MS Stichting MS Research
- 18-1023MS Stichting MS Research
- 20-1106MS Stichting MS Research
- 81X3100216 Deutsches Zentrum für Herz-Kreislaufforschung
- SFB-TR84 : subprojects A02 & C09, SFB-1449 subproject B01, SFB 1470 subproject A04, KU1218/9-1, KU1218/11-1, and KU1218/12-1 Deutsche Forschungsgemeinschaft
- PROVID (01KI20160A) and SYMPATH (01ZX1906A) Bundesministerium für Bildung und Forschung
- HA2016-02-02 Hersenstichting
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Affiliation(s)
- Cathrin E Hansen
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands.
- MS Center Amsterdam, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands.
| | - Alwin Kamermans
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands
| | - Kevin Mol
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Kristina Berve
- Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Carla Rodriguez-Mogeda
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands
| | - Wing Ka Fung
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Bert van Het Hof
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Ruud D Fontijn
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Susanne M A van der Pol
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura Michalick
- Institute of Physiology, Corporate member of the Freie Universität Berlin and Humboldt Universität to Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Wolfgang M Kuebler
- Institute of Physiology, Corporate member of the Freie Universität Berlin and Humboldt Universität to Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
- Departments of Surgery and Physiology, University of Toronto, Toronto, ON, Canada
| | - Boyd Kenkhuis
- Department of Human Genetics, Leiden University Medical Center Leiden, Leiden, The Netherlands
- UK Dementia Research Institute at University of Edinburgh, Edinburgh, UK
| | - Willeke van Roon-Mom
- Department of Human Genetics, Leiden University Medical Center Leiden, Leiden, The Netherlands
| | - Wolfgang Liedtke
- Department of Neurology, Duke University, Durham, NY, USA
- Department of Molecular Pathobiology, New York University College of Dentistry, New York, USA
| | | | - Gijs Kooij
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maarten E Witte
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
- MS Center Amsterdam, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands
- Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam UMC, Amsterdam, The Netherlands
| | - Helga E de Vries
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands.
- MS Center Amsterdam, Amsterdam UMC Location VU Medical Center, Amsterdam, The Netherlands.
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2
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Cagol A, Cortese R, Barakovic M, Schaedelin S, Ruberte E, Absinta M, Barkhof F, Calabrese M, Castellaro M, Ciccarelli O, Cocozza S, De Stefano N, Enzinger C, Filippi M, Jurynczyk M, Maggi P, Mahmoudi N, Messina S, Montalban X, Palace J, Pontillo G, Pröbstel AK, Rocca MA, Ropele S, Rovira À, Schoonheim MM, Sowa P, Strijbis E, Wattjes MP, Sormani MP, Kappos L, Granziera C. Diagnostic Performance of Cortical Lesions and the Central Vein Sign in Multiple Sclerosis. JAMA Neurol 2024; 81:143-153. [PMID: 38079177 PMCID: PMC10714285 DOI: 10.1001/jamaneurol.2023.4737] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/06/2023] [Indexed: 02/13/2024]
Abstract
Importance Multiple sclerosis (MS) misdiagnosis remains an important issue in clinical practice. Objective To quantify the performance of cortical lesions (CLs) and central vein sign (CVS) in distinguishing MS from other conditions showing brain lesions on magnetic resonance imaging (MRI). Design, Setting, and Participants This was a retrospective, cross-sectional multicenter study, with clinical and MRI data acquired between January 2010 and May 2020. Centralized MRI analysis was conducted between July 2020 and December 2022 by 2 raters blinded to participants' diagnosis. Participants were recruited from 14 European centers and from a multicenter pan-European cohort. Eligible participants had a diagnosis of MS, clinically isolated syndrome (CIS), or non-MS conditions; availability of a brain 3-T MRI scan with at least 1 sequence suitable for CL and CVS assessment; presence of T2-hyperintense white matter lesions (WMLs). A total of 1051 individuals were included with either MS/CIS (n = 599; 386 [64.4%] female; mean [SD] age, 41.5 [12.3] years) or non-MS conditions (including other neuroinflammatory disorders, cerebrovascular disease, migraine, and incidental WMLs in healthy control individuals; n = 452; 302 [66.8%] female; mean [SD] age, 49.2 [14.5] years). Five individuals were excluded due to missing clinical or demographic information (n = 3) or unclear diagnosis (n = 2). Exposures MS/CIS vs non-MS conditions. Main Outcomes and Measures Area under the receiver operating characteristic curves (AUCs) were used to explore the diagnostic performance of CLs and the CVS in isolation and in combination; sensitivity, specificity, and accuracy were calculated for various cutoffs. The diagnostic importance of CLs and CVS compared to conventional MRI features (ie, presence of infratentorial, periventricular, and juxtacortical WMLs) was ranked with a random forest model. Results The presence of CLs and the previously proposed 40% CVS rule had a sensitivity, specificity, and accuracy for MS of 59.0% (95% CI, 55.1-62.8), 93.6% (95% CI, 91.4-95.6), and 73.9% (95% CI, 71.6-76.3) and 78.7% (95% CI, 75.5-82.0), 86.0% (95% CI, 82.1-89.5), and 81.5% (95% CI, 78.9-83.7), respectively. The diagnostic performance of the CVS (AUC, 0.89 [95% CI, 0.86-0.91]) was superior to that of CLs (AUC, 0.77 [95% CI, 0.75-0.80]; P < .001), and was increased when combining the 2 imaging markers (AUC, 0.92 [95% CI, 0.90-0.94]; P = .04); in the random forest model, both CVS and CLs outperformed the presence of infratentorial, periventricular, and juxtacortical WMLs in supporting MS differential diagnosis. Conclusions and Relevance The findings in this study suggest that CVS and CLs may be valuable tools to increase the accuracy of MS diagnosis.
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Affiliation(s)
- Alessandro Cagol
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Health Sciences, University of Genova, Genova, Italy
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Muhamed Barakovic
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center, Basel, Switzerland
| | - Martina Absinta
- Institute of Experimental Neurology, Division of Neuroscience, Vita-Salute San Raffaele University and Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | - Frederik Barkhof
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, United Kingdom
- Multiple Sclerosis Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
| | - Massimiliano Calabrese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Castellaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- National Institute for Health and Care Research (NIHR) University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Sirio Cocozza
- Departments of Advanced Biomedical Sciences and Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Maciej Jurynczyk
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Pietro Maggi
- Department of Neurology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Neuroinflammation Imaging Lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Nima Mahmoudi
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Silvia Messina
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia, Department of Neurology-Neuroimmunology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
- Division of Neurology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Pontillo
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
- Multiple Sclerosis Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
- Departments of Advanced Biomedical Sciences and Electrical Engineering and Information Technology, University of Naples Federico II, Naples, Italy
| | - Anne-Katrin Pröbstel
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
- Departments of Biomedicine and Clinical Research, University Hospital of Basel and University of Basel, Basel, Switzerland
| | - Maria A. Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Menno M. Schoonheim
- Multiple Sclerosis Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
| | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eva Strijbis
- Multiple Sclerosis Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical College VUMC, Amsterdam, the Netherlands
| | - Mike P. Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Maria Pia Sormani
- Department of Health Sciences, University of Genova, Genova, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Policlinico San Martino, Genova, Italy
| | - Ludwig Kappos
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital Basel and University of Basel, Basel, Switzerland
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3
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Wang M, Liu C, Zou M, Niu Z, Zhu J, Jin T. Recent progress in epidemiology, clinical features, and therapy of multiple sclerosis in China. Ther Adv Neurol Disord 2023; 16:17562864231193816. [PMID: 37719665 PMCID: PMC10504852 DOI: 10.1177/17562864231193816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system characterized by inflammation, demyelination, and neurodegeneration. It mainly affects young adults, imposing a heavy burden on families and society. The epidemiology, clinical features, and management of MS are distinct among different countries. Although MS is a rare disease in China, there are 1.4 billion people in China, so the total number of MS patients is not small. Because of the lack of specific diagnostic biomarkers for MS, there is a high misdiagnosis rate in China, as in other regions. Due to different genetic backgrounds, the clinical manifestations of MS in Chinese are different from those in the West. Herein, this review aims to summarize the disease comprehensively, including clinical profile and the status of disease-modifying therapies in China based on published population-based observation and cohort studies, and also to compare with data from other countries and regions, thus providing help to develop diagnostic guideline and the novel therapeutic drugs. Meanwhile, we also discuss the problems and challenges we face, specifically for the diagnosis and treatment of MS in the middle- and low-income countries.
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Affiliation(s)
- Meng Wang
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Caiyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Meijuan Zou
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Zixuan Niu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, No. 1, Xinmin Street, Changchun 130021, China
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm 171 64, Sweden
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, No. 1, Xinmin Street, Changchun 130021, China
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4
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Daboul L, O'Donnell CM, Cao Q, Amin M, Rodrigues P, Derbyshire J, Azevedo C, Bar-Or A, Caverzasi E, Calabresi P, Cree BAC, Freeman L, Henry RG, Longbrake EE, Nakamura K, Oh J, Papinutto N, Pelletier D, Samudralwar RD, Suthiphosuwan S, Schindler MK, Sotirchos ES, Sicotte NL, Solomon AJ, Shinohara RT, Reich DS, Ontaneda D, Sati P. Effect of GBCA Use on Detection and Diagnostic Performance of the Central Vein Sign: Evaluation Using a 3-T FLAIR* Sequence in Patients With Suspected Multiple Sclerosis. AJR Am J Roentgenol 2023; 220:115-125. [PMID: 35975888 PMCID: PMC10016223 DOI: 10.2214/ajr.22.27731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND. The central vein sign (CVS) is a proposed MRI biomarker of multiple sclerosis (MS). The impact of gadolinium-based contrast agent (GBCA) administration on CVS evaluation remains poorly investigated. OBJECTIVE. The purpose of this study was to assess the effect of GBCA use on CVS detection and on the diagnostic performance of the CVS for MS using a 3-T FLAIR* sequence. METHODS. This study was a secondary analysis of data from the pilot study for the prospective multicenter Central Vein Sign: A Diagnostic Biomarker in Multiple Sclerosis (CAVS-MS), which recruited adults with suspected MS from April 2018 to February 2020. Participants underwent 3-T brain MRI including FLAIR and precontrast and post-contrast echo-planar imaging T2*-weighted acquisitions. Postprocessing was used to generate combined FLAIR and T2*-weighted images (hereafter, FLAIR*). MS diagnoses were established using the 2017 McDonald criteria. Thirty participants (23 women, seven men; mean age, 45 years) were randomly selected from the CAVS-MS pilot study cohort. White matter lesions (WMLs) were marked using FLAIR* images. A single observer, blinded to clinical data and GBCA use, reviewed marked WMLs on FLAIR* images for the presence of the CVS. RESULTS. Thirteen of 30 participants had MS. Across participants, on precontrast FLAIR* imaging, 218 CVS-positive and 517 CVS-negative WMLs were identified; on post-contrast FLAIR* imaging, 269 CVS-positive and 459 CVS-negative WMLs were identified. The fraction of WMLs that were CVS-positive on precontrast and postcontrast images was 48% and 58% in participants with MS and 7% and 10% in participants without MS, respectively. The median patient-level CVS-positivity rate on precontrast and postcontrast images was 43% and 67% for participants with MS and 4% and 8% for participants without MS, respectively. In a binomial model adjusting for MS diagnoses, GBCA use was associated with an increased likelihood of at least one CVS-positive WML (odds ratio, 1.6; p < .001). At a 40% CVS-positivity threshold, the sensitivity of the CVS for MS increased from 62% on precontrast images to 92% on postcontrast images (p = .046). Specificity was not significantly different between precontrast (88%) and postcontrast (82%) images (p = .32). CONCLUSION. GBCA use increased CVS detection on FLAIR* images, thereby increasing the sensitivity of the CVS for MS diagnoses. CLINICAL IMPACT. The postcontrast FLAIR* sequence should be considered for CVS evaluation in future investigational trials and clinical practice.
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Affiliation(s)
- Lynn Daboul
- Department of Neurology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Carly M O'Donnell
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Quy Cao
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Moein Amin
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Christina Azevedo
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Amit Bar-Or
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Eduardo Caverzasi
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Peter Calabresi
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Bruce A C Cree
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Leorah Freeman
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX
| | - Roland G Henry
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | | | - Kunio Nakamura
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Jiwon Oh
- Division of Neurology, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Nico Papinutto
- Department of Neurology, University of California at San Francisco, San Francisco, CA
| | - Daniel Pelletier
- Department of Neurology, University of Southern California, Los Angeles, CA
| | - Rohini D Samudralwar
- Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX
| | - Suradech Suthiphosuwan
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, ON, Canada
| | - Matthew K Schindler
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | - Nancy L Sicotte
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Penn Statistics in Imaging and Visualization Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
| | - Daniel Ontaneda
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
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5
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Kolb H, Al-Louzi O, Beck ES, Sati P, Absinta M, Reich DS. From pathology to MRI and back: Clinically relevant biomarkers of multiple sclerosis lesions. Neuroimage Clin 2022; 36:103194. [PMID: 36170753 PMCID: PMC9668624 DOI: 10.1016/j.nicl.2022.103194] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
Focal lesions in both white and gray matter are characteristic of multiple sclerosis (MS). Histopathological studies have helped define the main underlying pathological processes involved in lesion formation and evolution, serving as a gold standard for many years. However, histopathology suffers from an intrinsic bias resulting from over-reliance on tissue samples from late stages of the disease or atypical cases and is inadequate for routine patient assessment. Pathological-radiological correlative studies have established advanced MRI's sensitivity to several relevant MS-pathological substrates and its practicality for assessing dynamic changes and following lesions over time. This review focuses on novel imaging techniques that serve as biomarkers of critical pathological substrates of MS lesions: the central vein, chronic inflammation, remyelination and repair, and cortical lesions. For each pathological process, we address the correlative value of MRI to MS pathology, its contribution in elucidating MS pathology in vivo, and the clinical utility of the imaging biomarker.
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Affiliation(s)
- Hadar Kolb
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel,Corresponding author at: Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv-Yaffo, Israel.
| | - Omar Al-Louzi
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Erin S. Beck
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Martina Absinta
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA,Institute of Experimental Neurology (INSPE), IRCSS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Daniel S. Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA
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6
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Meaton I, Altokhis A, Allen CM, Clarke MA, Sinnecker T, Meier D, Enzinger C, Calabrese M, De Stefano N, Pitiot A, Giorgio A, Schoonheim MM, Paul F, Pawlak MA, Schmidt R, Granziera C, Kappos L, Montalban X, Rovira À, Wuerfel J, Evangelou N. Paramagnetic rims are a promising diagnostic imaging biomarker in multiple sclerosis. Mult Scler 2022; 28:2212-2220. [PMID: 36017870 DOI: 10.1177/13524585221118677] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND White matter lesions (WMLs) on brain magnetic resonance imaging (MRI) in multiple sclerosis (MS) may contribute to misdiagnosis. In chronic active lesions, peripheral iron-laden macrophages appear as paramagnetic rim lesions (PRLs). OBJECTIVE To evaluate the sensitivity and specificity of PRLs in differentiating MS from mimics using clinical 3T MRI scanners. METHOD This retrospective international study reviewed MRI scans of patients with MS (n = 254), MS mimics (n = 91) and older healthy controls (n = 217). WMLs, detected using fluid-attenuated inversion recovery MRI, were analysed with phase-sensitive imaging. Sensitivity and specificity were assessed for PRLs. RESULTS At least one PRL was found in 22.9% of MS and 26.1% of clinically isolated syndrome (CIS) patients. Only one PRL was found elsewhere. The identification of ⩾1 PRL was the optimal cut-off and had high specificity (99.7%, confidence interval (CI) = 98.20%-99.99%) when distinguishing MS and CIS from mimics and healthy controls, but lower sensitivity (24.0%, CI = 18.9%-36.6%). All patients with a PRL showing a central vein sign (CVS) in the same lesion (n = 54) had MS or CIS, giving a specificity of 100% (CI = 98.8%-100.0%) but equally low sensitivity (21.3%, CI = 16.4%-26.81%). CONCLUSION PRLs may reduce diagnostic uncertainty in MS by being a highly specific imaging diagnostic biomarker, especially when used in conjunction with the CVS.
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Affiliation(s)
- Isobel Meaton
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amjad Altokhis
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christopher Martin Allen
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
| | - Margareta A Clarke
- Institute of Imaging Science, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN, USA
| | - Tim Sinnecker
- Medical Image Analysis Center AG and Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | - Dominik Meier
- Medical Image Analysis Center AG and Department of Biomedical Engineering, University Basel, Basel, Switzerland
| | | | - Massimiliano Calabrese
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Alain Pitiot
- Laboratory of Image and Data Analysis, Ilixa Ltd, London, UK
| | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Friedemann Paul
- Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Mikolaj A Pawlak
- Department of Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, Poznan, Poland
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Cristina Granziera
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Head, Spine and Neuromedicine, Clinical Research and Biomedical Engineering, University Hospital, University of Basel, Basel, Switzerland
| | - Xavier Montalban
- Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jens Wuerfel
- Medical Image Analysis Center AG and Department of Biomedical Engineering, University Basel, Basel, Switzerland/Neurocure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Nikos Evangelou
- Mental Health and Clinical Neurosciences Academic Unit, School of Medicine, University of Nottingham, Nottingham, UK
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7
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Jensen-Kondering U, Larsen N, Huhndorf M, Jansen O, Lüddecke R, Stürner K, Ravesh MS. Central vein sign in patients with inflammatory lesion of the upper cervical spinal cord on susceptibility weighted imaging at 3 tesla. Preliminary results. Magn Reson Imaging 2022; 93:11-14. [PMID: 35914655 DOI: 10.1016/j.mri.2022.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/23/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND A central vein sign (CVS) has been described in vivo in patients with MS but also in other inflammatory lesion of the brain such as neuromyelits optica spectrum disease and others. Recently, it has been used to differentiate patients with MS from other inflammatory lesions of the brain. OBJECTIVE It was the goal of this study to demonstrate the feasibility of the depiction of the CVS in patients with inflammatory lesion of the upper cervical spinal cord using susceptibility weighted imaging (SWI). METHODS Consecutive patients with inflammatory lesions of the upper cervical spinal cord were included. Patients were scanned using a 3 T Philips Ingenia CX. The presence of the CVS was assessed by two raters. Demographic and clinical parameters were compared between patients with and those without a CVS. RESULTS 20 patients could be included. 15 patients had a diagnosis of MS. A CVS was present in 8 patients (40%). Agreement between the two raters was substantial (κ = 0.79). Time from first manifestation was significantly different (14 vs. 2 years, p = 0.021) between patients with CVS and without CVS. CONCLUSION The depiction of the CVS in the upper cervical spine is feasible. More research is necessary to evaluate these preliminary results and the value of the CVS in the spinal cord.
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Affiliation(s)
- U Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; Department of Neuroradiology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - N Larsen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Huhndorf
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - O Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - R Lüddecke
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K Stürner
- Department of Neurology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Salehi Ravesh
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Levasseur VA, Xiang B, Salter A, Yablonskiy DA, Cross AH. Stronger Microstructural Damage Revealed in Multiple Sclerosis Lesions With Central Vein Sign by Quantitative Gradient Echo MRI. J Cent Nerv Syst Dis 2022; 14:11795735221084842. [PMID: 35370433 PMCID: PMC8973074 DOI: 10.1177/11795735221084842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Multiple sclerosis (MS) lesions typically form around a central vein that can be visualized with FLAIR* MRI, creating the central vein sign (CVS) which may reflect lesion pathophysiology. Herein we used gradient echo plural contrast imaging (GEPCI) MRI to simultaneously visualize CVS and measure tissue damage in MS lesions. We examined CVS in relation to tissue integrity in white matter (WM) lesions and among MS subtypes. Objective We aimed to determine if CVS positive lesions were specific to MS subtype, if CVS can be detected consistently among readers using the GEPCI method, and if there were differences in tissue damage in lesions with vs without CVS. Subjects and Methods Thirty relapsing-remitting MS (RRMS) subjects and 38 primary and secondary progressive MS (PMS) subjects were scanned with GEPCI protocol at 3T. GEPCI T2*-SWI images were generated to visualize CVS. Two investigators independently evaluated WM lesions for CVS and measured lesion volumes. To estimate tissue damage severity, total lesion volume, and mean lesion volume, R2t*-based tissue damage score (TDS) of individual lesions and tissue damage load (TDL) were measured for CVS+, CVS-, and confluent lesions. Spearman correlations were made between MRI and clinical data. One-way ANCOVA with age and sex as covariates was used to compare measurements of CVS+ vs CVS- lesions in each individual. Results 398 of 548 lesions meeting inclusion criteria showed CVS. Most patients had ≥40% CVS+ lesions. CVS+ lesions were present in similar proportion among MS subtypes. Interobserver agreement was high for CVS detection. CVS+ and confluent lesions had higher average and total volumes vs CVS- lesions. CVS+ and confluent lesions had more tissue damage than CVS- lesions based on TDL and mean TDS. Conclusion CVS occurred in RRMS and PMS in similar proportions. CVS+ lesions had greater tissue damage and larger size than CVS- lesions.
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Affiliation(s)
- Victoria A. Levasseur
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Biao Xiang
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Amber Salter
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA, USA
| | - Dmitriy A. Yablonskiy
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Anne H. Cross
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
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9
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Al-Louzi O, Letchuman V, Manukyan S, Beck ES, Roy S, Ohayon J, Pham DL, Cortese I, Sati P, Reich DS. Central Vein Sign Profile of Newly Developing Lesions in Multiple Sclerosis: A 3-Year Longitudinal Study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1120. [PMID: 35027474 PMCID: PMC8759076 DOI: 10.1212/nxi.0000000000001120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/22/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES The central vein sign (CVS), a central linear hypointensity within lesions on T2*-weighted imaging, has been established as a sensitive and specific biomarker for the diagnosis of multiple sclerosis (MS). However, the CVS has not yet been comprehensively studied in newly developing MS lesions. We aimed to identify the CVS profiles of new white matter lesions in patients with MS followed over time and investigate demographic and clinical risk factors associated with new CVS+ or CVS- lesion development. METHODS In this retrospective longitudinal cohort study, adults from the NIH MS Natural History Study were considered for inclusion. Participants with new T2 or enhancing lesions were identified through review of the radiology report and/or longitudinal subtraction imaging. Each new lesion was evaluated for the CVS. Clinical characteristics were identified through chart review. RESULTS A total of 153 adults (95 relapsing-remitting MS, 27 secondary progressive MS, 16 primary progressive MS, 5 clinically isolated syndrome, and 10 healthy; 67% female) were included. Of this cohort, 96 had at least 1 new T2 or contrast-enhancing lesion during median 3.1 years (Q1-Q3: 0.7-6.3) of follow-up; lesions eligible for CVS evaluation were found in 62 (65%). Of 233 new CVS-eligible lesions, 159 (68%) were CVS+, with 30 (48%) individuals having only CVS+, 12 (19%) only CVS-, and 20 (32%) both CVS+ and CVS- lesions. In gadolinium-enhancing (Gd+) lesions, the CVS+ percentage increased from 102/152 (67%) at the first time point where the lesion was observed, to 92/114 (82%) after a median follow-up of 2.8 years. Younger age (OR = 0.5 per 10-year increase, 95% CI = 0.3-0.8) and higher CVS+ percentage at baseline (OR = 1.4 per 10% increase, 95% CI = 1.1-1.9) were associated with increased likelihood of new CVS+ lesion development. DISCUSSION In a cohort of adults with MS followed over a median duration of 3 years, most newly developing T2 or enhancing lesions were CVS+ (68%), and nearly half (48%) developed new CVS+ lesions only. Importantly, the effects of edema and T2 signal changes can obscure small veins in Gd+ lesions; therefore, caution and follow-up is necessary when determining their CVS status. TRIAL REGISTRATION INFORMATION Clinical trial registration number NCT00001248. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that younger age and higher CVS+ percentage at baseline are associated with new CVS+ lesion development.
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Affiliation(s)
- Omar Al-Louzi
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Vijay Letchuman
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Sargis Manukyan
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Erin S Beck
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Snehashis Roy
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Joan Ohayon
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Dzung L Pham
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Irene Cortese
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Pascal Sati
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Daniel S Reich
- From the Translational Neuroradiology Section (O.A.-L., V.L., S.M., E.S.B., P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; Department of Neurology (O.A.-L., P.S.), Cedars-Sinai Medical Center, Los Angeles, CA; Section on Neural Function (S.R.), National Institute of Mental Health, NIH, Bethesda, MD; Neuroimmunology Clinic (J.O., I.C.), National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD; and Center for Neuroscience and Regenerative Medicine (D.L.P.), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
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10
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Abstract
OBJECTIVE. Tumefactive demyelination mimics primary brain neoplasms on imaging, often necessitating brain biopsy. This article reviews the literature for the clinical and radiologic findings of tumefactive demyelination in various disease processes to facilitate identification of tumefactive demyelination on imaging. CONCLUSION. Both clinical and radiologic findings must be integrated to distinguish tumefactive demyelinating lesions from similarly appearing lesions on imaging. Further research on the immunopathogenesis of tumefactive demyelination and associated conditions will elucidate their interrelationship.
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11
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Abstract
PURPOSE OF REVIEW To summarize recent evidence from the application of susceptibility-based MRI sequences to investigate the 'central vein sign' (CVS) and 'iron rim' as biomarkers to improve the diagnostic work-up of multiple sclerosis (MS) and predict disease severity. RECENT FINDINGS The CVS is a specific biomarker for MS being detectable from the earliest phase of the disease. A threshold of 40% of lesions with the CVS can be optimal to distinguish MS from non-MS patients. Iron rim lesions, reflecting chronic active lesions, develop in relapsing-remitting MS patients and persist in progressive MS. They increase in size in the first few years after their formation and then stabilize. Iron rim lesions can distinguish MS from non-MS patients but not the different MS phenotypes. The presence of at least four iron rim lesions is associated with an earlier clinical disability, higher prevalence of clinically progressive MS and more severe brain atrophy. Automated methods for CVS and iron rim lesion detection are under development to facilitate their quantification. SUMMARY The assessment of the CVS and iron rim lesions is feasible in the clinical scenario and provides MRI measures specific to MS pathological substrates, improving diagnosis and prognosis of these patients.
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12
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AlTokhis AI, AlOtaibi AM, Felmban GA, Constantinescu CS, Evangelou N. Iron Rims as an Imaging Biomarker in MS: A Systematic Mapping Review. Diagnostics (Basel) 2020; 10:diagnostics10110968. [PMID: 33218056 PMCID: PMC7698946 DOI: 10.3390/diagnostics10110968] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/27/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Multiple sclerosis (MS) is an autoimmune, inflammatory, demyelinating and degenerative disease of the central nervous system (CNS). To date, there is no definitive imaging biomarker for diagnosing MS. The current diagnostic criteria are mainly based on clinical relapses supported by the presence of white matter lesions (WMLs) on MRI. However, misdiagnosis of MS is still a significant clinical problem. The paramagnetic, iron rims (IRs) around white matter lesions have been proposed to be an imaging biomarker in MS. This study aimed to carry out a systematic mapping review to explore the detection of iron rim lesions (IRLs), on clinical MR scans, and describe the characteristics of IRLs presence in MS versus other MS-mimic disorders. Methods: Publications from 2001 on IRs lesions were reviewed in three databases: PubMed, Web of Science and Embase. From the initial result set 718 publications, a final total of 38 papers were selected. Results: The study revealed an increasing interest in iron/paramagnetic rims lesions studies. IRs were more frequently found in periventricular regions and appear to be absent in MS-mimics. Conclusions IR is proposed as a promising imaging biomarker for MS.
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Affiliation(s)
- Amjad I. AlTokhis
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
- School of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
- Correspondence:
| | - Abdulmajeed M. AlOtaibi
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
- School of Applied Medical Sciences, King Saud bin Abdulaziz University, Riyadh 14611, Saudi Arabia
| | - Ghadah A. Felmban
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
- School of Applied Medical Sciences, King Saud bin Abdulaziz University, Riyadh 14611, Saudi Arabia
| | - Cris S. Constantinescu
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
| | - Nikos Evangelou
- School of Medicine, University of Nottingham, Nottingham, UK/Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (A.M.A.); (G.A.F.); (C.S.C.); (N.E.)
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13
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Investigation of the “central vein sign” in infratentorial multiple sclerosis lesions. Mult Scler Relat Disord 2020; 45:102409. [DOI: 10.1016/j.msard.2020.102409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/14/2020] [Accepted: 07/16/2020] [Indexed: 11/20/2022]
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14
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Vattoth S, Kadam GH, Gaddikeri S. Revised McDonald Criteria, MAGNIMS Consensus and Other Relevant Guidelines for Diagnosis and Follow Up of MS: What Radiologists Need to Know? Curr Probl Diagn Radiol 2020; 50:389-400. [PMID: 32665060 DOI: 10.1067/j.cpradiol.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/06/2020] [Accepted: 06/22/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Surjith Vattoth
- Department of Clinical Radiology, Weill Cornell Medicine, New York, NY.; Hamad Medical Corporation, Doha, Qatar
| | - Geetanjalee H Kadam
- Department of Diagnostic Radiology & Nuclear Medicine, Rush University Medical Center, Chicago, IL
| | - Santhosh Gaddikeri
- Department of Diagnostic Radiology & Nuclear Medicine, Rush University Medical Center, Chicago, IL..
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15
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Gaitán MI, Yañez P, Paday Formenti ME, Calandri I, Figueiredo E, Sati P, Correale J. SWAN-Venule: An Optimized MRI Technique to Detect the Central Vein Sign in MS Plaques. AJNR Am J Neuroradiol 2020; 41:456-460. [PMID: 32054616 DOI: 10.3174/ajnr.a6437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/08/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis lesions develop around small veins that are radiologically described as the so-called central vein sign. With 7T MR imaging and magnetic susceptibility-based sequences, the central vein sign has been observed in 80%-100% of MS lesions in patients' brains. However, a lower proportion ∼50% has been reported at 3T using susceptibility-weighted angiography (SWAN). Our aim was to assess a modified version of SWAN optimized at 3T for sensitive detection of the central vein sign. MATERIALS AND METHODS Thirty subjects with MS were scanned on a 3T clinical MR imaging system. 3D T2-weighted FLAIR and optimized 3D SWAN called SWAN-venule, were acquired after injection of a gadolinium-based contrast agent. Patients showing >3 focal white matter lesions were included. The central vein sign was recorded by 2 trained raters on SWAN-venule images in the supratentorial brain. RESULTS Twenty patients showing >3 white matter lesions were included. A total of 380 white matter lesions (135 periventricular, 144 deep white matter, and 101 juxtacortical) seen on both FLAIR and SWAN-venule images were analyzed. Overall, the central vein sign was detected in 86% of the white matter lesions (periventricular, 89%; deep white matter, 95%; and juxtacortical, 78%). CONCLUSIONS The SWAN-venule technique is an optimized MR imaging sequence for highly sensitive detection of the central vein sign in MS brain lesions. This work will facilitate the validation and integration of the central vein sign to increase the diagnostic certainty of MS and further prevent misdiagnosis in clinical practice.
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Affiliation(s)
- M I Gaitán
- From the Department of Neurology (M.I.G., J.C.), Neuroimmunolgy Section
| | - P Yañez
- Departments of Radiology (P.Y., M.E.P.F.)
| | | | - I Calandri
- Neurology (I.C.), FLENI, Buenos Aires, Argentina
| | | | - P Sati
- Translational Neuroradiology Section (P.S.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - J Correale
- From the Department of Neurology (M.I.G., J.C.), Neuroimmunolgy Section
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16
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Haacke EM, Chen Y, Utriainen D, Wu B, Wang Y, Xia S, He N, Zhang C, Wang X, Lagana MM, Luo Y, Fatemi A, Liu S, Gharabaghi S, Wu D, Sethi SK, Huang F, Sun T, Qu F, Yadav BK, Ma X, Bai Y, Wang M, Cheng J, Yan F. STrategically Acquired Gradient Echo (STAGE) imaging, part III: Technical advances and clinical applications of a rapid multi-contrast multi-parametric brain imaging method. Magn Reson Imaging 2019; 65:15-26. [PMID: 31629075 DOI: 10.1016/j.mri.2019.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/15/2022]
Abstract
One major thrust in radiology today is image standardization with a focus on rapidly acquired quantitative multi-contrast information. This is critical for multi-center trials, for the collection of big data and for the use of artificial intelligence in evaluating the data. Strategically acquired gradient echo (STAGE) imaging is one such method that can provide 8 qualitative and 7 quantitative pieces of information in 5 min or less at 3 T. STAGE provides qualitative images in the form of proton density weighted images, T1 weighted images, T2* weighted images and simulated double inversion recovery (DIR) images. STAGE also provides quantitative data in the form of proton spin density, T1, T2* and susceptibility maps as well as segmentation of white matter, gray matter and cerebrospinal fluid. STAGE uses vendors' product gradient echo sequences. It can be applied from 0.35 T to 7 T across all manufacturers producing similar results in contrast and quantification of the data. In this paper, we discuss the strengths and weaknesses of STAGE, demonstrate its contrast-to-noise (CNR) behavior relative to a large clinical data set and introduce a few new image contrasts derived from STAGE, including DIR images and a new concept referred to as true susceptibility weighted imaging (tSWI) linked to fluid attenuated inversion recovery (FLAIR) or tSWI-FLAIR for the evaluation of multiple sclerosis lesions. The robustness of STAGE T1 mapping was tested using the NIST/NIH phantom, while the reproducibility was tested by scanning a given individual ten times in one session and the same subject scanned once a week over a 12-week period. Assessment of the CNR for the enhanced T1W image (T1WE) showed a significantly better contrast between gray matter and white matter than conventional T1W images in both patients with Parkinson's disease and healthy controls. We also present some clinical cases using STAGE imaging in patients with stroke, metastasis, multiple sclerosis and a fetus with ventriculomegaly. Overall, STAGE is a comprehensive protocol that provides the clinician with numerous qualitative and quantitative images.
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Affiliation(s)
- E Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA.
| | - Yongsheng Chen
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - David Utriainen
- The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Bo Wu
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Yu Wang
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China; Neusoft Medical Systems Co., Ltd., Shanghai, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Yu Luo
- Department of Radiology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Ali Fatemi
- Departments of Radiology and Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Saifeng Liu
- The MRI Institute for Biomedical Research, Bingham Farms, MI, USA
| | - Sara Gharabaghi
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Sean K Sethi
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Feng Huang
- Neusoft Medical Systems Co., Ltd., Shanghai, China
| | - Taotao Sun
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feifei Qu
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brijesh K Yadav
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaoyue Ma
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yan Bai
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hu XY, Rajendran L, Lapointe E, Tam R, Li D, Traboulsee A, Rauscher A. Three-dimensional MRI sequences in MS diagnosis and research. Mult Scler 2019; 25:1700-1709. [DOI: 10.1177/1352458519848100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The most recent guidelines for magnetic resonance imaging (MRI) in multiple sclerosis (MS) recommend three-dimensional (3D) MRI sequences over their two-dimensional (2D) counterparts. This development has been made possible by advances in MRI scanner hardware and software. In this article, we review the 3D versions of conventional sequences, including T1-weighted, T2-weighted and fluid-attenuated inversion recovery (FLAIR), as well as more advanced scans, including double inversion recovery (DIR), FLAIR2, FLAIR*, phase-sensitive inversion recovery, and susceptibility weighted imaging (SWI).
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Affiliation(s)
- Xun Yang Hu
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Luckshi Rajendran
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Emmanuelle Lapointe
- Department of Medicine, Division of Neurology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Roger Tam
- Department of Radiology, School of Biomedical Engineering, The University of British Columbia, Vancouver, BC, Canada
| | - David Li
- Department of Radiology, UBC Hospital, Vancouver, BC, Canada
| | - Anthony Traboulsee
- Division of Neurology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Radiology, The University of British Columbia, Vancouver, BC, Canada
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Suthiphosuwan S, Sati P, Guenette M, Montalban X, Reich DS, Bharatha A, Oh J. The Central Vein Sign in Radiologically Isolated Syndrome. AJNR Am J Neuroradiol 2019; 40:776-783. [PMID: 31000526 DOI: 10.3174/ajnr.a6045] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Radiologically isolated syndrome describes asymptomatic individuals with incidental radiologic abnormalities suggestive of multiple sclerosis. Recent studies have demonstrated that >40% of white matter lesions in MS (and often substantially more) have visible central veins on MR imaging. This "central vein sign" reflects perivenous inflammatory demyelination and can assist in differentiating MS from other white matter disorders. We therefore hypothesized that >40% of white matter lesions in cases of radiologically isolated syndrome would show the central vein sign. MATERIALS AND METHODS We recruited 20 participants diagnosed with radiologically isolated syndrome after evaluation by a neurologist. We performed 3T MR imaging of the brain and cervical spinal cord. White matter lesions were analyzed for the central vein sign. RESULTS Of 391 total white matter lesions, 292 (75%) demonstrated the central vein sign (central vein sign+). The median proportion of central vein sign+ lesions per case was 87% (range, 29%-100%). When the "40% rule" that has been proposed to distinguish MS from other disorders was applied, of 20 participants, 18 cases of radiologically isolated syndrome (90%) had ≥40% central vein sign+ lesions (range, 55%-100%). Two participants (10%) had <40% central vein sign+ lesions (29% and 31%). When the simpler "rule of 6" was applied, 19 participants (95%) met these criteria. In multivariable models, the number of spinal cord and infratentorial lesions was associated with a higher proportion of central vein sign+ lesions (P = .002; P = .06, respectively). CONCLUSIONS Most cases of radiologically isolated syndrome had a high proportion of central vein sign+ lesions, suggesting that lesions in these individuals reflect perivenous inflammatory demyelination. Moreover, we found correlations between the proportion of central vein sign+ lesions and spinal cord lesions, a known risk factor for radiologically isolated syndrome progressing to MS. These findings raise the possibility, testable prospectively, that the central vein sign may have prognostic value in distinguishing patients with radiologically isolated syndrome at risk of developing clinical MS from those with white matter lesions of other etiologies.
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Affiliation(s)
- S Suthiphosuwan
- From the Division of Neuroradiology (S.S., A.B.)
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
| | - P Sati
- Translational Neuroradiology Section (P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - M Guenette
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
| | - X Montalban
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
| | - D S Reich
- Translational Neuroradiology Section (P.S., D.S.R.), National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
- Department of Neurology (D.S.R., J.O.), Johns Hopkins University, Baltimore, Maryland
| | - A Bharatha
- From the Division of Neuroradiology (S.S., A.B.)
- Division of Neurosurgery (A.B.), Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - J Oh
- Division of Neurology (S.S., M.G., X.M., J.O.), Department of Medicine
- Department of Neurology (D.S.R., J.O.), Johns Hopkins University, Baltimore, Maryland
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19
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Gabr RE, Pednekar AS, Kamali A, Lincoln JA, Nelson FM, Wolinsky JS, Narayana PA. Interleaved susceptibility-weighted and FLAIR MRI for imaging lesion-penetrating veins in multiple sclerosis. Magn Reson Med 2018; 80:1132-1137. [PMID: 29334139 PMCID: PMC5980669 DOI: 10.1002/mrm.27091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 11/10/2022]
Abstract
Purpose To simultaneously image brain lesions and veins in multiple sclerosis. Methods An interleaved sequence was developed to simultaneously acquire 3D T2*-weighted (or susceptibility-weighted, SW) and fluid-attenuated inversion recovery (FLAIR) images on a 3.0T MRI system. The pulse sequence parameters were calculated to minimize signal perturbation from steady state while maintaining acceptable image contrast and scan time. Fifteen multiple sclerosis patients were enrolled in this prospective study and underwent a standard MS imaging protocol. In addition, SW and FLAIR images were acquired separately and also in an interleaved manner. The SW and FLAIR images were combined into one image to visualize lesions and penetrating veins. The contrast ratios between white matter lesions and penetrating veins were compared between the interleaved sequence and the individual non-interleaved acquisitions. Results Interleaved scanning of the FLAIR and the SW pulse sequences was achieved, producing aligned images, and with similar image contrast as in the non-interleaved images. A total of 1076 lesions were identified in all patients on the combined SW-FLAIR image, of which 968 lesions (90%) had visible penetrating veins. Lesion-to-vein contrast ratio was 32.7 ± 17.9 (mean ± standard deviation) for the interleaved sequence compared to 28.1 ± 13.7 using the separate acquisitions (P<0.001). Conclusion The feasibility of interleaved acquisition of susceptibility-weighted and FLAIR images was demonstrated. This sequence provides self-registered images and facilitates the visualization of veins in brain lesions.
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Affiliation(s)
- Refaat E. Gabr
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
| | - Amol S. Pednekar
- Philips Healthcare, Cleveland, OH
- Texas Children’s Hospital, Houston, TX
| | - Arash Kamali
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
| | - John A Lincoln
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Flavia M. Nelson
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Jerry S. Wolinsky
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX
| | - Ponnada A. Narayana
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, TX
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20
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Tillema JM, Weigand SD, Dayan M, Shu Y, Kantarci OH, Lucchinetti CF, Port JD. Dark Rims: Novel Sequence Enhances Diagnostic Specificity in Multiple Sclerosis. AJNR Am J Neuroradiol 2018; 39:1052-1058. [PMID: 29700044 DOI: 10.3174/ajnr.a5636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/10/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The 2010 McDonald criteria are designed to sensitively detect MS; however, the low specificity of these criteria can occasionally lead to the misdiagnosis of MS. The purpose of this study was to determine whether a novel double inversion recovery MR imaging technique has the potential to increase the specificity of diagnostic criteria distinguishing MS from non-MS white matter lesions. MATERIALS AND METHODS This was a cross-sectional observational study. MR imaging data were acquired between 2011 and 2016. A novel double inversion recovery sequence that suppresses CSF and GM signal was used (GM-double inversion recovery). We compared WM lesions in a group of patients with multiple sclerosis and in a second group of positive controls with white matter lesions who did not have a diagnosis of MS. The presence of a rim on the GM-double inversion recovery MR imaging sequence was combined with the 2001 and 2010 McDonald disseminated-in-space criteria. Multiple MR imaging markers, including lesion location, size, and the presence of a rim, were compared between groups as well as a quantitative measure of lesion T1 hypointensity. RESULTS MR images from 107 patients with relapsing-remitting MS (median age, 32 years) and 36 positive control (median age, 39 years) subjects were analyzed. No significant differences were found in age and sex. In patients with MS, 1120/3211 lesions (35%) had a rim on GM-double inversion recovery; the positive control group had only 9/893 rim lesions (1%). Rims were associated with a decrease in the lesion T1 ratio. Using the 2010 MR imaging criteria plus the presence of rims on GM-double inversion recovery, we achieved 78% and 97% specificity in subjects with ≥1 and ≥2 rim lesions, respectively. CONCLUSIONS The addition of a novel GM-double inversion recovery technique enhanced specificity for diagnosing MS compared with established MR imaging criteria.
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Affiliation(s)
- J-M Tillema
- From the Departments of Neurology (J.-M.T., M.D., O.H.K., C.F.L.)
| | | | - M Dayan
- From the Departments of Neurology (J.-M.T., M.D., O.H.K., C.F.L.)
| | - Y Shu
- Radiology (Y.S., J.D.P.), Mayo Clinic, Rochester, Minnesota
| | - O H Kantarci
- From the Departments of Neurology (J.-M.T., M.D., O.H.K., C.F.L.)
| | - C F Lucchinetti
- From the Departments of Neurology (J.-M.T., M.D., O.H.K., C.F.L.)
| | - J D Port
- Radiology (Y.S., J.D.P.), Mayo Clinic, Rochester, Minnesota
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21
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Conventional and advanced MRI in multiple sclerosis. Rev Neurol (Paris) 2018; 174:391-397. [DOI: 10.1016/j.neurol.2018.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 12/28/2022]
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22
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Value of central vein sign in discriminating multiple sclerosis plaques from other white matter lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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23
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Trattnig S, Springer E, Bogner W, Hangel G, Strasser B, Dymerska B, Cardoso PL, Robinson SD. Key clinical benefits of neuroimaging at 7T. Neuroimage 2018; 168:477-489. [PMID: 27851995 PMCID: PMC5832016 DOI: 10.1016/j.neuroimage.2016.11.031] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/06/2016] [Accepted: 11/12/2016] [Indexed: 01/15/2023] Open
Abstract
The growing interest in ultra-high field MRI, with more than 35.000 MR examinations already performed at 7T, is related to improved clinical results with regard to morphological as well as functional and metabolic capabilities. Since the signal-to-noise ratio increases with the field strength of the MR scanner, the most evident application at 7T is to gain higher spatial resolution in the brain compared to 3T. Of specific clinical interest for neuro applications is the cerebral cortex at 7T, for the detection of changes in cortical structure, like the visualization of cortical microinfarcts and cortical plaques in Multiple Sclerosis. In imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology may be visualized with excellent spatial resolution. Using Susceptibility Weighted Imaging, the plaque-vessel relationship and iron accumulations in Multiple Sclerosis can be visualized, which may provide a prognostic factor of disease. Vascular imaging is a highly promising field for 7T which is dealt with in a separate dedicated article in this special issue. The static and dynamic blood oxygenation level-dependent contrast also increases with the field strength, which significantly improves the accuracy of pre-surgical evaluation of vital brain areas before tumor removal. Improvement in acquisition and hardware technology have also resulted in an increasing number of MR spectroscopic imaging studies in patients at 7T. More recent parallel imaging and short-TR acquisition approaches have overcome the limitations of scan time and spatial resolution, thereby allowing imaging matrix sizes of up to 128×128. The benefits of these acquisition approaches for investigation of brain tumors and Multiple Sclerosis have been shown recently. Together, these possibilities demonstrate the feasibility and advantages of conducting routine diagnostic imaging and clinical research at 7T.
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Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MRI, Vienna, Austria.
| | - Elisabeth Springer
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria; Christian Doppler Laboratory for Clinical Molecular MRI, Vienna, Austria.
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Gilbert Hangel
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Bernhard Strasser
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Barbara Dymerska
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Pedro Lima Cardoso
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
| | - Simon Daniel Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Lazarettgasse 14, A-1090, Vienna, Austria.
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24
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Huh SY. The early diagnosis and treatments in multiple sclerosis. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.2.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system that leads to neurological disability. The diagnosis of MS relies on the MRI criteria, which can demonstrate dissemination in space and time. Exclusion of other demyelinating mimics is essential because there are no specific biomarker for MS and MRI criteria are still have imperfect. There is incremental improvements in MS treatment option that have contributed to the delay of disease progression. The early initiation of DMT may ameliorate the neurological disability. In this review, we discusses the new diagnostic MS criteria and summarize the evidences supporting the early treatment in the course of MS.
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25
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Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 2017; 17:162-173. [PMID: 29275977 DOI: 10.1016/s1474-4422(17)30470-2] [Citation(s) in RCA: 4196] [Impact Index Per Article: 599.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/04/2017] [Accepted: 11/16/2017] [Indexed: 01/04/2023]
Abstract
The 2010 McDonald criteria for the diagnosis of multiple sclerosis are widely used in research and clinical practice. Scientific advances in the past 7 years suggest that they might no longer provide the most up-to-date guidance for clinicians and researchers. The International Panel on Diagnosis of Multiple Sclerosis reviewed the 2010 McDonald criteria and recommended revisions. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical clinically isolated syndrome, define what is needed to fulfil dissemination in time and space of lesions in the CNS, and stress the need for no better explanation for the presentation. The following changes were made: in patients with a typical clinically isolated syndrome and clinical or MRI demonstration of dissemination in space, the presence of CSF-specific oligoclonal bands allows a diagnosis of multiple sclerosis; symptomatic lesions can be used to demonstrate dissemination in space or time in patients with supratentorial, infratentorial, or spinal cord syndrome; and cortical lesions can be used to demonstrate dissemination in space. Research to further refine the criteria should focus on optic nerve involvement, validation in diverse populations, and incorporation of advanced imaging, neurophysiological, and body fluid markers.
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Kaunzner UW, Gauthier SA. MRI in the assessment and monitoring of multiple sclerosis: an update on best practice. Ther Adv Neurol Disord 2017; 10:247-261. [PMID: 28607577 DOI: 10.1177/1756285617708911] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/09/2017] [Indexed: 01/14/2023] Open
Abstract
Magnetic resonance imaging (MRI) has developed into the most important tool for the diagnosis and monitoring of multiple sclerosis (MS). Its high sensitivity for the evaluation of inflammatory and neurodegenerative processes in the brain and spinal cord has made it the most commonly used technique for the evaluation of patients with MS. Moreover, MRI has become a powerful tool for treatment monitoring, safety assessment as well as for the prognostication of disease progression. Clinically, the use of MRI has increased in the past couple decades as a result of improved technology and increased availability that now extends well beyond academic centers. Consequently, there are numerous studies supporting the role of MRI in the management of patients with MS. The aim of this review is to summarize the latest insights into the utility of MRI in MS.
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Affiliation(s)
- Ulrike W Kaunzner
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, New York, NY, USA
| | - Susan A Gauthier
- Judith Jaffe Multiple Sclerosis Center, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA
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Abstract
Magnetic resonance imaging (MRI) plays a key role in the investigation of cerebrovascular diseases. Compared with computed tomography (CT) and digital subtraction angiography (DSA), its advantages in diagnosing cerebrovascular pathology include its superior tissue contrast, its ability to visualize blood vessels without the use of a contrast agent, and its use of magnetic fields and radiofrequency pulses instead of ionizing radiation. In recent years, ultrahigh field MRI at 7 tesla (7 T) has shown promise in the diagnosis of many cerebrovascular diseases. The increased signal-to-noise ratio (SNR; 2.3x and 4.7x increase compared with 3 and 1.5 T, respectively) and contrast-to-noise ratio (CNR) at this higher field strength can be exploited to obtain a higher spatial resolution and higher lesion conspicuousness, enabling assessment of smaller brain structures and lesions. Cerebrovascular diseases can be assessed at different tissue levels; for instance, changes of the arteries feeding the brain can be visualized to determine the cause of ischemic stroke, regional changes in brain perfusion can be mapped to predict outcome after revascularization, and tissue damage, including old and recent ischemic infarcts, can be evaluated as a marker of ischemic burden. For the purpose of this review, we will discriminate 3 levels of assessment of cerebrovascular diseases using MRI: Pipes, Perfusion, and Parenchyma (3 Ps). The term Pipes refers to the brain-feeding arteries from the heart and aortic arch, upwards to the carotid arteries, vertebral arteries, circle of Willis, and smaller intracranial arterial branches. Perfusion is the amount of blood arriving at the brain tissue level, and includes the vascular reserve and perfusion territories. Parenchyma refers to the acute and chronic burden of brain tissue damage, which includes larger infarcts, smaller microinfarcts, and small vessel disease manifestations such as white matter lesions, lacunar infarcts, and microbleeds. In this review, we will describe the key developments in the last decade of 7-T MRI of cerebrovascular diseases, subdivided for these 3 levels of assessment.
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Sati P, Oh J, Constable RT, Evangelou N, Guttmann CRG, Henry RG, Klawiter EC, Mainero C, Massacesi L, McFarland H, Nelson F, Ontaneda D, Rauscher A, Rooney WD, Samaraweera APR, Shinohara RT, Sobel RA, Solomon AJ, Treaba CA, Wuerfel J, Zivadinov R, Sicotte NL, Pelletier D, Reich DS. The central vein sign and its clinical evaluation for the diagnosis of multiple sclerosis: a consensus statement from the North American Imaging in Multiple Sclerosis Cooperative. Nat Rev Neurol 2016; 12:714-722. [DOI: 10.1038/nrneurol.2016.166] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Trattnig S, Bogner W, Gruber S, Szomolanyi P, Juras V, Robinson S, Zbýň Š, Haneder S. Clinical applications at ultrahigh field (7 T). Where does it make the difference? NMR IN BIOMEDICINE 2016; 29:1316-34. [PMID: 25762432 DOI: 10.1002/nbm.3272] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/20/2015] [Accepted: 01/22/2015] [Indexed: 05/11/2023]
Abstract
Presently, three major MR vendors provide commercial 7-T units for clinical research under ethical permission, with the number of operating 7-T systems having increased to over 50. This rapid increase indicates the growing interest in ultrahigh-field MRI because of improved clinical results with regard to morphological as well as functional and metabolic capabilities. As the signal-to-noise ratio scales linearly with the field strength (B0 ) of the scanner, the most obvious application at 7 T is to obtain higher spatial resolution in the brain, musculoskeletal system and breast. Of specific clinical interest for neuro-applications is the cerebral cortex at 7 T, for the detection of changes in cortical structure as a sign of early dementia, as well as for the visualization of cortical microinfarcts and cortical plaques in multiple sclerosis. In the imaging of the hippocampus, even subfields of the internal hippocampal anatomy and pathology can be visualized with excellent resolution. The dynamic and static blood oxygenation level-dependent contrast increases linearly with the field strength, which significantly improves the pre-surgical evaluation of eloquent areas before tumor removal. Using susceptibility-weighted imaging, the plaque-vessel relationship and iron accumulation in multiple sclerosis can be visualized for the first time. Multi-nuclear clinical applications, such as sodium imaging for the evaluation of repair tissue quality after cartilage transplantation and (31) P spectroscopy for the differentiation between non-alcoholic benign liver disease and potentially progressive steatohepatitis, are only possible at ultrahigh fields. Although neuro- and musculoskeletal imaging have already demonstrated the clinical superiority of ultrahigh fields, whole-body clinical applications at 7 T are still limited, mainly because of the lack of suitable coils. The purpose of this article was therefore to review the clinical studies that have been performed thus far at 7 T, compared with 3 T, as well as those studies performed at 7 T that cannot be routinely performed at 3 T. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Siegfried Trattnig
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- CD Laboratory for Clinical Molecular MR Imaging
| | - Wolfgang Bogner
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stephan Gruber
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pavol Szomolanyi
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vladimir Juras
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Imaging Methods, Institute of Measurement Sciences, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Simon Robinson
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Štefan Zbýň
- High Field MR Center, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Haneder
- Vascular and Abdominal Imaging, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
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Leocani L, Rocca MA, Comi G. MRI and neurophysiological measures to predict course, disability and treatment response in multiple sclerosis. Curr Opin Neurol 2016; 29:243-53. [DOI: 10.1097/wco.0000000000000333] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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MRI criteria for the diagnosis of multiple sclerosis: MAGNIMS consensus guidelines. Lancet Neurol 2016; 15:292-303. [PMID: 26822746 PMCID: PMC4760851 DOI: 10.1016/s1474-4422(15)00393-2] [Citation(s) in RCA: 532] [Impact Index Per Article: 66.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/02/2015] [Accepted: 12/10/2015] [Indexed: 01/15/2023]
Abstract
In patients presenting with a clinically isolated syndrome, MRI can support and substitute clinical information in the diagnosis of multiple sclerosis by showing disease dissemination in space and time and by helping to exclude disorders that can mimic multiple sclerosis. MRI criteria were first included in the diagnostic work-up for multiple sclerosis in 2001, and since then several modifications to the criteria have been proposed in an attempt to simplify lesion-count models for showing disease dissemination in space, change the timing of MRI scanning to show dissemination in time, and increase the value of spinal cord imaging. Since the last update of these criteria, new data on the use of MRI to establish dissemination in space and time have become available, and MRI technology has improved. State-of-the-art MRI findings in these patients were discussed in a MAGNIMS workshop, the goal of which was to provide an evidence-based and expert-opinion consensus on proposed modifications to MRI criteria for the diagnosis of multiple sclerosis.
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Raz E, Branson B, Jensen JH, Bester M, Babb JS, Herbert J, Grossman RI, Inglese M. Relationship between iron accumulation and white matter injury in multiple sclerosis: a case-control study. J Neurol 2015; 262:402-9. [PMID: 25416468 PMCID: PMC4452503 DOI: 10.1007/s00415-014-7569-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/28/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
Despite the increasing development and applications of iron imaging, the pathophysiology of iron accumulation in multiple sclerosis (MS), and its role in disease progression and development of clinical disability, is poorly understood. The aims of our study were to determine the presence and extent of iron in T2 visible lesions and gray and white matter using magnetic field correlation (MFC) MRI and correlate with microscopic white matter (WM) injury as measured by diffusion tensor imaging (DTI). This is a case-control study including a series of 31 patients with clinically definite MS. The mean age was 39 years [standard deviation (SD) = 9.55], they were 11 males and 20 females, with a disease duration average of 3 years (range 0-13) and a median EDSS of 2 (0-4.5). Seventeen healthy volunteers (6 males and 11 females) with a mean age of 36 years (SD = 11.4) were recruited. All subjects underwent MR imaging on a 3T scanner using T2-weighted sequence, 3D T1 MPRAGE, MFC, single-shot DTI and post-contrast T1. T2-lesion volumes, brain volumetry, DTI parameters and iron quantification were calculated and multiple correlations were exploited. Increased MFC was found in the putamen (p = 0.061), the thalamus (p = 0.123), the centrum semiovale (p = 0.053), globus pallidus (p = 0.008) and gray matter (GM) (p = 0.004) of MS patients compared to controls. The mean lesional MFC was 121 s(-2) (SD = 67), significantly lower compared to the GM MFC (<0.0001). The GM mean diffusivity (MD) was inversely correlated with the MFC in the centrum semiovale (p < 0.001), and in the splenium of the corpus callosum (p < 0.001). Patients with MS have increased iron in the globus pallidus, putamen and centrum with a trend toward increased iron in all the brain structures. Quantitative iron evaluation of WM and GM may improve the understanding of MS pathophysiology, and might serve as a surrogate marker of disease progression.
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Affiliation(s)
- Eytan Raz
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - Brittany Branson
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Jens H. Jensen
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Maxim Bester
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre, Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - James S. Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Joseph Herbert
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Robert I. Grossman
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Matilde Inglese
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Department of Neurology, Radiology and Neuroscience, Icahn School of Medicine at Mount Sinai New York, NY
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