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Chen X, Schädelin S, Lu PJ, Ocampo-Pineda M, Weigel M, Barakovic M, Ruberte E, Cagol A, Marechal B, Kober T, Kuhle J, Kappos L, Melie-Garcia L, Granziera C. Personalized maps of T1 relaxometry abnormalities provide correlates of disability in multiple sclerosis patients. Neuroimage Clin 2023; 37:103349. [PMID: 36801600 PMCID: PMC9958406 DOI: 10.1016/j.nicl.2023.103349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVES AND AIMS Quantitative MRI (qMRI) has greatly improved the sensitivity and specificity of microstructural brain pathology in multiple sclerosis (MS) when compared to conventional MRI (cMRI). More than cMRI, qMRI also provides means to assess pathology within the normal-appearing and lesion tissue. In this work, we further developed a method providing personalized quantitative T1 (qT1) abnormality maps in individual MS patients by modeling the age dependence of qT1 alterations. In addition, we assessed the relationship between qT1 abnormality maps and patients' disability, in order to evaluate the potential value of this measurement in clinical practice. METHODS We included 119 MS patients (64 relapsing-remitting MS (RRMS), 34 secondary progressive MS (SPMS), 21 primary progressive MS (PPMS)), and 98 Healthy Controls (HC). All individuals underwent 3T MRI examinations, including Magnetization Prepared 2 Rapid Acquisition Gradient Echoes (MP2RAGE) for qT1 maps and High-Resolution 3D Fluid Attenuated Inversion Recovery (FLAIR) imaging. To calculate personalized qT1 abnormality maps, we compared qT1 in each brain voxel in MS patients to the average qT1 obtained in the same tissue (grey/white matter) and region of interest (ROI) in healthy controls, hereby providing individual voxel-based Z-score maps. The age dependence of qT1 in HC was modeled using linear polynomial regression. We computed the average qT1 Z-scores in white matter lesions (WMLs), normal-appearing white matter (NAWM), cortical grey matter lesions (GMcLs) and normal-appearing cortical grey matter (NAcGM). Lastly, a multiple linear regression (MLR) model with the backward selection including age, sex, disease duration, phenotype, lesion number, lesion volume and average Z-score (NAWM/NAcGM/WMLs/GMcLs) was used to assess the relationship between qT1 measures and clinical disability (evaluated with EDSS). RESULTS The average qT1 Z-score was higher in WMLs than in NAWM. (WMLs: 1.366 ± 0.409, NAWM: -0.133 ± 0.288, [mean ± SD], p < 0.001). The average Z-score in NAWM in RRMS patients was significantly lower than in PPMS patients (p = 0.010). The MLR model showed a strong association between average qT1 Z-scores in white matter lesions (WMLs) and EDSS (R2 = 0.549, β = 0.178, 97.5 % CI = 0.030 to 0.326, p = 0.019). Specifically, we measured a 26.9 % increase in EDSS per unit of qT1 Z-score in WMLs in RRMS patients (R2 = 0.099, β = 0.269, 97.5 % CI = 0.078 to 0.461, p = 0.007). CONCLUSIONS We showed that personalized qT1 abnormality maps in MS patients provide measures related to clinical disability, supporting the use of those maps in clinical practice.
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Affiliation(s)
- Xinjie Chen
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sabine Schädelin
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Po-Jui Lu
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Mario Ocampo-Pineda
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Muhamed Barakovic
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Esther Ruberte
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alessandro Cagol
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Benedicte Marechal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Neurology, University Hospital Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
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Vaneckova M, Piredda GF, Andelova M, Krasensky J, Uher T, Srpova B, Havrdova EK, Vodehnalova K, Horakova D, Hilbert T, Maréchal B, Fartaria MJ, Ravano V, Kober T. Periventricular gradient of T 1 tissue alterations in multiple sclerosis. Neuroimage Clin 2022; 34:103009. [PMID: 35561554 PMCID: PMC9112026 DOI: 10.1016/j.nicl.2022.103009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 01/12/2023]
Abstract
T1 relaxation times alterations were assessed based on a study-specific atlas. T1 alterations depend on distance from lateral ventricles (“periventricular gradient”). Gradient parameters correlate better with disability compared to conventional MRI.
Objective Pathology in multiple sclerosis is not homogenously distributed. Recently, it has been shown that structures adjacent to CSF are more severely affected. A gradient of brain tissue involvement was shown with more severe pathology in periventricular areas and in proximity to brain surfaces such as the subarachnoid spaces and ependyma, and hence termed the “surface–in” gradient. Here, we study whether (i) the surface-in gradient of periventricular tissue alteration measured by T1 relaxometry is already present in early multiple sclerosis patients, (ii) how it differs between early and progressive multiple sclerosis patients, and (iii) whether the gradient-derived metrics in normal-appearing white matter and lesions correlate better with physical disability than conventional MRI-based metrics. Methods Forty-seven patients with early multiple sclerosis, 52 with progressive multiple sclerosis, and 92 healthy controls were included in the study. Isotropic 3D T1 relaxometry maps were obtained using the Magnetization-Prepared 2 Rapid Acquisition Gradient Echoes sequence at 3 T. After spatially normalizing the T1 maps into a study-specific common space, T1 inter-subject variability within the healthy cohort was modelled voxel-wise, yielding a normative T1 atlas. Individual comparisons of each multiple sclerosis patient against the atlas were performed by computing z-scores. Equidistant bands of voxels were defined around the ventricles in the supratentorial white matter; the z-scores in these bands were analysed and compared between the early and progressive multiple sclerosis cohorts. Correlations between both conventional and z-score-gradient-derived MRI metrics and the Expanded Disability Status Scale were assessed. Results Patients with early and progressive multiple sclerosis demonstrated a periventricular gradient of T1 relaxation time z-scores. In progressive multiple sclerosis, z-score-derived metrics reflecting the gradient of tissue abnormality in normal-appearing white matter were more strongly correlated with disability (maximal rho = 0.374) than the conventional lesion volume and count (maximal rho = 0.189 and 0.21 respectively). In early multiple sclerosis, the gradient of normal-appearing white matter volume with z-scores > 2 at baseline correlated with clinical disability assessed at two years follow-up. Conclusion Our results suggest that the surface-in white matter gradient of tissue alteration is detectable with T1 relaxometry and is already present at clinical disease onset. The periventricular gradients correlate with clinical disability. The periventricular gradient in normal-appearing white matter may thus qualify as a promising biomarker for monitoring of disease activity from an early stage in all phenotypes of multiple sclerosis.
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Affiliation(s)
- Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Ravano V, Andelova M, Fartaria MJ, Mahdi MFAW, Maréchal B, Meuli R, Uher T, Krasensky J, Vaneckova M, Horakova D, Kober T, Richiardi J. Validating atlas-based lesion disconnectomics in multiple sclerosis: A retrospective multi-centric study. Neuroimage Clin 2022; 32:102817. [PMID: 34500427 PMCID: PMC8429972 DOI: 10.1016/j.nicl.2021.102817] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/30/2021] [Accepted: 08/30/2021] [Indexed: 12/01/2022]
Abstract
Structural disconnectomes can be modelled without diffusion using tractography atlases. Atlas-based and DTI-derived disconnectome topological metrics correlate strongly. MS patient disconnectomes relate to clinical scores.
The translational potential of MR-based connectivity modelling is limited by the need for advanced diffusion imaging, which is not part of clinical protocols for many diseases. In addition, where diffusion data is available, brain connectivity analyses rely on tractography algorithms which imply two major limitations. First, tracking algorithms are known to be sensitive to the presence of white matter lesions and therefore leading to interpretation pitfalls and poor inter-subject comparability in clinical applications such as multiple sclerosis. Second, tractography quality is highly dependent on the acquisition parameters of diffusion sequences, leading to a trade-off between acquisition time and tractography precision. Here, we propose an atlas-based approach to study the interplay between structural disconnectivity and lesions without requiring individual diffusion imaging. In a multi-centric setting involving three distinct multiple sclerosis datasets (containing both 1.5 T and 3 T data), we compare our atlas-based structural disconnectome computation pipeline to disconnectomes extracted from individual tractography and explore its clinical utility for reducing the gap between radiological findings and clinical symptoms in multiple sclerosis. Results using topological graph properties showed that overall, our atlas-based disconnectomes were suitable approximations of individual disconnectomes from diffusion imaging. Small-worldness was found to decrease for larger total lesion volumes thereby suggesting a loss of efficiency in brain connectivity of MS patients. Finally, the global efficiency of the created brain graph, combined with total lesion volume, allowed to stratify patients into subgroups with different clinical scores in all three cohorts.
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Affiliation(s)
- Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | | | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Reto Meuli
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Krasensky
- MR unit, Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Manuela Vaneckova
- MR unit, Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Olsson H, Andersen M, Kadhim M, Helms G. MP3RAGE: Simultaneous mapping of T 1 and B 1 + in human brain at 7T. Magn Reson Med 2022; 87:2637-2649. [PMID: 35037283 DOI: 10.1002/mrm.29151] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE To map T1 and the local flip angle ( B 1 + ) in human brain using a single MP3RAGE sequence with 3 rapid acquisitions of gradient echoes (RAGEs). THEORY AND METHODS A third RAGE with a relatively high flip angle was appended to an MP2RAGE sequence. Through curve fitting and a rational approximation for small flip angles and short TR, closed form solutions for T1 and B 1 + were derived. The influence of different k-space encoding schemes on precision and whether edge enhancement artifacts could be reduced with a saturation pulse applied prior to the third RAGE were explored. Validation of T1 estimates was performed using single-slice inversion recovery (IR) and a subsequent region-of-interest-based comparison, whereas validation of B 1 + was performed using a whole brain pixelwise comparison to a DREAM flip angle mapping protocol. Lastly, MP3RAGE was compared to T1 -mapping by MP2RAGE with separate B 1 + correction. RESULTS Whole brain maps of T1 and B 1 + at 1 mm isotropic resolution were obtained with MP3RAGE in 06:37 min. A linear-reverse centric-reverse centric phase-encoding order of the 3 RAGEs improved precision, and artifacts were successfully reduced with the saturation pulse. Estimations of T1 and B 1 + deviated +2.5 ± 3.1% and -1.7 ± 8.6% from their respective references. CONCLUSION T1 and B 1 + can be mapped simultaneously using MP3RAGE. The approach can be thought of as combining MP2RAGE with a dual flip angle T1 -mapping protocol. Both maps can be solved for analytically and will be inherently co-registered at the high resolution associated with MPRAGE.
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Affiliation(s)
- Hampus Olsson
- Department of Medical Radiation Physics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Mads Andersen
- Philips Healthcare, Copenhagen, Denmark.,Lund University Bioimaging Center, Lund University, Lund, Sweden
| | - Mustafa Kadhim
- Department of Medical Radiation Physics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Gunther Helms
- Department of Medical Radiation Physics, Clinical Sciences Lund, Lund University, Lund, Sweden
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Forodighasemabadi A, Baucher G, Soustelle L, Troalen T, Girard OM, Guye M, Grisoli JB, Ranjeva JP, Duhamel G, Callot V. Spinal cord and brain tissue impairments as long-term effects of rugby practice? An exploratory study based on T1 and ihMTsat measures. NEUROIMAGE: CLINICAL 2022; 35:103124. [PMID: 35905667 PMCID: PMC9421542 DOI: 10.1016/j.nicl.2022.103124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/14/2022] [Accepted: 07/20/2022] [Indexed: 12/03/2022] Open
Abstract
Diffuse degeneration of spinal cord (higher T1) is observed in retired rugby players. Demyelination of brain WM tracts (higher T1 / lower ihMTsat values) is present in rugby players. Early aging in both brain and spinal cord tissues may be linked to the rugby practice. The aforementioned effects may suggest cumulative effects of long-term impacts on the tissues.
Rugby players are subject to multiple impacts to their head and neck that could have adverse neurological effects and put them at increased risk of neurodegeneration. Previous studies demonstrated altered default mode network and diffusion metrics on brain, as well as more foraminal stenosis, disc protrusion and neck pain among players of contact sports as compared to healthy controls. However, the long-term effects of practice and repetitive impacts on brain and cervical spinal cord (cSC) of the rugby players have never been systematically investigated. In this study, 15 retired professional and amateur rugby players (R) and 15 age-matched healthy controls (HC) (all males; mean age R: 46.8 ± 7.6; and HC: 48.6 ± 9.5) were recruited both to investigate cord impairments and further characterize brain structure damage. Medical questionnaires including modified Japanese Orthopedic Association scale (mJOA) and Neck Disability Index (NDI) were filled by all participants. A 3 T multi-parametric MR protocol including conventional qualitative techniques such as T1-, T2-, and T2*-weighted sequences, as well as state-of-the art quantitative techniques including MP2RAGE T1 mapping and 3D ihMTRAGE, was used on both brain and cSC. Normalized brain WM and GM volumes, spine Overall Stenosis Score, cord cross-sectional area and regional T1 and ihMT metrics were derived from these acquisitions. Rugby players showed significantly higher NDI scores, as well as a faster decline of normalized brain GM volume with age as compared to HC. Moreover, higher T1 values on cSC suggestive of structural degeneration, together with higher T1 and lower ihMTsat on brain WM suggestive of demyelination, were observed in retired rugby players as compared to age-matched controls, which may suggest cumulative effects of long-term impacts on the tissues. Metrics also suggest early aging and different aging processes on brain tissue in the players. These preliminary observations provide new insights in the domain, which should now be further investigated on larger cohorts and multicentric longitudinal studies, and further correlated to the likelihood of neurodegenerative diseases and risk factors.
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Forodighasemabadi A, Rasoanandrianina H, El Mendili MM, Guye M, Callot V. An optimized MP2RAGE sequence for studying both brain and cervical spinal cord in a single acquisition at 3T. Magn Reson Imaging 2021; 84:18-26. [PMID: 34517015 DOI: 10.1016/j.mri.2021.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022]
Abstract
Magnetization Prepared 2 Rapid Acquisition Gradient Echo (MP2RAGE) is a T1 mapping technique that has been used broadly on brain and recently on cervical spinal cord (cSC). The growing interest for combined investigation of brain and SC in numerous pathologies of the central nervous system such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and traumatic injuries, now brings about the need for optimization with regards to this specific investigation. This implies large spatial coverage with high spatial resolution and short acquisition time, high CNR and low B1+ sensitivity, as well as high reproducibility and robust post-processing tools for T1 quantification in different regions of brain and SC. In this work, a dedicated protocol (referred to as Pr-BSC) has been optimized for simultaneous brain and cSC T1 MP2RAGE acquisition at 3T. After computer simulation optimization, the protocol was applied for in vivo validation experiments and compared to previously published state of the art protocols focusing on either the brain (Pr-B) or the cSC (Pr-SC). Reproducibility and in-ROI standard deviations were assessed on healthy volunteers in the perspective of future clinical use. The mean T1 values, obtained by the Pr-BSC, in brain white, gray and deep gray matters were: (mean ± in-ROI SD) 792 ± 27 ms, 1339 ± 139 ms and 1136 ± 88 ms, respectively. In cSC, T1 values for white matter corticospinal, posterior sensory, lateral sensory and rubro/reticulospinal tracts were 902 ± 41 ms, 920 ± 35 ms, 903 ± 46 ms, 891 ± 41 ms, respectively, and 954 ± 32 ms for anterior and intermediate gray matter. The Pr-BSC protocol showed excellent agreement with previously proposed Pr-B on brain and Pr-SC on cSC, with very high inter-scan reproducibility (coefficients of variation of 0.52 ± 0.36% and 1.12 ± 0.62% on brain and cSC, respectively). This optimized protocol covering both brain and cSC with a sub-millimetric isotropic spatial resolution in one acquisition of less than 8 min, opens up great perspectives for clinical applications focusing on degenerative tissue such as encountered in MS and ALS.
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Affiliation(s)
- Arash Forodighasemabadi
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France; Aix-Marseille Univ, Université Gustave Eiffel, LBA, Marseille, France; iLab-Spine International Associated Laboratory, Marseille-Montreal, France, Canada
| | - Henitsoa Rasoanandrianina
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France; Aix-Marseille Univ, Université Gustave Eiffel, LBA, Marseille, France; iLab-Spine International Associated Laboratory, Marseille-Montreal, France, Canada
| | - Mohamed Mounir El Mendili
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France
| | - Maxime Guye
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France
| | - Virginie Callot
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France; APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France; iLab-Spine International Associated Laboratory, Marseille-Montreal, France, Canada.
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Granziera C, Wuerfel J, Barkhof F, Calabrese M, De Stefano N, Enzinger C, Evangelou N, Filippi M, Geurts JJG, Reich DS, Rocca MA, Ropele S, Rovira À, Sati P, Toosy AT, Vrenken H, Gandini Wheeler-Kingshott CAM, Kappos L. Quantitative magnetic resonance imaging towards clinical application in multiple sclerosis. Brain 2021; 144:1296-1311. [PMID: 33970206 PMCID: PMC8219362 DOI: 10.1093/brain/awab029] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/25/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Quantitative MRI provides biophysical measures of the microstructural integrity of the CNS, which can be compared across CNS regions, patients, and centres. In patients with multiple sclerosis, quantitative MRI techniques such as relaxometry, myelin imaging, magnetization transfer, diffusion MRI, quantitative susceptibility mapping, and perfusion MRI, complement conventional MRI techniques by providing insight into disease mechanisms. These include: (i) presence and extent of diffuse damage in CNS tissue outside lesions (normal-appearing tissue); (ii) heterogeneity of damage and repair in focal lesions; and (iii) specific damage to CNS tissue components. This review summarizes recent technical advances in quantitative MRI, existing pathological validation of quantitative MRI techniques, and emerging applications of quantitative MRI to patients with multiple sclerosis in both research and clinical settings. The current level of clinical maturity of each quantitative MRI technique, especially regarding its integration into clinical routine, is discussed. We aim to provide a better understanding of how quantitative MRI may help clinical practice by improving stratification of patients with multiple sclerosis, and assessment of disease progression, and evaluation of treatment response.
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Affiliation(s)
- Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
- Quantitative Biomedical Imaging Group (qbig), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
- UCL Institutes of Healthcare Engineering and Neurology, London, UK
| | - Massimiliano Calabrese
- Neurology B, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola De Stefano
- Neurology, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Medical University of Graz, Graz, Austria
| | - Nikos Evangelou
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, multiple sclerosis Center Amsterdam, Neuroscience Amsterdam, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, and Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefan Ropele
- Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Graz, Austria
| | - Àlex Rovira
- Section of Neuroradiology (Department of Radiology), Vall d'Hebron University Hospital and Research Institute, Barcelona, Spain
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ahmed T Toosy
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
| | - Hugo Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, multiple sclerosis Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square multiple sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain MRI 3T Research Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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8
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Choi S, Spini M, Hua J, Harrison DM. Blood-brain barrier breakdown in non-enhancing multiple sclerosis lesions detected by 7-Tesla MP2RAGE ΔT1 mapping. PLoS One 2021; 16:e0249973. [PMID: 33901207 PMCID: PMC8075220 DOI: 10.1371/journal.pone.0249973] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/28/2021] [Indexed: 11/19/2022] Open
Abstract
Although the blood-brain barrier (BBB) is altered in most multiple sclerosis (MS) lesions, gadolinium enhancement is seen only in acute lesions. In this study, we aimed to investigate gadolinium-induced changes in T1 relaxation time in MS lesions on 7-tesla (7T) MRI as a means to quantify BBB breakdown in non-enhancing MS lesions. Forty-seven participants with MS underwent 7T MRI of the brain with a magnitude-prepared rapid acquisition of 2 gradient echoes (MP2RAGE) sequence before and after contrast. Subtraction of pre- and post-contrast T1 maps was used to measure T1 relaxation time change (ΔT1) from gadolinium. ΔT1 values were interrogated in enhancing white matter lesions (ELs), non-enhancing white matter lesions (NELs), and normal appearing white matter (NAWM) and metrics were compared to clinical data. ΔT1 was measurable in NELs (median: -0.139 (-0.304, 0.174) seconds; p < 0.001) and was negligible in NAWM (median: -0.001 (-0.036, 0.155) seconds; p = 0.516). Median ΔT1 in NELs correlated with disability as measured by Expanded Disability Status Scale (EDSS) (rho = -0.331, p = 0.026). Multiple measures of NEL ΔT1 variability also correlated with EDSS. NEL ΔT1 values were greater and more variable in patients with progressive forms of MS and greater in those not on MS treatment. Measurement of the changes in T1 relaxation time caused by contrast on 7T MP2RAGE reveals clinically relevant evidence of BBB breakdown in NELs in MS. This data suggests that NEL ΔT1 should be evaluated further as a potential biomarker of persistently disrupted BBB in MS.
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Affiliation(s)
- Seongjin Choi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Margaret Spini
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jun Hua
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United Stated of America
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
| | - Daniel M. Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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9
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Gromisch ES, Dhari Z. Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis. Neuropsychiatr Dis Treat 2021; 17:323-337. [PMID: 33574669 PMCID: PMC7872925 DOI: 10.2147/ndt.s256689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/22/2021] [Indexed: 12/19/2022] Open
Abstract
Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.
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Affiliation(s)
- Elizabeth S Gromisch
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Zaenab Dhari
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health Of New England, Hartford, CT, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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10
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Massire A, Seiler C, Troalen T, Girard OM, Lehmann P, Brun G, Bartoli A, Audoin B, Bartolomei F, Pelletier J, Callot V, Kober T, Ranjeva JP, Guye M. T1-Based Synthetic Magnetic Resonance Contrasts Improve Multiple Sclerosis and Focal Epilepsy Imaging at 7 T. Invest Radiol 2021; 56:127-133. [PMID: 32852445 DOI: 10.1097/rli.0000000000000718] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Ultra-high field magnetic resonance imaging (MRI) (≥7 T) is a unique opportunity to improve the clinical diagnosis of brain pathologies, such as multiple sclerosis or focal epilepsy. However, several shortcomings of 7 T MRI, such as radiofrequency field inhomogeneities, could degrade image quality and hinder radiological interpretation. To address these challenges, an original synthetic MRI method based on T1 mapping achieved with the magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) sequence was developed. The radiological quality of on-demand T1-based contrasts generated by this technique was evaluated in multiple sclerosis and focal epilepsy imaging at 7 T. MATERIALS AND METHODS This retrospective study was carried out from October 2017 to September 2019 and included 21 patients with different phenotypes of multiple sclerosis and 35 patients with focal epilepsy who underwent MRI brain examinations using a whole-body investigative 7 T magnetic resonance system. The quality of 2 proposed synthetic contrast images were assessed and compared with conventional images acquired at 7 T using the MP2RAGE sequence by 4 radiologists, evaluating 3 qualitative criteria: signal homogeneity, contrast intensity, and lesion visualization. Statistical analyses were performed on reported quality scores using Wilcoxon rank tests and further multiple comparisons tests. Intraobserver and interobserver reliabilities were calculated as well. RESULTS Radiological quality scores were reported higher for synthetic images when compared with original images, regardless of contrast, pathologies, or raters considered, with significant differences found for all 3 criteria (P < 0.0001, Wilcoxon rank test). None of the 4 radiologists ever rated a synthetic image "markedly worse" than an original image. Synthetic images were rated slightly less satisfying for only 3 epileptic patients, without precluding lesion identification. CONCLUSION T1-based synthetic MRI with the MP2RAGE sequence provided on-demand contrasts and high-quality images to the radiologist, facilitating lesion visualization in multiple sclerosis and focal epilepsy, while reducing the magnetic resonance examination total duration by removing an additional sequence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Fabrice Bartolomei
- Pôle de Neurosciences Cliniques, Service de Neurophysiologie, APHM, Hôpital de la Timone, Marseille, France
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11
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Galbusera R, Parmar K, Boillat Y, Fartaria MJ, Todea AR, Brien KO, Smolinski A, Kappos L, van der Zwaag W, Granziera C. Laminar analysis of the cerebellar cortex shows widespread damage in early MS patients: A pilot study at 7T MRI. Mult Scler J Exp Transl Clin 2020; 6:2055217320961409. [PMID: 33149930 PMCID: PMC7586276 DOI: 10.1177/2055217320961409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/21/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background To date, little is known about the presence and extent of cerebellar cortical pathology in early stages of MS. Objective The aims of this study were to (i) investigate microstructural changes in the normal-appearing cerebellar cortex of early MS patients by using 7 T MRI and (ii) evaluate the influence of those changes on clinical performance. Methods Eighteen RRMS patients and nine healthy controls underwent quantitative T1 and T2* measurement at 7 T MRI using high-resolution MP2RAGE and multi-echo gradient-echo imaging. After subtracting lesion masks, average T1 and T2* maps were computed for three layers in the cerebellar cortex and compared between groups using mixed effects models. Results The volume of the cerebellar cortex and its layers did not differ between patients and controls. In MS patients, significantly longer T1 values were observed in all vermis cortical layers and in the middle and external cortical layer of the cerebellar hemispheres. No between-group differences in T2* values were found. T1 values correlated with EDSS, SDMT and PASAT. Conclusions We found MRI evidence of damage in the normal-appearing cerebellar cortex at early MS stages and before volumetric changes. This microstructural alteration appears to be related to EDSS and cognitive performance.
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Affiliation(s)
- Riccardo Galbusera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Katrin Parmar
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Yohan Boillat
- Laboratory for Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Mario Joao Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG (HC CMEA SUI DI BM PI), Lausanne, Switzerland
| | - Alexandra-Ramona Todea
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Kieran O' Brien
- Siemens Healthcare Pty Ltd., Bowen Hills, Australia; Centre for Advanced Imaging, University of Queensland, Australia
| | - Anna Smolinski
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | | | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.,Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
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12
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Beaumont J, Gambarota G, Saint-Jalmes H, Acosta O, Ferré JC, Raniga P, Fripp J. High-resolution multi-T 1 -weighted contrast and T 1 mapping with low B 1 >+ sensitivity using the fluid and white matter suppression (FLAWS) sequence at 7T. Magn Reson Med 2020; 85:1364-1378. [PMID: 32989788 DOI: 10.1002/mrm.28517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/21/2020] [Accepted: 08/23/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE To demonstrate that fluid and white matter suppression (FLAWS) imaging can be used for high-resolution T1 mapping with low transmitted bias field ( B 1 + ) sensitivity at 7T. METHODS The FLAWS sequence was optimized for 0.8-mm isotropic resolution imaging. The theoretical accuracy and precision of the FLAWS T1 mapping was compared with the one of the magnetization-prepared two rapid gradient echoes (MP2RAGE) sequence optimized for low B 1 + sensitivity. FLAWS images were acquired at 7T on six healthy volunteers (21 to 48 years old; two women). MP2RAGE and saturation-prepared with two rapid gradient echoes (SA2RAGE) datasets were also acquired to obtain T1 mapping references and B 1 + maps. The contrast-to-noise ratio (CNR) between brain tissues was measured in the FLAWS-hco and MP2RAGE-uni images. The Pearson correlation was measured between the MP2RAGE and FLAWS T1 maps. The effect of B 1 + on FLAWS T1 mapping was assessed using the Pearson correlation. RESULTS The FLAWS-hco images were characterized by a higher brain tissue CNR ( CNR WM / GM = 5.5 , CNR WM / CSF = 14.7 , CNR GM / CSF = 10.3 ) than the MP2RAGE-uni images ( CNR WM / GM = 4.9 , CNR WM / CSF = 6.6 , CNR GM / CSF = 3.7 ). The theoretical accuracy and precision of the FLAWS T1 mapping ( acc = 91.9 % ; prec = 90.2 % ) were in agreement with those provided by the MP2RAGE T1 mapping ( acc = 90.0 % ; prec = 86.8 % ). A good agreement was found between in vivo T1 values measured with the MP2RAGE and FLAWS sequences (r = 0.91). A weak correlation was found between the FLAWS T1 map and the B 1 + map within cortical gray matter and white matter segmentations ( r WM = - 0.026 ; r GM = 0.081 ). CONCLUSION The results from this study suggest that FLAWS is a good candidate for high-resolution T1 -weighted imaging and T1 mapping at the field strength of 7T.
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Affiliation(s)
- Jérémy Beaumont
- Univ Rennes, CRLCC Eugene Marquis, Inserm, LTSI-UMR1099, Rennes, France.,The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Giulio Gambarota
- Univ Rennes, CRLCC Eugene Marquis, Inserm, LTSI-UMR1099, Rennes, France
| | | | - Oscar Acosta
- Univ Rennes, CRLCC Eugene Marquis, Inserm, LTSI-UMR1099, Rennes, France
| | - Jean-Christophe Ferré
- Univ Rennes, Inria, CNRS, Inserm, IRISA, EMPENN ERL U-1228, Rennes, France.,CHU Rennes, Department of Neuroradiology, Rennes, France
| | - Parnesh Raniga
- The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - Jurgen Fripp
- The Australian e-Health Research Centre, CSIRO, Brisbane, Australia
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13
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Spini M, Choi S, Harrison DM. 7T MPFLAIR versus MP2RAGE for Quantifying Lesion Volume in Multiple Sclerosis. J Neuroimaging 2020; 30:531-536. [PMID: 32569408 DOI: 10.1111/jon.12718] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND PURPOSE Use of fluid-attenuated inversion recovery (FLAIR) scans to quantify multiple sclerosis (MS) lesion volume on 7 Tesla (7T) magnetic resonance imaging (MRI) has many downsides, including poor image homogeneity. There are little data about the relative benefit of alternative modalities. The purpose of this paper is to investigate if magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) is a viable alternative to FLAIR for robust lesion volume measurement and disability correlations. METHODS Forty-seven participants with MS underwent annual brain 7T MRIs. Magnetization-prepared FLAIR (MPFLAIR) and MP2RAGE (both at .7 mm3 isotropic resolution) sequences from a total of 80 MRI scans from 47 subjects were reviewed. White matter lesion (WML) masks were manually constructed from MPFLAIR and T1 maps (from MP2RAGE). Lesion volumes (normalized to intracranial volume) were compared to clinical characteristics and disability scales scores by Pearson or Spearman correlation, as appropriate. Relative correlation strength was compared by Fisher r- to z-transformation. RESULTS Normalized lesion volume was greater in MPFLAIR masks (median .005 [range, .001-.030]) than from T1 maps (median .003 [range, .000-.015]). However, lesion volumes between MPFLAIR and T1 maps were highly correlated (rho = .87, P < .001). WML masks from both modalities correlated with most disability measures with no significant difference in the strength of correlation. CONCLUSIONS 7T MPFLAIR and MP2RAGE T1 map-based WML volumes are highly intercorrelated and both correlate with disability. Thus, MP2RAGE may be a viable alternative to FLAIR-based methods for WML measurement on 7T MRI in MS research.
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Affiliation(s)
- Margaret Spini
- School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Seongjin Choi
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Daniel M Harrison
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
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14
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Mueller SG. Mapping internal brainstem structures using MP2RAGE derived T1 weighted and T1 relaxation images at 3 and 7 T. Hum Brain Mapp 2020; 41:2173-2186. [PMID: 31971322 PMCID: PMC7198362 DOI: 10.1002/hbm.24938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 01/05/2020] [Accepted: 01/13/2020] [Indexed: 02/02/2023] Open
Abstract
The brainstem is a site of early pathology in several neurodegenerative diseases. The overall goal of this project was (a) To develop a method to segment internal brainstem structures from MP2RAGE derived images. (b) To compare the segmentations at 3 and 7 T. (c) To investigate age effects on intensities and segmentations. MP2RAGE derived T1 weighted images (UNI) and T1 relaxation maps (T1map) were obtained from two public data sets (LEMON: 50 3 T data sets, ATAG: 46 7 T data sets). The UNI and T1map images were rescaled using a linear scaling procedure and a ratio (RATIO) image calculated. The brainstem was extracted and k‐mean clustering used to identify six intensity clusters from the UNI, T1map and RATIO at 3 and 7 T. Nonlinear diffeomorphic mapping was used to warp the six intensity clusters in subject space into a common space to generate probabilistic group averages/priors that were used to inform the final probabilistic segmentations at the single subject level for each field strength. The six clusters corresponded to six brainstem tissue types (three gray matter clusters and two white matter clusters and one csf/tissue boundary cluster). The quantitative comparison of the 3 and 7 T probabilistic averages showed subtle differences that affected the localization of age‐associated brainstem volume losses. The segmentation approach presented here identified the same brainstem gray and white matter structures at both field strengths. Further studies are necessary to investigate how resolution and field strength contribute to the subtle differences observed at the two field strengths.
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Affiliation(s)
- Susanne G Mueller
- Department of Radiology, University of California, San Francisco, California
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15
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Rasoanandrianina H, Massire A, Taso M, Guye M, Ranjeva JP, Kober T, Callot V. Regional T 1 mapping of the whole cervical spinal cord using an optimized MP2RAGE sequence. NMR IN BIOMEDICINE 2019; 32:e4142. [PMID: 31393649 DOI: 10.1002/nbm.4142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 06/10/2023]
Abstract
The recently-proposed MP2RAGE sequence was purposely optimized for cervical spinal cord imaging at 3T. Sequence parameters were chosen to optimize gray/white matter T1 contrast with sub-millimetric resolution and scan-time < 10 min while preserving reliable T1 determination with minimal B1+ variation effects within a range of values compatible with pathologies and surrounding structures. Results showed good agreements with IR-based measurements, high MP2RAGE-based T1 reproducibility and preliminary evidences of age- and tract-related T1 variations in the healthy spinal cord.
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Affiliation(s)
- Henitsoa Rasoanandrianina
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
- Aix-Marseille University, IFSTTAR, LBA UMR_T24, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille, France-, Montreal, Canada
| | - Aurélien Massire
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille, France-, Montreal, Canada
| | - Manuel Taso
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille, France-, Montreal, Canada
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Maxime Guye
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Jean-Philippe Ranjeva
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille, France-, Montreal, Canada
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare, Lausanne, Switzerland
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Virginie Callot
- Aix-Marseille University, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
- iLab-Spine International Associated Laboratory, Marseille, France-, Montreal, Canada
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16
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Megna R, Alfano B, Lanzillo R, Costabile T, Comerci M, Vacca G, Carotenuto A, Moccia M, Servillo G, Prinster A, Brescia Morra V, Quarantelli M. Brain tissue volumes and relaxation rates in multiple sclerosis: implications for cognitive impairment. J Neurol 2018; 266:361-368. [PMID: 30498912 DOI: 10.1007/s00415-018-9139-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Both normal gray matter atrophy and brain tissue relaxation rates, in addition to total lesion volume, have shown significant correlations with cognitive test scores in multiple sclerosis (MS). Aim of the study was to assess the relative contributions of macro- and microstructural changes of both normal and abnormal brain tissues, probed, respectively, by their volumes and relaxation rates, to the cognitive status and physical disability of MS patients. METHODS MRI studies from 241 patients with relapsing-remitting MS were retrospectively analyzed by fully automated multiparametric relaxometric segmentation. Ordinal backward regression analysis was applied to the resulting volumes and relaxation rates of both normal (gray matter, normal-appearing white matter and CSF) and abnormal (T2-weighted lesions) brain tissues, controlling for age, sex and disease duration, to identify the main independent contributors to the cognitive status, as measured by the percentage of failed tests at a cognitive test battery (Rao's Brief Repeatable Battery and Stroop test, available in 186 patients), and to the physical disability, as assessed by the Expanded Disability Status Scale (EDSS). RESULTS The R1 relaxation rate (a putative marker of tissue disruption) of the MS lesions appeared the single most significant contributor to cognitive impairment (p < 0.001). On the contrary, the EDSS appeared mainly affected by the decrease in R2 of the gray matter (p < 0.0001), (possibly influenced by cortical plaques, edema and inflammation). CONCLUSIONS In RR-MS the tissue damage in white matter lesions appears the single main determinant of the cognitive status of patients, likely through disconnection phenomena, while the physical disability appears related to the involvement of gray matter.
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Affiliation(s)
- Rosario Megna
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145, Naples, Italy
| | - Bruno Alfano
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145, Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Teresa Costabile
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Marco Comerci
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145, Naples, Italy
| | - Giovanni Vacca
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Antonio Carotenuto
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Anna Prinster
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145, Naples, Italy.
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17
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Cognitive Deficits in Multiple Sclerosis: Recent Advances in Treatment and Neurorehabilitation. Curr Treat Options Neurol 2018; 20:53. [PMID: 30345468 DOI: 10.1007/s11940-018-0538-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW This article highlights recent progress in research on treatment and neurorehabilitation of cognitive impairment in multiple sclerosis (MS) including pharmacological interventions, physical exercise, and neuropsychological rehabilitation, both in conventional and technology-assisted settings. RECENT FINDINGS The most consistent evidence in terms of improvement or preservation of circumscribed cognitive scores in MS patients comes from moderately sampled randomized clinical trials on multimodal approaches that combine conventional or computerized neuropsychological training with psychoeducation or cognitive behavioral therapy. Disease-modifying treatments also appear to have beneficial effects in preventing or attenuating cognitive decline, whereas there is little evidence for agents such as donepezil or stimulants. Finally, physical exercise may yield some cognitive improvement in MS patients. Despite substantial and often promising research efforts, there is a lack of validated and widely accepted clinical procedures for cognitive neurorehabilitation in MS. Development of such approaches will require collaborative efforts towards the design of interventions that are fundamentally inspired by cognitive neuroscience, potentially guided by neuroimaging, and composed of conventional neuropsychological training and cognitive behavioral therapy as well as physical exercise and therapeutic video games. Subsequently, large-scale validation will be needed with meaningful outcome measures reflecting transfer to everyday cognitive function and maintenance of training effects.
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Sinnecker T, Granziera C, Wuerfel J, Schlaeger R. Future Brain and Spinal Cord Volumetric Imaging in the Clinic for Monitoring Treatment Response in MS. Curr Treat Options Neurol 2018; 20:17. [PMID: 29679165 DOI: 10.1007/s11940-018-0504-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Volumetric analysis of brain imaging has emerged as a standard approach used in clinical research, e.g., in the field of multiple sclerosis (MS), but its application in individual disease course monitoring is still hampered by biological and technical limitations. This review summarizes novel developments in volumetric imaging on the road towards clinical application to eventually monitor treatment response in patients with MS. RECENT FINDINGS In addition to the assessment of whole-brain volume changes, recent work was focused on the volumetry of specific compartments and substructures of the central nervous system (CNS) in MS. This included volumetric imaging of the deep brain structures and of the spinal cord white and gray matter. Volume changes of the latter indeed independently correlate with clinical outcome measures especially in progressive MS. Ultrahigh field MRI and quantitative MRI added to this trend by providing a better visualization of small compartments on highly resolving MR images as well as microstructural information. New developments in volumetric imaging have the potential to improve sensitivity as well as specificity in detecting and hence monitoring disease-related CNS volume changes in MS.
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Affiliation(s)
- Tim Sinnecker
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Cristina Granziera
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center Basel AG, Basel, Switzerland
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Regina Schlaeger
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedical Engineering, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
- Translational Imaging in Neurology (ThINK) Basel, Department of Medicine and Biomedical Engineering, University Hospital Basel and University of Basel, Basel, Switzerland.
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Choudhury NA, DeBaun MR, Rodeghier M, King AA, Strouse JJ, McKinstry RC. Silent cerebral infarct definitions and full-scale IQ loss in children with sickle cell anemia. Neurology 2017; 90:e239-e246. [PMID: 29263226 DOI: 10.1212/wnl.0000000000004832] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/26/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether application of the adult definition of silent cerebral infarct (SCI) (T2-weighted hyperintensity ≥5 mm with corresponding T1-weighted hypointensity on MRI) is associated with full-scale IQ (FSIQ) loss in children with sickle cell anemia (SCA), and if so, whether this loss is greater than that of the reference pediatric definition of SCI (T2-weighted hyperintensity ≥3 mm in children on MRI; change in FSIQ -5.2 points; p = 0.017; 95% confidence interval [CI] -9.48 to -0.93). METHODS Among children with SCA screened for SCI in the Silent Cerebral Infarct Transfusion trial, ages 5-14 years, a total of 150 participants (107 with SCIs and 43 without SCIs) were administered the Wechsler Abbreviated Scale of Intelligence. A multivariable linear regression was used to model FSIQ in this population, with varying definitions of SCI independently substituted for the SCI covariate. RESULTS The adult definition of SCI applied to 27% of the pediatric participants with SCIs and was not associated with a statistically significant change in FSIQ (unstandardized coefficient -3.9 points; p = 0.114; 95% CI -8.75 to 0.95), with predicted mean FSIQ of 92.1 and 96.0, respectively, for those with and without the adult definition of SCI. CONCLUSIONS The adult definition of SCI may be too restrictive and was not associated with significant FSIQ decline in children with SCA. Based on these findings, we find no utility in applying the adult definition of SCI to children with SCA and recommend maintaining the current pediatric definition of SCI in this population.
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Affiliation(s)
- Natasha A Choudhury
- From the School of Medicine (N.A.C.), Meharry Medical College; Department of Pediatrics (N.A.C., M.R.D.), Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consultants (M.R.), Chicago, IL; Program in Occupational Therapy and Department of Pediatrics Hematology/Oncology (A.A.K.) and Pediatric Radiology and Neuroradiology Sections (R.C.M.), Washington University School of Medicine, St. Louis, MO; and Department of Pediatrics and Medicine (J.J.S.), Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael R DeBaun
- From the School of Medicine (N.A.C.), Meharry Medical College; Department of Pediatrics (N.A.C., M.R.D.), Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consultants (M.R.), Chicago, IL; Program in Occupational Therapy and Department of Pediatrics Hematology/Oncology (A.A.K.) and Pediatric Radiology and Neuroradiology Sections (R.C.M.), Washington University School of Medicine, St. Louis, MO; and Department of Pediatrics and Medicine (J.J.S.), Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mark Rodeghier
- From the School of Medicine (N.A.C.), Meharry Medical College; Department of Pediatrics (N.A.C., M.R.D.), Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consultants (M.R.), Chicago, IL; Program in Occupational Therapy and Department of Pediatrics Hematology/Oncology (A.A.K.) and Pediatric Radiology and Neuroradiology Sections (R.C.M.), Washington University School of Medicine, St. Louis, MO; and Department of Pediatrics and Medicine (J.J.S.), Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allison A King
- From the School of Medicine (N.A.C.), Meharry Medical College; Department of Pediatrics (N.A.C., M.R.D.), Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consultants (M.R.), Chicago, IL; Program in Occupational Therapy and Department of Pediatrics Hematology/Oncology (A.A.K.) and Pediatric Radiology and Neuroradiology Sections (R.C.M.), Washington University School of Medicine, St. Louis, MO; and Department of Pediatrics and Medicine (J.J.S.), Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John J Strouse
- From the School of Medicine (N.A.C.), Meharry Medical College; Department of Pediatrics (N.A.C., M.R.D.), Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consultants (M.R.), Chicago, IL; Program in Occupational Therapy and Department of Pediatrics Hematology/Oncology (A.A.K.) and Pediatric Radiology and Neuroradiology Sections (R.C.M.), Washington University School of Medicine, St. Louis, MO; and Department of Pediatrics and Medicine (J.J.S.), Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert C McKinstry
- From the School of Medicine (N.A.C.), Meharry Medical College; Department of Pediatrics (N.A.C., M.R.D.), Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN; Rodeghier Consultants (M.R.), Chicago, IL; Program in Occupational Therapy and Department of Pediatrics Hematology/Oncology (A.A.K.) and Pediatric Radiology and Neuroradiology Sections (R.C.M.), Washington University School of Medicine, St. Louis, MO; and Department of Pediatrics and Medicine (J.J.S.), Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Intensity ratio to improve black hole assessment in multiple sclerosis. Mult Scler Relat Disord 2017; 19:140-147. [PMID: 29223871 DOI: 10.1016/j.msard.2017.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/03/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improved imaging methods are critical to assess neurodegeneration and remyelination in multiple sclerosis. Chronic hypointensities observed on T1-weighted brain MRI, "persistent black holes," reflect severe focal tissue damage. Present measures consist of determining persistent black holes numbers and volumes, but do not quantitate severity of individual lesions. OBJECTIVE Develop a method to differentiate black and gray holes and estimate the severity of individual multiple sclerosis lesions using standard magnetic resonance imaging. METHODS 38 multiple sclerosis patients contributed images. Intensities of lesions on T1-weighted scans were assessed relative to cerebrospinal fluid intensity using commercial software. Magnetization transfer imaging, diffusion tensor imaging and clinical testing were performed to assess associations with T1w intensity-based measures. RESULTS Intensity-based assessments of T1w hypointensities were reproducible and achieved > 90% concordance with expert rater determinations of "black" and "gray" holes. Intensity ratio values correlated with magnetization transfer ratios (R = 0.473) and diffusion tensor imaging metrics (R values ranging from 0.283 to -0.531) that have been associated with demyelination and axon loss. Intensity ratio values incorporated into T1w hypointensity volumes correlated with clinical measures of cognition. CONCLUSIONS This method of determining the degree of hypointensity within multiple sclerosis lesions can add information to conventional imaging.
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An Ultra-High Field Study of Cerebellar Pathology in Early Relapsing-Remitting Multiple Sclerosis Using MP2RAGE. Invest Radiol 2017; 52:265-273. [DOI: 10.1097/rli.0000000000000338] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thaler C, Faizy TD, Sedlacik J, Holst B, Stürner K, Heesen C, Stellmann JP, Fiehler J, Siemonsen S. T1 Recovery Is Predominantly Found in Black Holes and Is Associated with Clinical Improvement in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 38:264-269. [PMID: 28059711 DOI: 10.3174/ajnr.a5004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/08/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Quantitative MR imaging parameters help to evaluate disease progression in multiple sclerosis and increase correlation with clinical disability. We therefore hypothesized that T1 values might be a marker for ongoing tissue damage or even remyelination and may help increase clinical correlation. MATERIALS AND METHODS MR imaging was performed in 17 patients with relapsing-remitting MS at baseline and after 12 months of starting immunotherapy with dimethyl fumarate. On baseline images, lesion segmentation was performed for normal-appearing white matter, T2 hyperintense (FLAIR lesions), T1 hypointense (black holes), and contrast-enhancing lesions, and T1 relaxation times were obtained at baseline and after 12 months. Changes in clinical status were assessed by using the Expanded Disability Status Scale and Symbol Digit Modalities Test at both dates (Expanded Disability Status Scale-difference/Symbol Digit Modalities Test-diff). RESULTS The highest T1 relaxation time at baseline was measured in black holes (1460.2 ± 209.46 ms) followed by FLAIR lesions (1400.38 ± 189.1 ms), pure FLAIR lesions (1327.5 ± 210.04 ms), contrast-enhancing lesions (1205.59 ± 199.95 ms), and normal-appearing white matter (851.34 ± 30.61 ms). After 12 months, T1 values had decreased significantly in black holes (1369.4 ± 267.81 ms), contrast-enhancing lesions (1079.57 ± 183.36 ms) (both P < .001), and normal-appearing white matter (841.98 ± 36.1 ms, P = .006). With the Jonckheere-Terpstra Test, better clinical scores were associated with decreasing T1 relaxation times in black holes (P < .05). CONCLUSIONS T1 relaxation time is a useful quantitative MR imaging technique, which helps detect changes in MS lesions with time. We assume that these changes are associated with the degree of myelination within the lesions themselves and are pronounced in black holes. Additionally, decreasing T1 values in black holes were associated with clinical improvement.
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Affiliation(s)
- C Thaler
- From the Departments of Diagnostic and Interventional Neuroradiology (C.T., T.D.F., J.S., B.H., J.F., S.S.)
| | - T D Faizy
- From the Departments of Diagnostic and Interventional Neuroradiology (C.T., T.D.F., J.S., B.H., J.F., S.S.)
| | - J Sedlacik
- From the Departments of Diagnostic and Interventional Neuroradiology (C.T., T.D.F., J.S., B.H., J.F., S.S.)
| | - B Holst
- From the Departments of Diagnostic and Interventional Neuroradiology (C.T., T.D.F., J.S., B.H., J.F., S.S.)
| | - K Stürner
- Neurology (K.S., C.H., J.-P.S.).,Institute for Neuroimmunology and Clinical MS Research (K.S., C.H., J.-P.S., S.S.), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Heesen
- Neurology (K.S., C.H., J.-P.S.).,Institute for Neuroimmunology and Clinical MS Research (K.S., C.H., J.-P.S., S.S.), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - J-P Stellmann
- Neurology (K.S., C.H., J.-P.S.).,Institute for Neuroimmunology and Clinical MS Research (K.S., C.H., J.-P.S., S.S.), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - J Fiehler
- From the Departments of Diagnostic and Interventional Neuroradiology (C.T., T.D.F., J.S., B.H., J.F., S.S.)
| | - S Siemonsen
- From the Departments of Diagnostic and Interventional Neuroradiology (C.T., T.D.F., J.S., B.H., J.F., S.S.).,Institute for Neuroimmunology and Clinical MS Research (K.S., C.H., J.-P.S., S.S.), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Thaler C, Faizy T, Sedlacik J, Holst B, Stellmann JP, Young KL, Heesen C, Fiehler J, Siemonsen S. T1- Thresholds in Black Holes Increase Clinical-Radiological Correlation in Multiple Sclerosis Patients. PLoS One 2015; 10:e0144693. [PMID: 26659852 PMCID: PMC4676682 DOI: 10.1371/journal.pone.0144693] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/23/2015] [Indexed: 12/05/2022] Open
Abstract
Background Magnetic Resonance Imaging (MRI) is an established tool in diagnosing and evaluating disease activity in Multiple Sclerosis (MS). While clinical-radiological correlations are limited in general, hypointense T1 lesions (also known as Black Holes (BH)) have shown some promising results. The definition of BHs is very heterogeneous and depends on subjective visual evaluation. Objective We aimed to improve clinical-radiological correlations by defining BHs using T1 relaxation time (T1-RT) thresholds to achieve best possible correlation between BH lesion volume and clinical disability. Method 40 patients with mainly relapsing-remitting MS underwent MRI including 3-dimensional fluid attenuated inversion recovery (FLAIR), magnetization-prepared rapid gradient echo (MPRAGE) before and after Gadolinium (GD) injection and double inversion-contrast magnetization-prepared rapid gradient echo (MP2RAGE) sequences. BHs (BHvis) were marked by two raters on native T1-weighted (T1w)-MPRAGE, contrast-enhancing lesions (CE lesions) on T1w-MPRAGE after GD and FLAIR lesions (total-FLAIR lesions) were detected separately. BHvis and total-FLAIR lesion maps were registered to MP2RAGE images, and the mean T1-RT were calculated for all lesion ROIs. Mean T1 values of the cortex (CTX) were calculated for each patient. Subsequently, Spearman rank correlations between clinical scores (Expanded Disability Status Scale and Multiple Sclerosis Functional Composite) and lesion volume were determined for different T1-RT thresholds. Results Significant differences in T1-RT were obtained between all different lesion types with highest T1 values in visually marked BHs (BHvis: 1453.3±213.4 ms, total-FLAIR lesions: 1394.33±187.38 ms, CTX: 1305.6±35.8 ms; p<0.05). Significant correlations between BHvis/total-FLAIR lesion volume and clinical disability were obtained for a wide range of T1-RT thresholds. The highest correlation for BHvis and total-FLAIR lesion masks were found at T1-RT>1500 ms (Expanded Disability Status Scale vs. lesion volume: rBHvis = 0.442 and rtotal-FLAIR = 0.497, p<0.05; Multiple Sclerosis Functional Composite vs. lesion volume: rBHvis = -0.53 and rtotal-FLAIR = -0.627, p<0.05). Conclusion Clinical-radiological correlations in MS patients are increased by application of T1-RT thresholds. With the short acquisition time of the MP2RAGE sequences, quantitative T1 maps could be easily established in clinical studies.
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Affiliation(s)
- Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Tobias Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Brigitte Holst
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Kim Lea Young
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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