1
|
Dostál M, Keřkovský M, Stulík J, Bednařík J, Praksová P, Hulová M, Benešová Y, Koriťáková E, Šprláková-Puková A, Mechl M. MR Diffusion Properties of Cervical Spinal Cord as a Predictor of Progression to Multiple Sclerosis in Patients with Clinically Isolated Syndrome. J Neuroimaging 2020; 31:108-114. [PMID: 33253445 DOI: 10.1111/jon.12808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE This study's aim was to investigate diffusion properties of the cervical spinal cord in patients with clinically isolated syndrome (CIS) through analysis of diffusion tensor imaging (DTI) data and thereby to assess the capacity of this technique for predicting the progression of CIS to clinically definite multiple sclerosis (CDMS). METHODS The study groups were comprised of 47 patients with CIS (15 of them with progression to CDMS within 2 years of follow-up) and 57 asymptomatic controls. All patients and controls had undergone magnetic resonance imaging (MRI) of the cervical spine including DTI and brain MRI. Methodological approaches included histogram analysis of the cervical cord's diffusion parameters and evaluation of T2 hyperintense lesions of the spinal cord and brain. All parameters were compared between the study groups. Sensitivity and specificity calculations were then performed with a view to predicting conversion to CDMS. RESULTS The patient subgroups defined by progression to CDMS differed significantly in values of fractional anisotropy (FA) kurtosis measured within white matter (WM) and normal-appearing WM (NAWM). The same parameters also differed significantly when patients with progression to CDMS were compared to healthy controls. Receiver operating characteristic (ROC) analysis revealed sensitivity and specificity of FA kurtosis of WM and NAWM of 93% and 72%, respectively, in terms of predicting CIS to CDMS progression. CONCLUSION This study presents evidence that histogram analysis of diffusion parameters of the cervical spinal cord in patients with CIS may be helpful in predicting conversion to CDMS.
Collapse
Affiliation(s)
- Marek Dostál
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Jakub Stulík
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Josef Bednařík
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Petra Praksová
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Monika Hulová
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Yvonne Benešová
- Department of Neurology, University Hospital Brno and Masaryk University, Czech Republic
| | - Eva Koriťáková
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Andrea Šprláková-Puková
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Marek Mechl
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| |
Collapse
|
2
|
Stock B, Shrestha M, Seiler A, Foerch C, Hattingen E, Steinmetz H, Deichmann R, Wagner M, Gracien RM. Distribution of Cortical Diffusion Tensor Imaging Changes in Multiple Sclerosis. Front Physiol 2020; 11:116. [PMID: 32231581 PMCID: PMC7083109 DOI: 10.3389/fphys.2020.00116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Diffuse cortical damage in relapsing–remitting multiple sclerosis (RRMS) is clinically relevant but cannot be directly assessed with conventional MRI. In this study, it was aimed to use diffusion tensor imaging (DTI) techniques with optimized intrinsic eddy current compensation to quantify and characterize cortical mean diffusivity (MD) and fractional anisotropy (FA) changes in RRMS and to analyze the distribution of these changes across the cortex. Materials and Methods Three-Tesla MRI acquisition, mapping of the MD providing information about the integrity of microstructural barriers and of the FA reflecting axonal density and surface-based analysis with Freesurfer were performed for 24 RRMS patients and 25 control subjects. Results Across the whole cortex, MD was increased in patients (p < 0.001), while surface-based analysis revealed focal cortical FA decreases. MD and FA changes were distributed inhomogeneously across the cortex, the MD increase being more widespread than the FA decrease. Cortical MD correlated with the Expanded Disability Status Scale (EDSS, r = 0.38, p = 0.03). Conclusion Damage of microstructural barriers occurs inhomogeneously across the cortex in RRMS and might be spatially more widespread than axonal degeneration. The results and, in particular, the correlation with the clinical status indicate that DTI might be a promising technique for the monitoring of cortical damage under treatment in larger clinical studies.
Collapse
Affiliation(s)
- Benjamin Stock
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Department of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Manoj Shrestha
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Alexander Seiler
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Christian Foerch
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany.,Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| |
Collapse
|
3
|
Lapucci C, Romano N, Schiavi S, Saitta L, Uccelli A, Boffa G, Pardini M, Signori A, Castellan L, Inglese M, Roccatagliata L. Degree of microstructural changes within T1-SE versus T1-GE hypointense lesions in multiple sclerosis: relevance for the definition of "black holes". Eur Radiol 2020; 30:3843-3851. [PMID: 32162002 DOI: 10.1007/s00330-020-06761-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/08/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To retrospectively evaluate the different performances of T1-SE and T1-GE sequences in detecting hypointense lesions in multiple sclerosis (MS), to quantify the degree of microstructural damage within lesions and to correlate them with patient clinical status. METHODS Sixty clinically isolated syndrome (CIS) and MS patients underwent brain magnetic resonance imaging (MRI) on 1.5-T and 3-T scanners. We identified T2 fluid-attenuated inversion recovery hyperintense lesions with no hypointense signal on T1-SE/T1-GE (a), hypointense lesions only on T1-GE (b), and hypointense lesions on both T1-SE and T1-GE sequences (c). We compared mean lesion number (LN) and volume (LV) identified on T1-SE and T1-GE sequences, correlating them with Expanded Disability Status Scale (EDSS); fractional anisotropy (FA) and mean diffusivity (MD) values inside each lesion type were extracted and normal-appearing white matter (NAWM). RESULTS Thirty-five patients were female. Mean age was 39.2 (± 7.8); median EDSS was 3 (± 2). There were 23 CIS, 21 relapsing-remitting (RR), and 16 progressive MS. T1-GE and T1-SE LN and LV were significantly different (p < 0.001), both correlating with EDSS. Both FA and MD metrics resulted significantly different among the three lesion groups and NAWM (p < 0.001). FA and MD values extracted from (b) and (c) showed statistically significant differences (p < 0.001), while for (a) and (b), the differences were not significant (p = 0.31 for FA and p = 0.62 for MD). CONCLUSION T1-SE hypointense lesions demonstrated a more pronounced degree of microstructural damage. T1-weighted sequence type must be more carefully evaluated in clinical and research settings. KEY POINTS • T1-weighted spin-echo (T1-SE) images detect chronic hypointense lesions (so called black holes) associated with more severe microstructural changes. • In the last years, three-dimensional (3D) T1-weighted gradient-echo (T1-GE) sequences are often utilized in lieu of T1-SE acquisition, more so at 3 T or higher fields. • T1-weighted sequence type must be more carefully evaluated in clinical and research settings in the definition of "black holes" in MS, in order to avoid the overestimation of the effective severe tissue damage.
Collapse
Affiliation(s)
- Caterina Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.
| | - Nicola Romano
- Department of Health Sciences (DISSAL) -Radiology Section, University of Genoa, Genoa, Italy
| | - Simona Schiavi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Department of Computer Science, University of Verona, Verona, Italy
| | - Laura Saitta
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Giacomo Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences (DISSAL) - Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Lucio Castellan
- Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Luca Roccatagliata
- Department of Health Sciences (DISSAL) -Radiology Section, University of Genoa, Genoa, Italy.,Department of Neuroradiology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| |
Collapse
|
4
|
Cassiano MT, Lanzillo R, Alfano B, Costabile T, Comerci M, Prinster A, Moccia M, Megna R, Morra VB, Quarantelli M, Brunetti A. Voxel-based analysis of gray matter relaxation rates shows different correlation patterns for cognitive impairment and physical disability in relapsing-remitting multiple sclerosis. NEUROIMAGE-CLINICAL 2020; 26:102201. [PMID: 32062567 PMCID: PMC7025083 DOI: 10.1016/j.nicl.2020.102201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/13/2020] [Accepted: 01/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regional analyses of markers of microstructural gray matter (GM) changes, including relaxation rates, have shown inconsistent correlations with physical and cognitive impairment in MS. OBJECTIVE To assess voxelwise the correlation of the R1 and R2 relaxation rates with the physical and cognitive impairment in MS. METHODS GM R1 and R2 relaxation rate maps were obtained in 241 relapsing-remitting MS patients by relaxometric segmentation of MRI studies. Correlations with the Expanded Disability Status Scale (EDSS) and the percentage of impaired cognitive test (Brief Repeatable Battery and Stroop Test, available in 186 patients) were assessed voxelwise, including voxel GM content as nuisance covariate to remove the effect of atrophy on the correlations. RESULTS Extensive clusters of inverse correlation between EDSS and R2 were detected throughout the brain, while inverse correlations with R1 were mostly limited to perirolandic and supramarginal cortices. Cognitive impairment correlated negatively with R1, and to a lesser extent with R2, in the middle frontal, mesial temporal, midcingulate and medial parieto-occipital cortices. CONCLUSION In relapsing-remitting MS patients, GM microstructural changes correlate diffusely with physical disability, independent of atrophy, with a preferential role of the sensorimotor cortices. Neuronal damage in the limbic system and dorsolateral prefrontal cortices correlates with cognitive dysfunction.
Collapse
Affiliation(s)
- Maria Teresa Cassiano
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| | - Roberta Lanzillo
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Bruno Alfano
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145 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
| | - Anna Prinster
- Biostructure and Bioimaging Institute, National Research Council, Via De Amicis, 95, 80145 Naples, Italy
| | - Marcello Moccia
- Department of Neurosciences, Reproductive Science and Odontostomatology, University "Federico II", Naples, Italy
| | - Rosario Megna
- 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.
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Via Pansini, 5, 80131 Naples, Italy
| |
Collapse
|
5
|
ElSayed MEKA, El-Toukhy MMB, Asaad RE, El-Serafy OA. Diffusion tensor imaging for assessment of normally appearing white matter of the brain and spinal cord in cases of multiple sclerosis: a multi-parametric correlation in view of patient’s clinical status. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0031-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
6
|
Abstract
Multiple sclerosis (MS) is a progressive neurodegenerative disease, affecting 1 million Americans and 2.5 million people globally. Although the diagnosis is made clinically, imaging plays a major role in diagnosing and monitoring disease progression and treatment response. Magnetic resonance imaging (MRI) has proven sensitive in imaging MS lesions, but the characterization offered by routine clinical MRI remains qualitative and with discrepancies between imaging and clinical findings. We investigated the ability of digital analysis of noncontrast head computed tomography (CT) images to detect global brain changes of MS. All routine diagnostic head CTs obtained on patients with known MS obtained from 1 of 2 scan platforms from 6/1/2011 to 6/1/2015 were reviewed. Head CT images from 54 patients with MS met inclusion criteria. Head CT images were processed and histogram metrics were compared to age- and gender- matched control subjects from the same CT scanners during the same time interval. Histogram metrics were correlated with plaque burden as seen on MRI studies. Compared with control subjects, patients had increased total brain radiodensity (P < .0001), further characterized as an increased histogram modal radiodensity (P < .0001) with decrease in histogram skewness (P < .0001). Radiodensity decreased with increasing plaque burden. Similar findings were seen in the patients with only mild plaque burden sub- group. Radiodensity is a unique tissue metric that is not measured by other imaging techniques. Our study finds that brain radiodensity histogram metrics highly correlate with MS, even in cases with minimal plaque burden.
Collapse
Affiliation(s)
- Keith A Cauley
- Department of Radiology, Geisinger Medical Center, Danville, PA; and
| | - Samuel W Fielden
- Department of Radiology, Geisinger Medical Center, Danville, PA; and.,Department of Imaging Science & Innovation, Geisinger Health System, Lewisburg, PA
| |
Collapse
|
7
|
Homos MD, Ali MT, Osman MF, Nabil DM. DTI metrics reflecting microstructural changes of normal appearing deep grey matter in multiple sclerosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
8
|
Lizak N, Clough M, Millist L, Kalincik T, White OB, Fielding J. Impairment of Smooth Pursuit as a Marker of Early Multiple Sclerosis. Front Neurol 2016; 7:206. [PMID: 27917151 PMCID: PMC5116770 DOI: 10.3389/fneur.2016.00206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/02/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a diffuse disease that disrupts wide-ranging cerebral networks. The control of saccades and smooth pursuit are similarly dependent upon widespread networks, with the assessment of pursuit offering an opportunity to examine feedback regulation. We sought to characterize pursuit deficits in MS and to examine their relationship with disease duration. METHODS Twenty healthy controls, 20 patients with a clinically isolated syndrome (CIS), and 40 patients with clinically definite MS (CDMS) participated. Thirty-six trials of Rashbass' step-ramp paradigm of smooth pursuit, evenly split by velocity (8.65°, 17.1°, and 25.9°/s) and ramp direction (left/right), were performed. Four parameters were measured: latency of pursuit onset, closed-loop pursuit gain, number of saccades, and summed saccade amplitudes during pursuit. For CDMS patients, these were correlated with disease duration and Expanded Disability Status Scale (EDSS) score. RESULTS Closed-loop pursuit gain was significantly lower in CIS than controls at all speeds. CDMS gain was lower than controls at medium pursuit velocity. CDMS patients also displayed longer pursuit latency than controls at all velocities. All patients accumulated increased summed saccade amplitudes at slow and medium pursuit speeds, and infrequent high-amplitude saccades at the fast speed. No pursuit variable significantly correlated with EDSS or disease duration in CDMS patients. CONCLUSION Smooth pursuit is significantly compromised in MS from onset. Low pursuit gain and increased saccadic amplitudes may be robust markers of disseminated pathology in CIS and in more advanced MS. Pursuit may be useful in measuring early disease.
Collapse
Affiliation(s)
- Nathaniel Lizak
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Monash School of Medicine, Monash University, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Meaghan Clough
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia
| | - Lynette Millist
- Department of Neurology, Royal Melbourne Hospital , Melbourne, VIC , Australia
| | - Tomas Kalincik
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Owen B White
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Joanne Fielding
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia; School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, VIC, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| |
Collapse
|
9
|
Shu N, Duan Y, Xia M, Schoonheim MM, Huang J, Ren Z, Sun Z, Ye J, Dong H, Shi FD, Barkhof F, Li K, Liu Y. Disrupted topological organization of structural and functional brain connectomes in clinically isolated syndrome and multiple sclerosis. Sci Rep 2016; 6:29383. [PMID: 27403924 PMCID: PMC4941534 DOI: 10.1038/srep29383] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/17/2016] [Indexed: 12/30/2022] Open
Abstract
The brain connectome of multiple sclerosis (MS) has been investigated by several previous studies; however, it is still unknown how the network changes in clinically isolated syndrome (CIS), the earliest stage of MS, and how network alterations on a functional level relate to the structural level in MS disease. Here, we investigated the topological alterations of both the structural and functional connectomes in 41 CIS and 32 MS patients, compared to 35 healthy controls, by combining diffusion tensor imaging and resting-state functional MRI with graph analysis approaches. We found that the structural connectome showed a deviation from the optimal pattern as early as the CIS stage, while the functional connectome only showed local changes in MS patients, not in CIS. When comparing two patient groups, the changes appear more severe in MS. Importantly, the disruptions of structural and functional connectomes in patients occurred in the same direction and locally correlated in sensorimotor component. Finally, the extent of structural network changes was correlated with several clinical variables in MS patients. Together, the results suggested early disruption of the structural brain connectome in CIS patients and provided a new perspective for investigating the relationship of the structural and functional alterations in MS.
Collapse
Affiliation(s)
- Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, P. R. China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, P. R. China
| | - Yunyun Duan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - Mingrui Xia
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, P. R. China.,Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, P. R. China
| | - Menno M Schoonheim
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam 1007 MB, The Netherlands.,Department of Anatomy and Neuroscience, VU University Medical Center, Amsterdam 1007 MB, The Netherlands
| | - Jing Huang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - Zhuoqiong Ren
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - Zheng Sun
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - Fu-Dong Shi
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, P. R. China
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam 1007 MB, The Netherlands
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China
| | - Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China.,Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam 1007 MB, The Netherlands.,Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, P. R. China
| |
Collapse
|
10
|
Durhan G, Diker S, Has AC, Karakaya J, Tuncer Kurne A, Oguz KK. Influence of cigarette smoking on white matter in patients with clinically isolated syndrome as detected by diffusion tensor imaging. Diagn Interv Radiol 2016; 22:291-6. [PMID: 27015443 DOI: 10.5152/dir.2015.15415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Cigarette smoking has been associated with increased occurrence of multiple sclerosis (MS), as well as clinical disability and disease progression in MS. We aimed to assess the effects of smoking on the white matter (WM) in patients with clinically isolated syndrome (CIS) using diffusion tensor imaging. METHODS Smoker patients with CIS (n=16), smoker healthy controls (n=13), nonsmoker patients with CIS (n=17) and nonsmoker healthy controls (n=14) were included. Thirteen regions-of-interest including nonenhancing T1 hypointense lesion and perilesional WM, and 11 normal-appearing white matter (NAWM) regions were drawn on color-coded fractional anisotropy (FA) maps. Lesion load was determined in terms of number and volume of WM hyperintensities. RESULTS A tendency towards greater lesion load was found in smoker patients. T1 hypointense lesions and perilesional WM had reduced FA and increased mean diffusivity to a similar degree in smoker and nonsmoker CIS patients. Compared with healthy smokers, smoker CIS patients had more extensive NAWM changes shown by increased mean diffusivity. There was no relationship between diffusion metrics and clinical disability scores, duration of the disease and degree of smoking exposure. CONCLUSION Smoker patients showed a tendency towards having greater number of WM lesions and displayed significantly more extensive NAWM abnormalities.
Collapse
Affiliation(s)
- Gamze Durhan
- Department of Radiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
11
|
Al-Radaideh A, Mougin OE, Lim SY, Chou IJ, Constantinescu CS, Gowland P. Histogram analysis of quantitative T1 and MT maps from ultrahigh field MRI in clinically isolated syndrome and relapsing-remitting multiple sclerosis. NMR IN BIOMEDICINE 2015; 28:1374-1382. [PMID: 26346925 DOI: 10.1002/nbm.3385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/19/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
This study used quantitative MRI to study normal appearing white matter (NAWM) in patients with clinically isolated syndromes suggestive of multiple sclerosis and relapsing-remitting multiple sclerosis (RRMS). This was done at ultrahigh field (7 T) for greater spatial resolution and sensitivity. 17 CIS patients, 11 RRMS patients, and 20 age-matched healthy controls were recruited. They were scanned using a 3D inversion recovery turbo field echo sequence to measure the longitudinal relaxation time (T1). A 3D magnetization transfer prepared turbo field echo (MT-TFE) sequence was also acquired, first without a presaturation pulse and then with the MT presaturation pulse applied at -1.05 kHz and +1.05 kHz off resonance from water to produce two magnetization transfer ratio maps (MTR(-) and MTR(+)). Histogram analysis was performed on the signal from the voxels in the NAWM mask. The upper quartile cut-off of the T1 histogram was significantly higher in RRMS patients than in controls (p < 0.05), but there was no difference in CIS. In contrast, MTR was significantly different between CIS or RRMS patients and controls (p < 0.05) for most histogram measures considered. The difference between MTR(+) and MTR(-) signals showed that NOE contributions dominated the changes found. There was a weak negative correlation (r = -0.46, p < 0.05) between the mode of T1 distributions and healthy controls' age; this was not significant for MTR(+) (r = -0.34, p > 0.05) or MTR(-) (r = 0.13, p > 0.05). There was no significant correlation between the median of T1, MTR(-), or MTR(+) and the age of healthy controls. Furthermore, no significant correlation was observed between EDSS or disease duration and T1, MTR(-), or MTR(+) for either CIS or RRMS patients. In conclusion, MTR was found to be more sensitive to early changes in MS disease than T1.
Collapse
Affiliation(s)
- Ali Al-Radaideh
- Medical Imaging, The Hashemite University, Zarqa, Jordan
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Olivier E Mougin
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Su-Yin Lim
- Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - I-Jun Chou
- Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Paediatric Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Penny Gowland
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| |
Collapse
|
12
|
Callosal anatomical and effective connectivity between primary motor cortices predicts visually cued bimanual temporal coordination performance. Brain Struct Funct 2015; 221:3427-43. [DOI: 10.1007/s00429-015-1110-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/09/2015] [Indexed: 12/18/2022]
|
13
|
Ocular motor measures of cognitive dysfunction in multiple sclerosis I: inhibitory control. J Neurol 2015; 262:1130-7. [PMID: 25851743 DOI: 10.1007/s00415-015-7645-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/10/2015] [Accepted: 01/11/2015] [Indexed: 10/23/2022]
Abstract
Our ability to control and inhibit behaviours that are inappropriate, unsafe, or no longer required is crucial for functioning successfully in complex environments. Here, we investigated whether a series of ocular motor (OM) inhibition tasks could dissociate deficits in patients with multiple sclerosis (MS), including patients with only a probable diagnosis (clinically isolated syndrome: CIS), from healthy individuals as well as a function of increasing disease duration. 25 patients with CIS, 25 early clinically definite MS patients (CDMS: ≤7 years of diagnosis), 24 late CDMS patients (>7 years from diagnosis), and 25 healthy controls participated. All participants completed a series of classic OM inhibition tasks [antisaccade (AS) task, memory-guided (MG) task, endogenous cue task], and a neuropsychological inhibition task [paced auditory serial addition test (PASAT)]. Clinical disability was characterised in CDMS patients using the Expanded Disability Severity Scale (EDSS). OM (latency and error) and PASAT performance were compared between patient groups and controls, as well as a function of disease duration. For CDMS patients only, results were correlated with EDSS score. All patient groups made more errors than controls on all OM tasks; error rate did not increase with increasing disease duration. In contrast, saccade latency (MG and endogenous cue tasks) was found to worsen with increasing disease duration. PASAT performance did not discriminate patient groups or disease duration. The EDSS did not correlate with any measure. These OM measures appear to dissociate deficit between patients at different disease durations. This suggests their utility as a measure of progression from the earliest inception of the disease.
Collapse
|
14
|
Bonnier G, Roche A, Romascano D, Simioni S, Meskaldji D, Rotzinger D, Lin YC, Menegaz G, Schluep M, Du Pasquier R, Sumpf TJ, Frahm J, Thiran JP, Krueger G, Granziera C. Advanced MRI unravels the nature of tissue alterations in early multiple sclerosis. Ann Clin Transl Neurol 2014; 1:423-32. [PMID: 25356412 PMCID: PMC4184670 DOI: 10.1002/acn3.68] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/27/2014] [Accepted: 04/28/2014] [Indexed: 01/16/2023] Open
Abstract
Introduction In patients with multiple sclerosis (MS), conventional magnetic resonance imaging (MRI) provides only limited insights into the nature of brain damage with modest clinic-radiological correlation. In this study, we applied recent advances in MRI techniques to study brain microstructural alterations in early relapsing-remitting MS (RRMS) patients with minor deficits. Further, we investigated the potential use of advanced MRI to predict functional performances in these patients. Methods Brain relaxometry (T1, T2, T2*) and magnetization transfer MRI were performed at 3T in 36 RRMS patients and 18 healthy controls (HC). Multicontrast analysis was used to assess for microstructural alterations in normal-appearing (NA) tissue and lesions. A generalized linear model was computed to predict clinical performance in patients using multicontrast MRI data, conventional MRI measures as well as demographic and behavioral data as covariates. Results Quantitative T2 and T2* relaxometry were significantly increased in temporal normal-appearing white matter (NAWM) of patients compared to HC, indicating subtle microedema (P = 0.03 and 0.004). Furthermore, significant T1 and magnetization transfer ratio (MTR) variations in lesions (mean T1 z-score: 4.42 and mean MTR z-score: −4.09) suggested substantial tissue loss. Combinations of multicontrast and conventional MRI data significantly predicted cognitive fatigue (P = 0.01, Adj-R2 = 0.4), attention (P = 0.0005, Adj-R2 = 0.6), and disability (P = 0.03, Adj-R2 = 0.4). Conclusion Advanced MRI techniques at 3T, unraveled the nature of brain tissue damage in early MS and substantially improved clinical–radiological correlations in patients with minor deficits, as compared to conventional measures of disease.
Collapse
Affiliation(s)
- Guillaume Bonnier
- Advanced Clinical Imaging Technology group, Siemens Healthcare IM BM PI Lausanne, Switzerland ; Neuro-immunology and Laboratoire de recherché en neuroimagérie, Neurology Division, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland ; LTS5, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Alexis Roche
- Advanced Clinical Imaging Technology group, Siemens Healthcare IM BM PI Lausanne, Switzerland ; LTS5, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland ; Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland
| | - David Romascano
- Advanced Clinical Imaging Technology group, Siemens Healthcare IM BM PI Lausanne, Switzerland ; LTS5, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - Samanta Simioni
- Neuro-immunology and Laboratoire de recherché en neuroimagérie, Neurology Division, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland
| | - Djalel Meskaldji
- LTS5, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| | - David Rotzinger
- Department of Radiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland
| | - Ying-Chia Lin
- Department of Computer Science, University of Verona Verona, Italy
| | - Gloria Menegaz
- Department of Computer Science, University of Verona Verona, Italy
| | - Myriam Schluep
- Neuro-immunology and Laboratoire de recherché en neuroimagérie, Neurology Division, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland
| | - Renaud Du Pasquier
- Neuro-immunology and Laboratoire de recherché en neuroimagérie, Neurology Division, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland
| | - Tilman Johannes Sumpf
- Biomedizinische NMR Forschungs GmbH, Max Planck Institute for Biophysical Chemistry Goettingen, Germany
| | - Jens Frahm
- Biomedizinische NMR Forschungs GmbH, Max Planck Institute for Biophysical Chemistry Goettingen, Germany
| | | | - Gunnar Krueger
- Advanced Clinical Imaging Technology group, Siemens Healthcare IM BM PI Lausanne, Switzerland ; Healthcare Sector IM&WS S, Siemens Schweiz AG Renens, Switzerland
| | - Cristina Granziera
- Advanced Clinical Imaging Technology group, Siemens Healthcare IM BM PI Lausanne, Switzerland ; Neuro-immunology and Laboratoire de recherché en neuroimagérie, Neurology Division, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and University of Lausanne Lausanne, Switzerland ; LTS5, Ecole Polytechnique Fédérale de Lausanne Lausanne, Switzerland
| |
Collapse
|
15
|
Odenthal C, Coulthard A. The prognostic utility of MRI in clinically isolated syndrome: a literature review. AJNR Am J Neuroradiol 2014; 36:425-31. [PMID: 24831592 DOI: 10.3174/ajnr.a3954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
For patients presenting with clinically isolated syndrome, the treating clinician needs to advise the patient on the probability of conversion to clinically definite multiple sclerosis. MR imaging may give useful prognostic information, and there is large body of literature pertaining to the use of MR imaging in assessing patients presenting with clinically isolated syndrome. This literature review evaluates the accuracy of MR imaging in predicting which patients with clinically isolated syndrome will go on to develop long-term disease and/or disability. New and emerging MR imaging technologies and their applicability to patients with clinically isolated syndrome are also considered.
Collapse
Affiliation(s)
- C Odenthal
- From the School of Medicine (C.O.), University of Queensland, Brisbane, Queensland, Australia
| | - A Coulthard
- Department of Medical Imaging (A.C.), Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
Van Schependom J, Gielen J, Laton J, D'hooghe MB, De Keyser J, Nagels G. Graph theoretical analysis indicates cognitive impairment in MS stems from neural disconnection. Neuroimage Clin 2014; 4:403-10. [PMID: 24567912 PMCID: PMC3930112 DOI: 10.1016/j.nicl.2014.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/14/2014] [Accepted: 01/22/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND The mechanisms underlying cognitive impairment in MS are still poorly understood. However, due to the specific pathology of MS, one can expect alterations in connectivity leading to physical and cognitive impairment. AIM In this study we aimed at assessing connectivity differences in EEG between cognitively impaired (CI) and cognitively preserved (CP) MS patients. We also investigated the influence of the measures used to construct networks. METHODS We included 308 MS patients and divided them into two groups based on their cognitive score. Graph theoretical network analyses were conducted based on networks constructed using different connectivity measures, i.e. correlation, correlation in the frequency domain, coherence, partial correlation, the phase lag index and the imaginary part of coherency. The most commonly encountered network parameters were calculated and compared between the two groups using Wilcoxon's rank test. Clustering coefficients and path lengths were normalized to a randomized mean clustering coefficient and path length for each patient. False discovery rate was used to correct for the multiple comparisons and Cohen's d effect sizes are reported. RESULTS Coherence analysis suggests that theta and delta connectivity is significantly smaller in cognitively impaired patients. Small-worldness differences are found in networks based on correlation, theta and delta coherence and correlation in the frequency domain. Modularity was related to age but not to cognition. CONCLUSION Cognitive deterioration in MS is a symptom that seems to be caused by neural disconnections, probably the white matter tracts connecting both hemispheres, and leads to a wide range in network differences which can be assessed by applying GTA to EEG data. In the future, these results may lead to cheaper and more objective assessments of cognitive impairment in MS.
Collapse
Affiliation(s)
- Jeroen Van Schependom
- UZ Brussel, Vrije Universiteit Brussel, Center for Neurosciences, Laarbeeklaan 101, 1090 Brussels, Belgium
- Faculté de Psychologie et des Sciences de l'Education, Place du parc 20, 7000 Mons, Belgium
| | - Jeroen Gielen
- UZ Brussel, Vrije Universiteit Brussel, Center for Neurosciences, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jorne Laton
- UZ Brussel, Vrije Universiteit Brussel, Center for Neurosciences, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Marie B. D'hooghe
- UZ Brussel, Vrije Universiteit Brussel, Center for Neurosciences, Laarbeeklaan 101, 1090 Brussels, Belgium
- National MS Center Melsbroek, Vanheylenstraat 16, 1820 Melsbroek, Belgium
| | - Jacques De Keyser
- National MS Center Melsbroek, Vanheylenstraat 16, 1820 Melsbroek, Belgium
| | - Guy Nagels
- UZ Brussel, Vrije Universiteit Brussel, Center for Neurosciences, Laarbeeklaan 101, 1090 Brussels, Belgium
- National MS Center Melsbroek, Vanheylenstraat 16, 1820 Melsbroek, Belgium
- Faculté de Psychologie et des Sciences de l'Education, Place du parc 20, 7000 Mons, Belgium
| |
Collapse
|
17
|
Diffusion Tensor Imaging in NAWM and NADGM in MS and CIS: Association with Candidate Biomarkers in Sera. Mult Scler Int 2013; 2013:265259. [PMID: 24455265 PMCID: PMC3877634 DOI: 10.1155/2013/265259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 10/09/2013] [Accepted: 10/09/2013] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to evaluate diffusion tensor imaging (DTI) indices in the corpus callosum and pyramidal tract in normal-appearing white matter (NAWM) and the caudate nucleus and thalamus in deep grey matter (NADGM) in all MS subtypes and clinically isolated syndrome (CIS). Furthermore, it was determined whether these metrics are associated with clinical measures and the serum levels of candidate immune biomarkers. Apparent diffusion coefficients (ADC) values were significantly higher than in controls in all six studied NAWM regions in SPMS, 4/6 regions in RRMS and PPMS and 2/6 regions in CIS. In contrast, decreased fractional anisotropy (FA) values in comparison to controls were detected in 2/6 NAWM regions in SPMS and 1/6 in RRMS and PPMS. In RRMS, the level of neurological disability correlated with thalamic FA values (r = 0.479, P = 0.004). In chronic progressive subtypes and CIS, ADC values of NAWM and NADGM were associated with the levels of MIF, sFas, and sTNF-α. Our data indicate that DTI may be useful in detecting pathological changes in NAWM and NADGM in MS patients and that these changes are related to neurological disability.
Collapse
|
18
|
DTI Measurements in Multiple Sclerosis: Evaluation of Brain Damage and Clinical Implications. Mult Scler Int 2013; 2013:671730. [PMID: 23606965 PMCID: PMC3628664 DOI: 10.1155/2013/671730] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/20/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Diffusion tensor imaging (DTI) is an effective means of quantifying parameters of demyelination and axonal loss. The application of DTI in Multiple Sclerosis (MS) has yielded noteworthy results. DTI abnormalities, which are already detectable in patients with clinically isolated syndrome (CIS), become more pronounced as disease duration and neurological impairment increase. The assessment of the microstructural alterations of white and grey matter in MS may shed light on mechanisms responsible for irreversible disability accumulation. In this paper, we examine the DTI analysis methods, the results obtained in the various tissues of the central nervous system, and correlations with clinical features and other MRI parameters. The adoption of DTI metrics to assess the outcome of prognostic measures may represent an extremely important step forward in the MS research field.
Collapse
|
19
|
Muhlert N, Sethi V, Schneider T, Daga P, Cipolotti L, Haroon HA, Parker GJ, Ourselin S, Wheeler-Kingshott CA, Miller DH, Ron MA, Chard DT. Diffusion MRI-based cortical complexity alterations associated with executive function in multiple sclerosis. J Magn Reson Imaging 2012; 38:54-63. [DOI: 10.1002/jmri.23970] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/02/2012] [Indexed: 01/02/2023] Open
Affiliation(s)
- Nils Muhlert
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Varun Sethi
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Torben Schneider
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Pankaj Daga
- UCL Centre for Medical Image Computing; London; UK
| | - Lisa Cipolotti
- Neuropsychology department; National Hospital for Neurology and Neurosurgery; London; UK
| | - Hamied A. Haroon
- Biomedical Imaging Institute; University of Manchester; Manchester; UK
| | - Geoff J.M. Parker
- Biomedical Imaging Institute; University of Manchester; Manchester; UK
| | | | | | - David H. Miller
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Maria A. Ron
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| | - Declan T. Chard
- NMR Unit; Department of Neuroinflammation; UCL Institute of Neurology; London; UK
| |
Collapse
|
20
|
Vishwas MS, Healy BC, Pienaar R, Gorman MP, Grant PE, Chitnis T. Diffusion tensor analysis of pediatric multiple sclerosis and clinically isolated syndromes. AJNR Am J Neuroradiol 2012; 34:417-23. [PMID: 22859275 DOI: 10.3174/ajnr.a3216] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DTI has shown focal and diffuse white matter abnormalities in adults and children with MS. Here we explore whether DTI abnormalities are present at the time of a first attack or CIS in children and whether early DTI features can predict the development of MS. MATERIALS AND METHODS We assessed region-of-interest and tract-based mean ADC and mean FA values for 3 major white matter pathways and NAWM in 20 children with MS, 27 children with forms of CIS, and controls. Tracts were selected by using standard region-of-interest placements on color FA maps. Identical ROIs were placed in the NAWM on b = 0 T2-weighted images to ensure that both ROIs and resulting tracts passed through NAWM. Conventional MR imaging characteristics were assessed by visual inspection. Statistical analysis compared FA and ADC values between groups by a t test. Logistic regression assessed the predictive value of DTI measures and published conventional MR imaging measures for conversion from CIS to MS. RESULTS In pediatric patients with MS, all white matter pathways and analysis confined to the NAWM demonstrated higher mean ADC values and lower mean FA than in controls. In contrast, there were no significant differences in mean ADC and mean FA of white matter pathways in all CIS cohorts compared with controls. In the CIS cohort, none of the DTI measures in white matter pathways or in NAWM were significantly associated with conversion to RRMS in univariate or multivariate models (P > .05 in all models). CONCLUSIONS There are significant anisotropic abnormalities in the NAWM of major tracts in children with MS. In contrast, there were no significant changes in pediatric patients with CIS compared with controls at baseline. DTI measures did not predict conversion to MS. The period between CIS and conversion to pediatric MS may represent a window of opportunity for the prevention of diffuse damage in the CNS and potentially progressive disability.
Collapse
Affiliation(s)
- M S Vishwas
- Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital for Children, Boston, Massachusetts 02114, USA
| | | | | | | | | | | |
Collapse
|
21
|
McFarland HF. Examination of the role of magnetic resonance imaging in multiple sclerosis: A problem-orientated approach. Ann Indian Acad Neurol 2011; 12:254-63. [PMID: 20182573 PMCID: PMC2824953 DOI: 10.4103/0972-2327.58284] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/20/2009] [Indexed: 01/09/2023] Open
Abstract
Magnetic Resonance Imaging (MRI) has brought in several benefits to the study of Multiple Sclerosis (MS). It provides accurate measurement of disease activity, facilitates precise diagnosis, and aid in the assessment of newer therapies. The imaging guidelines for MS are broadly divided in to approaches for imaging patients with suspected MS or clinically isolated syndromes (CIS) or for monitoring patients with established MS. In this review, the technical aspects of MR imaging for MS are briefly discussed. The imaging process need to capture the twin aspects of acute MS viz. the autoimmune acute inflammatory process and the neurodegenerative process. Gadolinium enhanced MRI can identify acute inflammatory lesions precisely. The commonly applied MRI marker of disease progression is brain atrophy. Whole brain magnetization Transfer Ratio (MTR) and Magnetic Resonance Spectroscopy (MRS) are two other techniques use to monitor disease progression. A variety of imaging techniques such as Double Inversion Recovery (DIR), Spoiled Gradient Recalled (SPGR) acquisition, and Fluid Attenuated Inversion Recovery (FLAIR) have been utilized to study the cortical changes in MS. MRI is now extensively used in the Phase I, II and III clinical trials of new therapies. As the technical aspects of MRI advance rapidly, and higher field strengths become available, it is hoped that the impact of MRI on our understanding of MS will be even more profound in the next decade.
Collapse
|
22
|
When to initiate disease-modifying drugs for relapsing remitting multiple sclerosis in adults? Mult Scler Int 2011; 2011:724871. [PMID: 22096641 PMCID: PMC3195775 DOI: 10.1155/2011/724871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 02/27/2011] [Indexed: 12/23/2022] Open
Abstract
For patients with Relapsing Remitting Multiple Scierosis Beta Interfaerons and Glatiramer Acetate were the first to be licensed for treatment. This review deals with one major question: when to initiate therapy? Through exploring the unique characteristics of the disease and treatement we suggest an approach that should be helpful in the process of decision-making.
Collapse
|
23
|
Shu N, Liu Y, Li K, Duan Y, Wang J, Yu C, Dong H, Ye J, He Y. Diffusion tensor tractography reveals disrupted topological efficiency in white matter structural networks in multiple sclerosis. ACTA ACUST UNITED AC 2011; 21:2565-77. [PMID: 21467209 DOI: 10.1093/cercor/bhr039] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is currently known about the alterations in the topological organization of the white matter (WM) structural networks in patients with multiple sclerosis (MS). In the present study, we used diffusion tensor imaging and deterministic tractography to map the WM structural networks in 39 MS patients and 39 age- and gender-matched healthy controls. Graph theoretical methods were applied to investigate alterations in the network efficiency in these patients. The MS patients and the controls exhibited efficient small-world properties in their WM structural networks. However, the global and local network efficiencies were significantly decreased in the MS patients compared with the controls, with the most pronounced changes observed in the sensorimotor, visual, default-mode, and language areas. Furthermore, the decreased network efficiencies were significantly correlated with the expanded disability status scale scores, the disease durations, and the total WM lesion loads. Together, the results suggest a disrupted integrity in the large-scale brain systems in MS, thus providing new insights into the understanding of MS connectome. Our data also suggest that a topology-based brain network analysis can provide potential biomarkers for disease diagnosis and for monitoring the progression and treatment effects for patients with MS.
Collapse
Affiliation(s)
- Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Zhou Y, Qun-Xu, Qin LD, Qian LJ, Cao WW, Xu JR. A primary study of diffusion tensor imaging-based histogram analysis in vascular cognitive impairment with no dementia. Clin Neurol Neurosurg 2011; 113:92-7. [DOI: 10.1016/j.clineuro.2010.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 09/07/2010] [Accepted: 09/14/2010] [Indexed: 10/19/2022]
|
25
|
Lin F, Yu C, Liu Y, Li K, Lei H. Diffusion tensor group tractography of the corpus callosum in clinically isolated syndrome. AJNR Am J Neuroradiol 2010; 32:92-8. [PMID: 20966062 DOI: 10.3174/ajnr.a2273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Many studies have observed atrophy and abnormal diffusion within the CC in MS. However, few studies have addressed whether such abnormalities appear at the earliest stage of MS, especially in CIS. In this study, we aimed to investigate the CC integrity and patterns of CC abnormalities in CIS with diffusion tensor group tractography. MATERIALS AND METHODS First, probability maps of the entire CC and its subregions (genu, body, and splenium) were created from 19 healthy subjects. Then these probability maps were used to evaluate diffusion within the entire CC and its segments in 19 patients with CIS. Five indices, including the midsagittal CC area, FA, MD, λ(1), and λ(23), were used to characterize CC integrity. RESULTS Significant differences were found between patients with CIS and healthy controls in the entire CC and its segments. For the entire CC, patients with CIS had a significantly lower midsagittal CC area and FA, higher MD and λ(23), with a trend toward higher λ(1). These 4 diffusion measures were correlated with T2 lesion volume. Moreover, abnormal white matter integrity was present in subregions of the CC; there was a robust significant increase in λ(23) in the body and splenium and no difference in λ(1) in the genu. CONCLUSIONS Our results suggest that atrophy and abnormal diffusion inside the CC appear at the stage of CIS and the severity of damage in the genu is milder than that in the body and splenium.
Collapse
Affiliation(s)
- F Lin
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, People's Republic of China.
| | | | | | | | | |
Collapse
|
26
|
McFarland HF. Examination of the role of MRI in multiple sclerosis: a problem orientated approach. Results Probl Cell Differ 2010; 51:287-301. [PMID: 19960380 DOI: 10.1007/400_2009_33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Current multiple sclerosis (MS) is generally thought to consist of two general pathological processes; acute inflammation and degeneration. The relationship between these two components is not understood. What is clear, however, is that the measures of acute inflammation are a poor predictor of long-term disability. Although some have suggested that inflammation may not contribute directly to the essential pathology in MS or that it is secondary to tissue degeneration, most students of the disease believe that the two processes are linked. Therefore, applications of MRI to measure both components of the disease are important. As most readers know, considerable success has been achieved in measuring acute inflammation and very little success has been obtained in identifying measures that correlate with disability and the prediction of future disability has not been achieved. In this review, we will examine the successes and failures of MRI in measuring these two components of the disease process. Consequently, we will not attempt to provide a detailed review of each MRI technique or sequence that has been applied to MS (a number of excellent reviews are available) but rather discuss how these techniques have been applied to answer specific questions. We will provide some comments on the use of MRI in clinical trials as well as in clinical practice. Finally, we will end with a brief discussion of future challenges.
Collapse
|
27
|
Raz E, Cercignani M, Sbardella E, Totaro P, Pozzilli C, Bozzali M, Pantano P. Clinically isolated syndrome suggestive of multiple sclerosis: voxelwise regional investigation of white and gray matter. Radiology 2009; 254:227-34. [PMID: 20019140 DOI: 10.1148/radiol.2541090817] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To quantify white matter (WM) and gray matter (GM) damage in patients who presented with clinically isolated syndrome (CIS), which is suggestive of multiple sclerosis (MS), by combining volume-based morphometry (VBM) and tract-based spatial statistics (TBSS). MATERIALS AND METHODS This prospective HIPAA-compliant study was approved by the institutional review board. Written informed consent was obtained from all participants. In this study, 34 consecutive patients (21 women, 13 men; mean age, 31.7 years +/- 7.7 [standard deviation]) who presented with CIS were recruited. The magnetic resonance (MR) examination included dual-echo fast spin-echo, three-dimensional T1, and diffusion-tensor imaging. Sixteen matched healthy volunteers served as control subjects. T2 lesion volumes were assessed with a semiautomatic technique. VBM and TBSS were used for the GM and WM analyses, respectively, to compare regional GM volumes and fractional anisotropy (FA) values in the two groups. RESULTS TBSS analysis revealed a pattern of diffuse FA reductions in patients with CIS at the cluster level (P < .05). Regions of decreased FA involved most of the WM pathways, including the corticospinal tracts, corpus callosum, and superior and inferior longitudinal fasciculi. There were no significant differences between the two groups in terms of global GM, WM, or cerebrospinal fluid volume or in terms of regional GM volume. CONCLUSION Diffuse WM damage not accompanied by any change in GM or WM volume is observed in patients with CIS. This suggests that WM involvement plays a relevant role in the early phases of MS. Subsequently detected GM damage may be secondary to WM alterations.
Collapse
Affiliation(s)
- Eytan Raz
- Department of Neurological Sciences, Sapienza University of Rome, Viale dell' Università, 30, 00185 Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
28
|
Ceccarelli A, Rocca MA, Neema M, Martinelli V, Arora A, Tauhid S, Ghezzi A, Comi G, Bakshi R, Filippi M. Deep gray matter T2 hypointensity is present in patients with clinically isolated syndromes suggestive of multiple sclerosis. Mult Scler 2009; 16:39-44. [PMID: 19965516 DOI: 10.1177/1352458509350310] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gray matter (GM) magnetic resonance imaging (MRI) T2 hypointensity, a putative marker of iron deposition, is a frequent finding in patients with clinically definite (CD) multiple sclerosis (MS). The objective of this study was to assess: (a) how early deep GM T2 hypointensity occurs in MS, by studying patients with clinically isolated syndromes (CIS) suggestive of MS, and (b) whether they contribute to predict subsequent evolution to CDMS. Dual-echo scans using two different acquisition protocols were acquired from 47 CIS patients and 13 healthy controls (HC). Normalized T2-intensity of the basal ganglia and thalamus was quantified. Patients were assessed clinically at the time of MRI acquisition and after three years. During the observation period, 18 patients (38%) evolved to CDMS. At the baseline, only the GM T2-intensity of the left caudate nucleus was significantly reduced in CIS patients in comparison with the HC (p = 0.04). At the baseline, the T2 intensity of the left caudate nucleus was significantly lower (p = 0.01) in CIS patients with disease dissemination in space (DIS), but not in those without DIS, compared to the HC. The baseline T2 lesion volume, but not GM T2 hypointensity, was associated with evolution to CDMS (hazard ratio = 1.60, 95% confidence interval (CI) = 1.05-2.42; p = 0.02). In CIS patients, deep GM is not spared, suggesting that iron-related changes and neurodegeneration occurs early. The magnitude of such damage is only minor and not associated with an increased risk of evolution to CDMS.
Collapse
Affiliation(s)
- Antonia Ceccarelli
- Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Grey matter pathology in clinically early multiple sclerosis: evidence from magnetic resonance imaging. J Neurol Sci 2009; 282:5-11. [PMID: 19201002 DOI: 10.1016/j.jns.2009.01.012] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 01/08/2009] [Accepted: 01/17/2009] [Indexed: 11/22/2022]
Abstract
In multiple sclerosis (MS) it is emerging that the most visible element of pathology, white matter (WM) lesions, represents only a fraction of the disease burden borne by the brain; non-lesional WM is also damaged, as is the grey matter (GM). Evidence is also accruing that GM damage may be a major determinant of longer-term outcomes in MS, and that such damage occurs from the earliest clinical stages of the disease. In this review, we focus on the early stages of relapse onset MS, considering the nature, extent and evolution of GM pathology, as determined using magnetic resonance imaging.
Collapse
|