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Hahn A, Bode J, Schuhegger S, Krüwel T, Sturm VJF, Zhang K, Jende JME, Tews B, Heiland S, Bendszus M, Breckwoldt MO, Ziener CH, Kurz FT. Brain tumor classification of virtual NMR voxels based on realistic blood vessel-induced spin dephasing using support vector machines. NMR IN BIOMEDICINE 2022; 35:e4307. [PMID: 32289884 DOI: 10.1002/nbm.4307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 05/28/2023]
Abstract
Remodeling of tissue microvasculature commonly promotes neoplastic growth; however, there is no imaging modality in oncology yet that noninvasively quantifies microvascular changes in clinical routine. Although blood capillaries cannot be resolved in typical magnetic resonance imaging (MRI) measurements, their geometry and distribution influence the integral nuclear magnetic resonance (NMR) signal from each macroscopic MRI voxel. We have numerically simulated the expected transverse relaxation in NMR voxels with different dimensions based on the realistic microvasculature in healthy and tumor-bearing mouse brains (U87 and GL261 glioblastoma). The 3D capillary structure in entire, undissected brains was acquired using light sheet fluorescence microscopy to produce large datasets of the highly resolved cerebrovasculature. Using this data, we trained support vector machines to classify virtual NMR voxels with different dimensions based on the simulated spin dephasing accountable to field inhomogeneities caused by the underlying vasculature. In prediction tests with previously blinded virtual voxels from healthy brain tissue and GL261 tumors, stable classification accuracies above 95% were reached. Our results indicate that high classification accuracies can be stably attained with achievable training set sizes and that larger MRI voxels facilitated increasingly successful classifications, even with small training datasets. We were able to prove that, theoretically, the transverse relaxation process can be harnessed to learn endogenous contrasts for single voxel tissue type classifications on tailored MRI acquisitions. If translatable to experimental MRI, this may augment diagnostic imaging in oncology with automated voxel-by-voxel signal interpretation to detect vascular pathologies.
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Affiliation(s)
- Artur Hahn
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Julia Bode
- Schaller Research Group at the University of Heidelberg and the German Cancer Research Center (DKFZ), Molecular Mechanisms of Tumor Invasion, Heidelberg, Germany
| | - Sarah Schuhegger
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Thomas Krüwel
- Schaller Research Group at the University of Heidelberg and the German Cancer Research Center (DKFZ), Molecular Mechanisms of Tumor Invasion, Heidelberg, Germany
| | - Volker J F Sturm
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiology E010, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ke Zhang
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiology E010, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Björn Tews
- Schaller Research Group at the University of Heidelberg and the German Cancer Research Center (DKFZ), Molecular Mechanisms of Tumor Invasion, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael O Breckwoldt
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian H Ziener
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiology E010, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Radiology E010, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Jende JME, Mooshage C, Kender Z, Kopf S, Groener JB, Heiland S, Juerchott A, Nawroth P, Bendszus M, Kurz FT. Magnetic Resonance Neurography Reveals Smoking-Associated Decrease in Sciatic Nerve Structural Integrity in Type 2 Diabetes. Front Neurosci 2022; 15:811085. [PMID: 35242003 PMCID: PMC8886720 DOI: 10.3389/fnins.2021.811085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
Objective It is controversially discussed in how far smoking contributes to diabetic polyneuropathy (DPN) in type 2 diabetes (T2D). Diffusion-weighted magnetic resonance neurography (MRN) at 3 Tesla has been shown to provide objective values for structural nerve integrity in patients with T2D. The aim of this study was to investigate the contribution of cigarette smoking on structural nerve integrity in T2D. Methods This cross-sectional prospective cohort study investigated the structural integrity of the sciatic nerve in 10 smokers, 40 never-smokers, and 20 ex-smokers with T2D and 10 healthy control subjects, using diffusion tensor imaging MRN at 3 Tesla and semi-automated nerve fiber tracking. Results were correlated with clinical, electrophysiological, and serological data. Results The sciatic nerve’s fractional anisotropy (FA), a parameter for structural nerve integrity, was significantly lower in smokers with T2D when compared to controls (p = 0.002) and never-smokers (p = 0.015), and lower in ex-smokers when compared to controls (p = 0.015). In addition, sciatic nerve radial diffusivity, a marker of myelin damage, was increased in smokers versus controls and never-smokers (p = 0.048, p = 0.049, respectively). Furthermore, FA in T2D patients was negatively correlated with clinical and electrophysiological markers of DPN. FA also showed negative correlations with the pulse wave velocity, a marker of arterial stiffness and associated microangiopathy, in controls (r = −0.70; p = 0.037), never-smokers (r = −0.45; p = 0.004), ex-smokers (r = −0.55; p = 0.009), and a similar trend in smokers (r = −0.63; p = 0.076). Negative correlations were found between FA and skin auto-fluorescence, a marker of tissue advanced glycation end product accumulation and therefore long-term glycemic stress in T2D, in never-smokers (r = −0.39; p = 0.020) and smokers (r = −0.84; p = 0.004), but not in ex-smokers (r = −0.07; p = 0.765). Conclusion The findings indicate that smoking contributes to sciatic nerve damage in T2D, potentially worsening DPN due to glycemic stress and less microangiopathy-associated myelin damage in active smokers, while angiopathic effects predominate in ex-smokers. To stop smoking may therefore pose a promising preventive measure to slow the progression of DPN in T2D.
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Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Mooshage
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Jan B Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry, Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany.,Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Radiology (E010), German Cancer Research Center, Heidelberg, Germany
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3
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Rotkopf LT, Wehrse E, Kampf T, Vogel P, Schlemmer HP, Ziener CH. Spin echo formation in muscle tissue. Phys Rev E 2021; 104:034419. [PMID: 34654209 DOI: 10.1103/physreve.104.034419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/13/2021] [Indexed: 11/07/2022]
Abstract
Determination of the spin echo signal evolution and of transverse relaxation rates is of high importance for microstructural modeling of muscle tissue in magnetic resonance imaging. So far, numerically exact solutions for the NMR signal dynamics in muscle tissue models have been reported only for the gradient echo free induction decay, with spin echo problems usually solved by approximate methods. In this work, we modeled the spin echo signal numerically exact by discretizing the radial dimension of the Bloch-Torrey equation and expanding the angular dependency in terms of even Chebyshev polynomials. This allows us to express the time dependence of the local magnetization as a closed-form matrix expression. Using this method, we were able to accurately capture the spin echo local and total magnetization dynamics. The obtained transverse relaxation rates showed a high concordance with random walker and finite-element simulations. We could demonstrate that in cases of smaller diffusion coefficients, the commonly used strong collision approximation significantly underestimates the true value considerably. Instead, the limiting behavior in this regime is correctly described either by the full solution or by the slow diffusion approximation. Experimentally measured transverse relaxation rates of a mouse limb muscle showed an angular dependence in accordance with the theoretical prediction.
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Affiliation(s)
- L T Rotkopf
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 220, 69120 Heidelberg, Germany.,Medical Faculty, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - E Wehrse
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 220, 69120 Heidelberg, Germany.,Medical Faculty, Ruprecht-Karls-University Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - T Kampf
- University of Würzburg, Department of Experimental Physics 5, Am Hubland, 97074 Würzburg, Germany.,Würzburg University Hospital, Department of Neuroradiology, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - P Vogel
- University of Würzburg, Department of Experimental Physics 5, Am Hubland, 97074 Würzburg, Germany
| | - H-P Schlemmer
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 220, 69120 Heidelberg, Germany
| | - C H Ziener
- Department of Radiology, German Cancer Research Center, Im Neuenheimer Feld 220, 69120 Heidelberg, Germany
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Kurz FT, Buschle LR, Rotkopf LT, Herzog FS, Sterzik A, Schlemmer HP, Kampf T, Bendszus M, Heiland S, Ziener CH. Dependence of the frequency distribution around a sphere on the voxel orientation. Z Med Phys 2021; 31:403-419. [PMID: 33750628 DOI: 10.1016/j.zemedi.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
Microscopically small magnetic field inhomogeneities within an external static magnetic field cause a free induction decay in magnetic resonance imaging that generally exhibits two transverse components that are usually summarized to a complex entity. The Fourier transform of the complex-valued free induction decay is the purely real and positive-valued frequency distribution which allows an easy interpretation of the underlying dephasing mechanism. Typically, the frequency distribution inside a cubic voxel as caused by a spherical magnetic field inhomogeneity is determined by a histogram technique in terms of subdivision of the whole voxel into smaller subvoxels. A faster and more accurate computation is achieved by analytical expressions for the frequency distribution that are derived in this work. In contrast to the usually assumed simplified case of a spherical voxel, we also consider the tilt angles of the cubic voxel to the external magnetic field. The typical asymmetric form of the frequency distribution is reproduced and analyzed for the more realistic case of a cubic voxel. We observe a splitting of frequency distribution peaks for increasing tilt of the cubic voxel against the direction of the external magnetic field in analogy to the case for dephasing around cylindrical, vessel-like objects inside cubic voxels. These results are of value, e.g., for the analysis of susceptibility-weighted images or in quantitative susceptibility imaging since the reconstruction of these images is performed in cubic-shaped voxels.
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Affiliation(s)
- F T Kurz
- Heidelberg University Hospital, Dept. of Neuroradiology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Cancer Research Center, E010 Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - L R Buschle
- German Cancer Research Center, E010 Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg University, Faculty of Physics and Astronomy, INF 227, 69120 Heidelberg, Germany
| | - L T Rotkopf
- German Cancer Research Center, E010 Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - F S Herzog
- German Cancer Research Center, E010 Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg University, Faculty of Physics and Astronomy, INF 227, 69120 Heidelberg, Germany
| | - A Sterzik
- German Cancer Research Center, E010 Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg University, Faculty of Physics and Astronomy, INF 227, 69120 Heidelberg, Germany
| | - H-P Schlemmer
- German Cancer Research Center, E010 Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - T Kampf
- University of Würzburg, Dept. of Experimental Physics 5, Am Hubland, 97074 Würzburg, Germany; Würzburg University Hospital, Dept. of Neuroradiology, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - M Bendszus
- Heidelberg University Hospital, Dept. of Neuroradiology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - S Heiland
- Heidelberg University Hospital, Dept. of Neuroradiology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - C H Ziener
- Heidelberg University Hospital, Dept. of Neuroradiology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; German Cancer Research Center, E010 Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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Jende JME, Kender Z, Rother C, Alvarez-Ramos L, Groener JB, Pham M, Morgenstern J, Oikonomou D, Hahn A, Juerchott A, Kollmer J, Heiland S, Kopf S, Nawroth PP, Bendszus M, Kurz FT. Diabetic Polyneuropathy Is Associated With Pathomorphological Changes in Human Dorsal Root Ganglia: A Study Using 3T MR Neurography. Front Neurosci 2020; 14:570744. [PMID: 33100960 PMCID: PMC7546893 DOI: 10.3389/fnins.2020.570744] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022] Open
Abstract
Diabetic neuropathy (DPN) is one of the most severe and yet most poorly understood complications of diabetes mellitus. In vivo imaging of dorsal root ganglia (DRG), a key structure for the understanding of DPN, has been restricted to animal studies. These have shown a correlation of decreased DRG volume with neuropathic symptom severity. Our objective was to investigate correlations of DRG morphology and signal characteristics at 3 Tesla (3T) magnetic resonance neurography (MRN) with clinical and serological data in diabetic patients with and without DPN. In this cross-sectional study, participants underwent 3T MRN of both L5 DRG using an isotropic 3D T2-weighted, fat-suppressed sequence with subsequent segmentation of DRG volume and analysis of normalized signal properties. Overall, 55 diabetes patients (66 ± 9 years; 32 men; 30 with DPN) took part in this study. DRG volume was smaller in patients with severe DPN when compared to patients with mild or moderate DPN (134.7 ± 21.86 vs 170.1 ± 49.22; p = 0.040). In DPN patients, DRG volume was negatively correlated with the neuropathy disability score (r = −0.43; 95%CI = −0.66 to −0.14; p = 0.02), a measure of neuropathy severity. DRG volume showed negative correlations with triglycerides (r = −0.40; 95%CI = −0.57 to −0.19; p = 0.006), and LDL cholesterol (r = −0.33; 95%CI = −0.51 to −0.11; p = 0.04). There was a strong positive correlation of normalized MR signal intensity (SI) with the neuropathy symptom score in the subgroup of patients with painful DPN (r = 0.80; 95%CI = 0.46 to 0.93; p = 0.005). DRG SI was positively correlated with HbA1c levels (r = 0.30; 95%CI = 0.09 to 0.50; p = 0.03) and the triglyceride/HDL ratio (r = 0.40; 95%CI = 0.19 to 0.57; p = 0.007). In this first in vivo study, we found DRG morphological degeneration and signal increase in correlation with neuropathy severity. This elucidates the potential importance of MR-based DRG assessments in studying structural and functional changes in DPN.
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Affiliation(s)
- Johann M E Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Rother
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lucia Alvarez-Ramos
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Jan B Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany.,Medicover Neuroendokrinologie, Munich, Germany
| | - Mirko Pham
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Jakob Morgenstern
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Dimitrios Oikonomou
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Artur Hahn
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jennifer Kollmer
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany
| | - Peter P Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany.,German Center of Diabetes Research, München-Neuherberg, Germany.,Joint Institute for Diabetes and Cancer at Helmholtz-Zentrum Munich and Heidelberg University, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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6
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Hahn A, Bode J, Krüwel T, Kampf T, Buschle LR, Sturm VJF, Zhang K, Tews B, Schlemmer HP, Heiland S, Bendszus M, Ziener CH, Breckwoldt MO, Kurz FT. Gibbs point field model quantifies disorder in microvasculature of U87-glioblastoma. J Theor Biol 2020; 494:110230. [PMID: 32142806 DOI: 10.1016/j.jtbi.2020.110230] [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: 01/24/2019] [Revised: 10/28/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
Microvascular proliferation in glioblastoma multiforme is a biological key mechanism to facilitate tumor growth and infiltration and a main target for treatment interventions. The vascular architecture can be obtained by Single Plane Illumination Microscopy (SPIM) to evaluate vascular heterogeneity in tumorous tissue. We make use of the Gibbs point field model to quantify the order of regularity in capillary distributions found in the U87 glioblastoma model in a murine model and to compare tumorous and healthy brain tissue. A single model parameter Γ was assigned that is linked to tissue-specific vascular topology through Monte-Carlo simulations. Distributions of the model parameter Γ differ significantly between glioblastoma tissue with mean 〈ΓG〉=2.1±0.4, as compared to healthy brain tissue with mean 〈ΓH〉=4.9±0.4, suggesting that the average Γ-value allows for tissue differentiation. These results may be used for diagnostic magnetic resonance imaging, where it has been shown recently that Γ is linked to tissue-inherent relaxation parameters.
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Affiliation(s)
- Artur Hahn
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; Department of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, Heidelberg 69120, Germany
| | - Julia Bode
- Molecular Mechanisms of Tumor Invasion, Schaller Research Group, University of Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
| | - Thomas Krüwel
- Molecular Mechanisms of Tumor Invasion, Schaller Research Group, University of Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
| | - Thomas Kampf
- Department of Experimental Physics 5, University of Würzburg, Am Hubland, Würzburg 97074, Germany; Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Straße 2, Würzburg 97080, Germany
| | - Lukas R Buschle
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; Department of Radiology E010, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Volker J F Sturm
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; Department of Radiology E010, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Ke Zhang
- Department of Radiology E010, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Björn Tews
- Molecular Mechanisms of Tumor Invasion, Schaller Research Group, University of Heidelberg and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
| | - Heinz-Peter Schlemmer
- Department of Radiology E010, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany
| | - Christian H Ziener
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; Department of Radiology E010, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Michael O Breckwoldt
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
| | - Felix T Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany; Department of Radiology E010, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany.
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7
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Groener JB, Jende JME, Kurz FT, Kender Z, Treede RD, Schuh-Hofer S, Nawroth PP, Bendszus M, Kopf S. Understanding Diabetic Neuropathy-From Subclinical Nerve Lesions to Severe Nerve Fiber Deficits: A Cross-Sectional Study in Patients With Type 2 Diabetes and Healthy Control Subjects. Diabetes 2020; 69:436-447. [PMID: 31826867 DOI: 10.2337/db19-0197] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022]
Abstract
Studies on magnetic resonance neurography (MRN) in diabetic polyneuropathy (DPN) have found proximal sciatic nerve lesions. The aim of this study was to evaluate the functional relevance of sciatic nerve lesions in DPN, with the expectation of correlations with the impairment of large-fiber function. Sixty-one patients with type 2 diabetes (48 with and 13 without DPN) and 12 control subjects were enrolled and underwent MRN, quantitative sensory testing, and electrophysiological examinations. There were differences in mechanical detection (Aβ fibers) and mechanical pain (Aδ fibers) but not in thermal pain and thermal detection clusters (C fibers) among the groups. Lesion load correlated with lower Aα-, Aβ-, and Aδ-fiber but not with C-fiber function in all participants. Patients with lower function showed a higher load of nerve lesions than patients with elevated function or no measurable deficit despite apparent DPN. Longer diabetes duration was associated with higher lesion load in patients with DPN, suggesting that nerve lesions in DPN may accumulate over time and become clinically relevant once a critical amount of nerve fascicles is affected. Moreover, MRN is an objective method for determining lower function mainly in medium and large fibers in DPN.
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Affiliation(s)
- Jan B Groener
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
- Medicover Neuroendokrinologie, Munich, Germany
| | - Johann M E Jende
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix T Kurz
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Zoltan Kender
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sigrid Schuh-Hofer
- Department of Neurophysiology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter P Nawroth
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
- Joint Heidelberg-ICD Translational Diabetes Program, Helmoltz-Zentrum, Munich, Germany
| | - Martin Bendszus
- Neuroradiology, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- Endocrinology and Clinical Chemistry, Internal Medicine Department I, University Hospital Heidelberg, Heidelberg, Germany
- Deutsches Zentrum für Diabetesforschung (DZD) e.V., München-Neuherberg, Germany
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Lee J, Hyun JW, Lee J, Choi EJ, Shin HG, Min K, Nam Y, Kim HJ, Oh SH. So You Want to Image Myelin Using MRI: An Overview and Practical Guide for Myelin Water Imaging. J Magn Reson Imaging 2020; 53:360-373. [PMID: 32009271 DOI: 10.1002/jmri.27059] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/01/2020] [Accepted: 01/02/2020] [Indexed: 12/22/2022] Open
Abstract
Myelin water imaging (MWI) is an MRI imaging biomarker for myelin. This method can generate an in vivo whole-brain myelin water fraction map in approximately 10 minutes. It has been applied in various applications including neurodegenerative disease, neurodevelopmental, and neuroplasticity studies. In this review we start with a brief introduction of myelin biology and discuss the contributions of myelin in conventional MRI contrasts. Then the MRI properties of myelin water and four different MWI methods, which are categorized as T2 -, T2 *-, T1 -, and steady-state-based MWI, are summarized. After that, we cover more practical issues such as availability, interpretation, and validation of these methods. To illustrate the utility of MWI as a clinical research tool, MWI studies for two diseases, multiple sclerosis and neuromyelitis optica, are introduced. Additional topics about imaging myelin in gray matter and non-MWI methods for myelin imaging are also included. Although technical and physiological limitations exist, MWI is a potent surrogate biomarker of myelin that carries valuable and useful information of myelin. Evidence Level: 5 Technical Efficacy: 1 J. MAGN. RESON. IMAGING 2021;53:360-373.
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Affiliation(s)
- Jongho Lee
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital, National Cancer Center, Goyang-si, Korea
| | - Jieun Lee
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Eun-Jung Choi
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Hyeong-Geol Shin
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Kyeongseon Min
- Laboratory for Imaging Science and Technology, Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Yoonho Nam
- Department of Radiology, Seoul Saint Mary's Hospital, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital, National Cancer Center, Goyang-si, Korea
| | - Se-Hong Oh
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Korea.,Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
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Jende JME, Groener JB, Rother C, Kender Z, Hahn A, Hilgenfeld T, Juerchott A, Preisner F, Heiland S, Kopf S, Pham M, Nawroth P, Bendszus M, Kurz FT. Association of Serum Cholesterol Levels With Peripheral Nerve Damage in Patients With Type 2 Diabetes. JAMA Netw Open 2019; 2:e194798. [PMID: 31150078 PMCID: PMC6547108 DOI: 10.1001/jamanetworkopen.2019.4798] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Lowering serum cholesterol levels is a well-established treatment for dyslipidemia in patients with type 2 diabetes (T2D). However, nerve lesions in patients with T2D increase with lower serum cholesterol levels, suggesting that lowering serum cholesterol levels is associated with diabetic polyneuropathy (DPN) in patients with T2D. OBJECTIVE To investigate whether there is an association between serum cholesterol levels and peripheral nerve lesions in patients with T2D with and without DPN. DESIGN, SETTING, AND PARTICIPANTS This single-center, cross-sectional, prospective cohort study was performed from June 1, 2015, to March 31, 2018. Observers were blinded to clinical data. A total of 256 participants were approached, of whom 156 were excluded. A total of 100 participants consented to undergo magnetic resonance neurography of the right leg at the Department of Neuroradiology and clinical, serologic, and electrophysiologic assessment at the Department of Endocrinology, Heidelberg University Hospital, Heidelberg, Germany. EXPOSURES Quantification of the nerve's diameter and lipid equivalent lesion (LEL) load with a subsequent analysis of all acquired clinical and serologic data with use of 3.0-T magnetic resonance neurography of the right leg with 3-dimensional reconstruction of the sciatic nerve. MAIN OUTCOMES AND MEASURES The primary outcome was lesion load and extension. Secondary outcomes were clinical, serologic, and electrophysiologic findings. RESULTS A total of 100 participants with T2D (mean [SD] age, 64.6 [0.9] years; 68 [68.0%] male) participated in the study. The LEL load correlated positively with the nerve's mean cross-sectional area (r = 0.44; P < .001) and the maximum length of a lesion (r = 0.71; P < .001). The LEL load was negatively associated with total serum cholesterol level (r = -0.41; P < .001), high-density lipoprotein cholesterol level (r = -0.30; P = .006), low-density lipoprotein cholesterol level (r = -0.33; P = .003), nerve conduction velocities of the tibial (r = -0.33; P = .01) and peroneal (r = -0.51; P < .001) nerves, and nerve conduction amplitudes of the tibial (r = -0.31; P = .02) and peroneal (r = -0.28; P = .03) nerves. CONCLUSIONS AND RELEVANCE The findings suggest that lowering serum cholesterol levels in patients with T2D and DPN is associated with a higher amount of nerve lesions and declining nerve conduction velocities and amplitudes. These findings may be relevant to emerging therapies that promote an aggressive lowering of serum cholesterol levels in patients with T2D.
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Affiliation(s)
- Johann M. E. Jende
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan B. Groener
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), München-Neuherberg, Germany
| | - Christian Rother
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Zoltan Kender
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
| | - Artur Hahn
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Fabian Preisner
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kopf
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), München-Neuherberg, Germany
| | - Mirko Pham
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Peter Nawroth
- Department of Endocrinology, Diabetology and Clinical Chemistry (Internal Medicine 1), Heidelberg University Hospital, Heidelberg, Germany
- German Center of Diabetes Research (DZD), München-Neuherberg, Germany
- Institute for Diabetes and Cancer, Helmholtz Diabetes Center, Helmholtz Center Munich, Munich, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T. Kurz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Buschle LR, Kurz FT, Kampf T, Schlemmer HP, Ziener CH. Spin dephasing around randomly distributed vessels. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2019; 299:12-20. [PMID: 30529850 DOI: 10.1016/j.jmr.2018.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
We analyze the gradient echo signal in the presence of blood vessel networks. Both, diffusion and susceptibility effects are analytically emphasized within the Bloch-Torrey equation. Solving this equation, we present the first exact description of the local magnetization around a single vessel. This allows us to deduce the gradient echo signal of parallel vessels randomly distributed in a plane, which is valid for arbitrary mean vessel diameters in the range of physiological relevant blood volume fractions. Thus, the results are potentially relevant for gradient echo measurements of blood vessel networks with arbitrary vessel size.
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Affiliation(s)
- L R Buschle
- German Cancer Research Center - DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Heidelberg University, Faculty of Physics and Astronomy, Im Neuenheimer Feld 227, 69120 Heidelberg, Germany
| | - F T Kurz
- German Cancer Research Center - DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - T Kampf
- University of Würzburg, Department of Experimental Physics 5, Am Hubland, 97074 Würzburg, Germany; Würzburg University Hospital, Department of Neuroradiology, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - H P Schlemmer
- German Cancer Research Center - DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - C H Ziener
- German Cancer Research Center - DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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