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Gonzalez-Martinez A, Bose G, Lokhande H, Saxena S, Healy BC, Polgar-Turcsanyi M, Weiner HL, Chitnis T. Early miR-320b and miR-25-3p miRNA levels correlate with multiple sclerosis severity at 10 years: a cohort study. J Neuroinflammation 2023; 20:136. [PMID: 37264432 DOI: 10.1186/s12974-023-02816-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic demyelinating autoimmune disorder which may cause long-term disability. MicroRNA (miRNA) are stable, non-coding molecules that have been identified in our Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB)-cohort, as well as other international cohorts, as potential disease biomarkers in MS. However, few studies have evaluated the association of miRNA expression early in the MS disease course with long-term outcomes. Therefore, we aimed to evaluate the potential role of three candidate serum miRNAs previously correlated with MS disability in patients with MS, miR-320b, miR-25-3p and miRNA 486-5p, as early biomarkers of MS disability at 10-year follow-up. MAIN BODY We included 144 patients with serum obtained within three years of MS onset. miRNA expression was measured by RNA extraction followed by RT-PCR. Demographic, clinical, brain MRI and other biomarkers were collected. The primary outcome was the association between early miRNA expression and retaining benign MS, defined as EDSS ≤ 2 at 10-year follow-up. Among the 144 patients, 104 were benign and 40 were not benign at 10-year follow-up. 89 (62%) were women, with mean age at onset 37.7 (SD: 9.6) years. Patients who retained benign MS had lower values of miR-25-3p (p = 0.047) and higher miR-320b (p = 0.025) values. Development of SPMS was associated with higher miR-320b (p = 0.002) levels. Brain parenchymal fraction at year 10 was negatively correlated with miR-25-3p (p = 0.0004) and positively correlated with miR-320b (p = 0.006). No association was found between miR-486-5p and any outcome, and 10-year T2-lesion volume was not associated with any miRNA. CONCLUSIONS Our results show that miR-320b and miR-25-3p expression are early biomarkers associated with MS severity and brain atrophy. This study provides class III evidence of that miR-320b and miR-25-3p are associated with long-term MS disability which may be a potential tool to risk-stratify patients with MS for early treatment decisions.
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Affiliation(s)
- Alicia Gonzalez-Martinez
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases (ARCND), Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9002K, Boston, MA, 02115, USA
| | - Gauruv Bose
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases (ARCND), Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9002K, Boston, MA, 02115, USA
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Hrishikesh Lokhande
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases (ARCND), Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9002K, Boston, MA, 02115, USA
| | - Shrishti Saxena
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases (ARCND), Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9002K, Boston, MA, 02115, USA
| | - Brian C Healy
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Mariann Polgar-Turcsanyi
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases (ARCND), Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9002K, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Howard L Weiner
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Tanuja Chitnis
- Translational Neuroimmunology Research Center (TNRC), Ann Romney Center for Neurologic Diseases (ARCND), Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, 9002K, Boston, MA, 02115, USA.
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
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2
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Gentile G, Mattiesing RM, Brouwer I, van Schijndel RA, Uitdehaag BMJ, Twisk JWR, Kappos L, Freedman MS, Comi G, Jack D, Barkhof F, De Stefano N, Vrenken H, Battaglini M. The spatio-temporal relationship between concurrent lesion and brain atrophy changes in early multiple sclerosis: A post-hoc analysis of the REFLEXION study. Neuroimage Clin 2023; 38:103397. [PMID: 37086648 PMCID: PMC10300577 DOI: 10.1016/j.nicl.2023.103397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/30/2023] [Accepted: 04/02/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND White matter (WM) lesions and brain atrophy are present early in multiple sclerosis (MS). However, their spatio-temporal relationship remains unclear. METHODS Yearly magnetic resonance images were analysed in 387 patients with a first clinical demyelinating event (FCDE) from the 5-year REFLEXION study. Patients received early (from baseline; N = 258; ET) or delayed treatment (from month-24; N = 129; DT) with subcutaneous interferon beta-1a. FSL-SIENA/VIENA were used to provide yearly percentage volume change of brain (PBVC) and ventricles (PVVC). Yearly total lesion volume change (TLVC) was determined by a semi-automated method. Using linear mixed models and voxel-wise analyses, we firstly investigated the overall relationship between TLVC and PBVC and between TLVC and PVVC in the same follow-up period. Analyses were then separately performed for: the untreated period of DT patients (first two years), the first year of treatment (year 1 for ET and year 3 for DT), and a period where patients had received at least 1 year of treatment (stable treatment; ET: years 2, 3, 4, and 5; DT: years 4 and 5). RESULTS Whole brain: across the whole study period, lower TLVC was related to faster atrophy (PBVC: B = 0.046, SE = 0.013, p < 0.001; PVVC: B = -0.466, SE = 0.118, p < 0.001). Within the untreated period of DT patients, lower TLVC was related to faster atrophy (PBVC: B = 0.072, SE = 0.029, p = 0.013; PVVC: B = -0.917, SE = 0.306, p = 0.003). A similar relationship was found within the first year of treatment of ET patients (PBVC: B = 0.081, SE = 0.027, p = 0.003; PVVC: B = -1.08, SE = 0.284, p < 0.001), consistent with resolving oedema and pseudo-atrophy. Voxel-wise: overall, higher TLVC was related to faster ventricular enlargement. Lower TLVC was related to faster widespread atrophy in year 1 in both ET (first year of treatment) and DT (untreated) patients. In the second untreated year of DT patients and within the stable treatment period of ET patients (year 4), faster periventricular and occipital lobe atrophy was associated with higher TLVC. CONCLUSIONS WM lesion changes and atrophy occurred simultaneously in early MS. Spatio-temporal correspondence of these two processes involved mostly the periventricular area. Within the first year of the study, in both treatment groups, faster atrophy was linked to lower lesion volume changes, consistent with higher shrinking and disappearing lesion activity. This might reflect the pseudo-atrophy phenomenon that is probably related to the therapy driven (only in ET patients, as they received treatment from baseline) and "natural" (both ET and DT patients entered the study after a FCDE) resolution of oedema. In an untreated period and later on during stable treatment, (real) atrophy was related to higher lesion volume changes, consistent with increased new and enlarging lesion activity.
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Affiliation(s)
- Giordano Gentile
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; Siena Imaging SRL, 53100 Siena, Italy.
| | - Rozemarijn M Mattiesing
- MS Center Amsterdam, Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Iman Brouwer
- MS Center Amsterdam, Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Ronald A van Schijndel
- MS Center Amsterdam, Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Bernard M J Uitdehaag
- MS Center Amsterdam, Neurology, Amsterdam Neuroscience, Amsterdam UMC location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Jos W R Twisk
- Epidemiology and Data Science, Amsterdam UMC location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology, and Neuroscience Basel (RC2NB), University Hospital Basel, CH-4031 Basel, Switzerland; Neurology Departments of Head, Spine and Neuromedicine, Biomedical Engineering and Clinical Research, University of Basel, Basel, Switzerland
| | - Mark S Freedman
- Department of Medicine, University of Ottawa, Ottawa ON, K1N 6N5, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa ON, K1H 8L6, Ontario, Canada
| | - Giancarlo Comi
- Università Vita Salute San Raffaele, Casa di Cura del Policlinico, 20132 Milan, Italy
| | - Dominic Jack
- Merck Serono Ltd, Feltham, TW14 8HD, UK, an affiliate of Merck KGaA
| | - Frederik Barkhof
- MS Center Amsterdam, Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands; UCL Institutes of Neurology and Healthcare Engineering, London, WC1E 6BT, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy
| | - Hugo Vrenken
- MS Center Amsterdam, Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC location VUmc, De Boelelaan 1118, 1081 HZ Amsterdam, the Netherlands
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; Siena Imaging SRL, 53100 Siena, Italy
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Pozzilli C, Pugliatti M, Vermersch P, Grigoriadis N, Alkhawajah M, Airas L, Oreja-Guevara C. Diagnosis and treatment of progressive multiple sclerosis: A position paper. Eur J Neurol 2023; 30:9-21. [PMID: 36209464 PMCID: PMC10092602 DOI: 10.1111/ene.15593] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/05/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is an unpredictable disease characterised by a highly variable disease onset and clinical course. Three main clinical phenotypes have been described. However, distinguishing between the two progressive forms of MS can be challenging for clinicians. This article examines how the diagnostic definitions of progressive MS impact clinical research, the design of clinical trials and, ultimately, treatment decisions. METHODS We carried out an extensive review of the literature highlighting differences in the definition of progressive forms of MS, and the importance of assessing the extent of the ongoing inflammatory component in MS when making treatment decisions. RESULTS Inconsistent results in phase III clinical studies of treatments for progressive MS, may be attributable to differences in patient characteristics (e.g., age, clinical and radiological activity at baseline) and endpoint definitions. In both primary and secondary progressive MS, patients who are younger and have more active disease will derive the greatest benefit from the available treatments. CONCLUSIONS We recommend making treatment decisions based on the individual patient's pattern of disease progression, as well as functional, clinical and imaging parameters, rather than on their clinical phenotype. Because the definition of progressive MS differs across clinical studies, careful selection of eligibility criteria and study endpoints is needed for future studies in patients with progressive MS.
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Affiliation(s)
- Carlo Pozzilli
- Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy.,Department of Human Neuroscience, University Sapienza, Rome, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,Interdepartmental Center of Research for Multiple Sclerosis and Neuro-inflammatory and Degenerative Diseases, University of Ferrara, Ferrara, Italy
| | - Patrick Vermersch
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
| | - Nikolaos Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology, Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mona Alkhawajah
- Section of Neurology, Neurosciences Center, King Faisal Specialist Hospital and Research Center, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia
| | - Laura Airas
- Division of Clinical Neurosciences, University of Turku, Turku, Finland.,Neurocenter of Turku University Hospital, Turku, Finland
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
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4
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Sandroff BM, Motl RW, Román CAF, Wylie GR, DeLuca J, Cutter GR, Benedict RHB, Dwyer MG, Zivadinov R. Thalamic atrophy moderates associations among aerobic fitness, cognitive processing speed, and walking endurance in persons with multiple sclerosis. J Neurol 2022; 269:5531-5540. [PMID: 35718819 PMCID: PMC9474622 DOI: 10.1007/s00415-022-11205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Thalamic atrophy (TA) represents a biomarker of neurodegeneration and associated dysfunction/decline in physical and cognitive functioning among persons with multiple sclerosis (MS). Aerobic fitness, as an end point of exercise training, represents a promising target for restoring function in MS, but it is unknown if such effects differ by TA. This cross-sectional study examined whether aerobic fitness was differentially associated with cognitive processing speed and walking endurance in persons with MS who present with and without TA. METHODS 44 fully ambulatory persons with MS completed a graded exercise test for measuring aerobic fitness (VO2peak) and underwent 3T MRI for measuring TA, the Symbol Digit Modalities Test (SDMT), and the 6-min walk (6MW). We performed Spearman correlations (rs) among VO2peak, SDMT, and 6MW scores overall, and in persons with and without TA. We applied Fisher's z-test for comparing correlations based on TA status. RESULTS When controlling for age, EDSS score, and global MRI measures of atrophy, VO2peak was strongly associated with SDMT scores (prs = 0.74, p < 0.01) and 6MW performance (prs = 0.77, p < 0.01) in persons with TA, whereas VO2peak was not associated with SDMT scores (prs = - 0.01, p = 0.99) or 6MW performance (prs = 0.25, p = 0.38) in those without TA. The correlations between VO2peak and SDMT (z = 2.86, p < 0.01) and VO2peak and 6MW (z = 2.33, p = 0.02) were significantly stronger in the TA group. DISCUSSION This study provides initial evidence of strong, selective associations among aerobic fitness, cognitive processing speed, and walking endurance in persons with TA as a biomarker for MS-related neurodegeneration. Such data support TA as a moderator of the association among aerobic fitness, cognitive processing speed, and walking endurance in persons with MS. Future research should carefully consider the role of TA when designing trials of aerobic exercise, cognition, and mobility in MS.
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Affiliation(s)
- Brian M Sandroff
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA.
- Rutgers New Jersey Medical School, Newark, NJ, USA.
| | | | - Cristina A F Román
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Glenn R Wylie
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - John DeLuca
- Center for Neuropsychology and Neuroscience Research, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ, 07052, USA
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Gary R Cutter
- University of Alabama at Birmingham, Birmingham, AL, USA
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5
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Pompura SL, Hafler DA, Dominguez-Villar M. Fatty Acid Metabolism and T Cells in Multiple Sclerosis. Front Immunol 2022; 13:869197. [PMID: 35603182 PMCID: PMC9116144 DOI: 10.3389/fimmu.2022.869197] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Cellular metabolic remodeling is intrinsically linked to the development, activation, differentiation, function, and survival of T cells. T cells transition from a catabolic, naïve state to an anabolic effector state upon T cell activation. Subsequently, specialization of T cells into T helper (Th) subsets, including regulatory T cells (Treg), requires fine-tuning of metabolic programs that better support and optimize T cell functions for that particular environment. Increasingly, studies have shown that changes in nutrient availability at both the cellular and organismal level during disease states can alter T cell function, highlighting the importance of better characterizing metabolic-immune axes in both physiological and disease settings. In support of these data, a growing body of evidence is emerging that shows specific lipid species are capable of altering the inflammatory functional phenotypes of T cells. In this review we summarize the metabolic programs shown to support naïve and effector T cells, and those driving Th subsets. We then discuss changes to lipid profiles in patients with multiple sclerosis, and focus on how the presence of specific lipid species can alter cellular metabolism and function of T cells.
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Affiliation(s)
- Saige L. Pompura
- Departments of Neurology and Immunobiology, Yale School of Medicine, New Haven, CT, United States
| | - David A. Hafler
- Departments of Neurology and Immunobiology, Yale School of Medicine, New Haven, CT, United States
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Voigt I, Inojosa H, Dillenseger A, Haase R, Akgün K, Ziemssen T. Digital Twins for Multiple Sclerosis. Front Immunol 2021; 12:669811. [PMID: 34012452 PMCID: PMC8128142 DOI: 10.3389/fimmu.2021.669811] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022] Open
Abstract
An individualized innovative disease management is of great importance for people with multiple sclerosis (pwMS) to cope with the complexity of this chronic, multidimensional disease. However, an individual state of the art strategy, with precise adjustment to the patient's characteristics, is still far from being part of the everyday care of pwMS. The development of digital twins could decisively advance the necessary implementation of an individualized innovative management of MS. Through artificial intelligence-based analysis of several disease parameters - including clinical and para-clinical outcomes, multi-omics, biomarkers, patient-related data, information about the patient's life circumstances and plans, and medical procedures - a digital twin paired to the patient's characteristic can be created, enabling healthcare professionals to handle large amounts of patient data. This can contribute to a more personalized and effective care by integrating data from multiple sources in a standardized manner, implementing individualized clinical pathways, supporting physician-patient communication and facilitating a shared decision-making. With a clear display of pre-analyzed patient data on a dashboard, patient participation and individualized clinical decisions as well as the prediction of disease progression and treatment simulation could become possible. In this review, we focus on the advantages, challenges and practical aspects of digital twins in the management of MS. We discuss the use of digital twins for MS as a revolutionary tool to improve diagnosis, monitoring and therapy refining patients' well-being, saving economic costs, and enabling prevention of disease progression. Digital twins will help make precision medicine and patient-centered care a reality in everyday life.
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Affiliation(s)
| | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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7
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Valcarcel AM, Muschelli J, Pham DL, Martin ML, Yushkevich P, Brandstadter R, Patterson KR, Schindler MK, Calabresi PA, Bakshi R, Shinohara RT. TAPAS: A Thresholding Approach for Probability Map Automatic Segmentation in Multiple Sclerosis. Neuroimage Clin 2020; 27:102256. [PMID: 32428847 PMCID: PMC7236059 DOI: 10.1016/j.nicl.2020.102256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/15/2022]
Abstract
Total brain white matter lesion (WML) volume is the most widely established magnetic resonance imaging (MRI) outcome measure in studies of multiple sclerosis (MS). To estimate WML volume, there are a number of automatic segmentation methods available, yet manual delineation remains the gold standard approach. Automatic approaches often yield a probability map to which a threshold is applied to create lesion segmentation masks. Unfortunately, few approaches systematically determine the threshold employed; many methods use a manually selected threshold, thus introducing human error and bias into the automated procedure. In this study, we propose and validate an automatic thresholding algorithm, Thresholding Approach for Probability Map Automatic Segmentation in Multiple Sclerosis (TAPAS), to obtain subject-specific threshold estimates for probability map automatic segmentation of T2-weighted (T2) hyperintense WMLs. Using multimodal MRI, the proposed method applies an automatic segmentation algorithm to obtain probability maps. We obtain the true subject-specific threshold that maximizes the Sørensen-Dice similarity coefficient (DSC). Then the subject-specific thresholds are modeled on a naive estimate of volume using a generalized additive model. Applying this model, we predict a subject-specific threshold in data not used for training. We ran a Monte Carlo-resampled split-sample cross-validation (100 validation sets) using two data sets: the first obtained from the Johns Hopkins Hospital (JHH) on a Philips 3 Tesla (3T) scanner (n = 94) and a second collected at the Brigham and Women's Hospital (BWH) using a Siemens 3T scanner (n = 40). By means of the proposed automated technique, in the JHH data we found an average reduction in subject-level absolute error of 0.1 mL per one mL increase in manual volume. Using Bland-Altman analysis, we found that volumetric bias associated with group-level thresholding was mitigated when applying TAPAS. The BWH data showed similar absolute error estimates using group-level thresholding or TAPAS likely since Bland-Altman analyses indicated no systematic biases associated with group or TAPAS volume estimates. The current study presents the first validated fully automated method for subject-specific threshold prediction to segment brain lesions.
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Affiliation(s)
- Alessandra M Valcarcel
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - John Muschelli
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Dzung L Pham
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20892, United States
| | - Melissa Lynne Martin
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Paul Yushkevich
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Rachel Brandstadter
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Kristina R Patterson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Matthew K Schindler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Peter A Calabresi
- Department of Neurology, School of Medicine Johns Hopkins University, Baltimore, MD 21287, United States
| | - Rohit Bakshi
- Department of Neurology, Brigham Women's Hospital, Harvard Medical School, Boston, MA 02115, United States; Department of Radiology, Brigham Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Center for Biomedical Image Computing and Analytics (CBICA), Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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8
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Bakshi R, Healy BC, Dupuy SL, Kirkish G, Khalid F, Gundel T, Asteggiano C, Yousuf F, Alexander A, Hauser SL, Weiner HL, Henry RG. Brain MRI Predicts Worsening Multiple Sclerosis Disability over 5 Years in the SUMMIT Study. J Neuroimaging 2020; 30:212-218. [PMID: 31994814 DOI: 10.1111/jon.12688] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND PURPOSE Brain MRI-derived lesions and atrophy are related to multiple sclerosis (MS) disability. In the Serially Unified Multicenter MS Investigation (SUMMIT), from Brigham and Women's Hospital (BWH) and University of California, San Francisco (UCSF), we assessed whether MRI methodologic heterogeneity may limit the ability to pool multisite data sets to assess 5-year clinical-MRI associations. METHODS Patients with relapsing-remitting (RR) MS (n = 100 from each site) underwent baseline brain MRI and baseline and 5-year clinical evaluations. Patients were matched on sex (74 women each), age, disease duration, and Expanded Disability Status Scale (EDSS) score. MRI was performed with differences between sites in both acquisition (field strength, voxel size, pulse sequences), and postprocessing pipeline to assess brain parenchymal fraction (BPF) and T2 lesion volume (T2LV). RESULTS The UCSF cohort showed higher correlation than the BWH cohort between T2LV and disease duration. UCSF showed a higher inverse correlation between BPF and age than BWH. UCSF showed a higher inverse correlation than BWH between BPF and 5-year EDSS score. Both cohorts showed inverse correlations between BPF and T2LV, with no between-site difference. The pooled but not individual cohort data showed a link between a lower baseline BPF and the subsequent 5-year worsening in disability in addition to other stronger relationships in the data. CONCLUSIONS MRI acquisition and processing differences may result in some degree of heterogeneity in assessing brain lesion and atrophy measures in patients with MS. Pooling of data across sites is beneficial to correct for potential biases in individual data sets.
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Affiliation(s)
- Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA.,Department of Radiology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Brian C Healy
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Sheena L Dupuy
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Gina Kirkish
- Department of Neurology, University of California, San Francisco, CA
| | - Fariha Khalid
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Tristan Gundel
- Department of Neurology, University of California, San Francisco, CA
| | - Carlo Asteggiano
- Department of Neurology, University of California, San Francisco, CA
| | - Fawad Yousuf
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Amber Alexander
- Department of Neurology, University of California, San Francisco, CA
| | - Stephen L Hauser
- Department of Neurology, University of California, San Francisco, CA
| | - Howard L Weiner
- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
| | - Roland G Henry
- Department of Neurology, University of California, San Francisco, CA
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- Department of Neurology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA
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Abstract
Multiple sclerosis (MS) affects approximately 1 million persons in the United States, and is the leading cause of neurological disability in young adults. The concept of precision medicine is now being applied to MS and has the promise of improved care. MS patients experience a variety of neurological symptoms, and disease severity ranges from mild to severe, and the biological underpinnings of these phenotypes are now starting to be elucidated. Precision medicine involves the classification of disease subtypes based on the underlying biology, rather than clinical phenotypes alone, and may govern disease course and treatment response. Over 18 disease-modifying drugs have been approved for the treatment of MS, and several biomarkers of treatment response are emerging. This article provides an overview of the concepts of precision medicine and emerging biological markers and their evolving role in decision-making in MS management.
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Affiliation(s)
- Tanuja Chitnis
- Tanuja Chitnis Partners Multiple Sclerosis Center, Department of Neurology, Brigham and Women’s Hospital, Boston, MA, USA/Harvard Medical School, Boston, MA, USA/Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Boston, MA, USA
| | - Alexandre Prat
- Alexandre Prat Department of Neurology, Université de Montréal, Montréal, QC, Canada
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Pinter D, Beckmann CF, Fazekas F, Khalil M, Pichler A, Gattringer T, Ropele S, Fuchs S, Enzinger C. Morphological MRI phenotypes of multiple sclerosis differ in resting-state brain function. Sci Rep 2019; 9:16221. [PMID: 31700126 PMCID: PMC6838050 DOI: 10.1038/s41598-019-52757-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 09/29/2019] [Indexed: 11/09/2022] Open
Abstract
We aimed to assess differences in resting-state functional connectivity (FC) between distinct morphological MRI-phenotypes in multiple sclerosis (MS). Out of 180 MS patients, we identified those with high T2-hyperintense lesion load (T2-LL) and high normalized brain volume (NBV; a predominately white matter damage group, WMD; N = 37) and patients with low T2-LL and low NBV (N = 37; a predominately grey matter damage group; GMD). Independent component analysis of resting-state fMRI was used to test for differences in the sensorimotor network (SMN) between MS MRI-phenotypes and compared to 37 age-matched healthy controls (HC). The two MS groups did not differ regarding EDSS scores, disease duration and distribution of clinical phenotypes. WMD compared to GMD patients showed increased FC in all sub-units of the SMN (sex- and age-corrected). WMD patients had increased FC compared to HC and GMD patients in the central SMN (leg area). Only in the WMD group, higher EDSS scores and T2-LL correlated with decreased connectivity in SMN sub-units. MS patients with distinct morphological MRI-phenotypes also differ in brain function. The amount of focal white matter pathology but not global brain atrophy affects connectivity in the central SMN (leg area) of the SMN, consistent with the notion of a disconnection syndrome.
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Affiliation(s)
- Daniela Pinter
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
| | - Christian F Beckmann
- Donders Institute, Cognitive Neuroscience Department and Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Kapittelweg 29, Nijmegen, The Netherlands
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
| | - Alexander Pichler
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
| | - Siegrid Fuchs
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria.
- Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Auenbruggerplatz 22, Graz, Austria.
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz, Austria.
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11
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Hemond CC, Healy BC, Tauhid S, Mazzola MA, Quintana FJ, Gandhi R, Weiner HL, Bakshi R. MRI phenotypes in MS: Longitudinal changes and miRNA signatures. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e530. [PMID: 30800720 PMCID: PMC6384020 DOI: 10.1212/nxi.0000000000000530] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/09/2018] [Indexed: 12/20/2022]
Abstract
Objective To classify and immunologically characterize persons with MS based on brain lesions and atrophy and their associated microRNA profiles. Methods Cerebral T2-hyperintense lesion volume (T2LV) and brain parenchymal fraction (BPF) were quantified and used to define MRI phenotypes as follows: type I: low T2LV, low atrophy; type II: high T2LV, low atrophy; type III: low T2LV, high atrophy; type IV: high T2LV, high atrophy, in a large cross-sectional cohort (n = 1,088) and a subset with 5-year lngitudinal follow-up (n = 153). Serum miRNAs were assessed on a third MS cohort with 2-year MRI phenotype stability (n = 98). Results One-third of the patients had lesion-atrophy dissociation (types II or III) in both the cross-sectional and longitudinal cohorts. At 5 years, all phenotypes had progressive atrophy (p < 0.001), disproportionally in type II (BPF -2.28%). Only type IV worsened in physical disability. Types I and II showed a 5-year MRI phenotype conversion rate of 33% and 46%, whereas III and IV had >90% stability. Type II switched primarily to IV (91%); type I switched primarily to II (47%) or III (37%). Baseline higher age (p = 0.006) and lower BPF (p < 0.001) predicted 5-year phenotype conversion. Each MRI phenotype demonstrated an miRNA signature whose underlying biology implicates blood-brain barrier pathology: hsa.miR.22.3p, hsa.miR.361.5p, and hsa.miR.345.5p were the most valid differentiators of MRI phenotypes. Conclusions MRI-defined MS phenotypes show high conversion rates characterized by the continuation of either predominant neurodegeneration or inflammation and support the partial independence of these 2 measures. MicroRNA signatures of these phenotypes suggest a role for blood-brain barrier integrity.
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Affiliation(s)
- Christopher C Hemond
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
| | - Brian C Healy
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
| | - Shahamat Tauhid
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
| | - Maria A Mazzola
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
| | - Francisco J Quintana
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
| | - Roopali Gandhi
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
| | - Howard L Weiner
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
| | - Rohit Bakshi
- Departments of Neurology (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.) and Department of Radiology (R.B.); Brigham and Women's Hospital (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Laboratory for Neuroimaging Research (C.C.H., S.T., R.H.); Partners Multiple Sclerosis Center (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); Ann Romney Center for Neurologic Diseases (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W, R.B.); and Harvard Medical School (C.C.H., B.C.H., S.T., M.A.M., F.J.Q., R.G., H.L.W., R.B.), Boston, MA
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12
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Raji A, Ostwaldt AC, Opfer R, Suppa P, Spies L, Winkler G. MRI-Based Brain Volumetry at a Single Time Point Complements Clinical Evaluation of Patients With Multiple Sclerosis in an Outpatient Setting. Front Neurol 2018; 9:545. [PMID: 30140245 PMCID: PMC6095003 DOI: 10.3389/fneur.2018.00545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 06/19/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose: Thalamic atrophy and whole brain atrophy in multiple sclerosis (MS) are associated with disease progression. The motivation of this study was to propose and evaluate a new grouping scheme which is based on MS patients' whole brain and thalamus volumes measured on MRI at a single time point. Methods: In total, 185 MS patients (128 relapsing-remitting (RRMS) and 57 secondary-progressive MS (SPMS) patients) were included from an outpatient facility. Whole brain parenchyma (BP) and regional brain volumes were derived from single time point MRI T1 images. Standard scores (z-scores) were computed by comparing individual brain volumes against corresponding volumes from healthy controls. A z-score cut-off of −1.96 was applied to separate pathologically atrophic from normal brain volumes for thalamus and whole BP (accepting a 2.5% error probability). Subgroup differences with respect to the Symbol Digit Modalities Test (SDMT) and the Expanded Disability Status Scale (EDSS) were assessed. Results: Except for two, all MS patients showed either no atrophy (group 0: 61 RRMS patients, 10 SPMS patients); thalamic but no BP atrophy (group 1: 37 RRMS patients; 18 SPMS patients) or thalamic and BP atrophy (group 2: 28 RRMS patients; 29 SPMS patients). RRMS patients without atrophy and RRMS patients with thalamic atrophy did not differ in EDSS, however, patients with thalamus and BP atrophy showed significantly higher EDSS scores than patients in the other groups. Conclusion: MRI-based brain volumetry at a single time point is able to reliably distinguish MS patients with isolated thalamus atrophy (group 1) from those without brain atrophy (group 0). MS patients with isolated thalamus atrophy might be at risk for the development of widespread atrophy and disease progression. Since RRMS patients in group 0 and 1 are clinically not distinguishable, the proposed grouping may aid identification of RRMS patients at risk of disease progression and thus complement clinical evaluation in the routine patient care.
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Affiliation(s)
| | | | | | - Per Suppa
- jung diagnostics GmbH, Hamburg, Germany
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13
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Abstract
Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis, longitudinal monitoring, evaluation of therapeutic response, and scientific investigations in multiple sclerosis (MS). The clinical usage of MRI has increased in parallel with technical innovations in the technique itself; the widespread adoption of clinically routine MRI at 1.5T has allowed sensitive qualitative and quantitative assessments of macroscopic central nervous system (CNS) inflammatory demyelinating lesions and tissue atrophy. However, conventional MRI lesion measures lack specificity for the underlying MS pathology and only weakly correlate with clinical status. Higher field strength units and newer, advanced MRI techniques offer increased sensitivity and specificity in the detection of disease activity and disease severity. This review summarizes the current status and future prospects regarding the role of MRI in the characterization of MS-related brain and spinal cord involvement.
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Affiliation(s)
- Christopher C Hemond
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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14
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Abstract
Multiple sclerosis (MS) has long been considered a CD4 T-cell disease, primarily because of the findings that the strongest genetic risk for MS is the major histocompatibility complex (MHC) class II locus, and that T cells play a central role in directing the immune response. The importance that the T helper (Th)1 cytokine, interferon γ (IFN-γ), and the Th17 cytokine, interleukin (IL)-17, play in MS pathogenesis is indicated by recent clinical trial data by the enhanced presence of Th1/Th17 cells in central nervous system (CNS) tissue, cerebrospinal fluid (CSF), and blood, and by research on animal models of MS, such as experimental autoimmune encephalomyelitis (EAE). Although the majority of research on MS pathogenesis has centered on the role of effector CD4 T cells, accumulating data suggests that CD8 T cells may play a significant role in the human disease. In fact, in contrast to most animal models, the primary T cell found in the CNS in patients with MS, is the CD8 T cell. As patient-derived effector T cells are also resistant to mechanisms of dominant tolerance such as that induced by interaction with regulatory T cells (Tregs), their reduced response to regulation may also contribute to the unchecked effector T-cell activity in patients with MS. These concepts will be discussed below.
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Affiliation(s)
- Belinda J Kaskow
- Center for Neurologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Clare Baecher-Allan
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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15
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Matsushita F, Kida H, Tabei KI, Nakano C, Matsuura K, Ii Y, Sasaki R, Taniguchi A, Narita Y, Maeda M, Satoh M, Tomimoto H. Clinical significance of cortical lesions in patients with multiple sclerosis: A neuropsychological and neuroimaging study. Brain Behav 2018; 8:e00934. [PMID: 29541544 PMCID: PMC5840446 DOI: 10.1002/brb3.934] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION This study aims to investigate the association between the presence and frequency of cortical lesions (CLs), and the clinical and psychological features of multiple sclerosis (MS). METHODS A total of 19 patients with MS were examined using double inversion recovery (DIR) sequences with 3T magnetic resonance imaging (MRI) and classified into two groups: CL and non-CL. In-house software was used to quantitatively determine the atrophy of each brain region. Activities of daily living (ADL) were estimated using the Kurtzke Expanded Disability Status Scale (EDSS). Cognitive function was assessed using the following tests: Mini-Mental State Examination (MMSE), Trail Making Test (TMT), and Paced Auditory Serial Addition Task (PASAT). Z-scores were used to assess significant differences in the neuropsychological test outcomes between the groups. RESULTS Six of 19 patients had subcortical and deep WM lesions (non-CL group; diagnosed with relapsing-remitting MS). Thirteen of 19 patients had both subcortical and cortical lesions (CL group; 9-relapsing-remitting MS; 4-primary/secondary progressive MS). There were no significant differences in age, education, and disease duration, but EDSS scores were significantly higher in the CL group compared to the non-CL group. There were no significant differences in gray and white matter volume between the CL and the non-CL groups, but the white matter lesion volume was significantly higher in the CL group compared to the non-CL group. Neuropsychological tests showed significant performance worsening in the CL group as compared to the standard values for healthy individuals in their age group, especially in the TMT data. CONCLUSIONS Progressive MS, which was associated with decreased physical functioning, ADL, and cognitive impairment, was found in patients in the CL group.
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Affiliation(s)
- Futoshi Matsushita
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan.,Department of Occupational Therapy Morinomiya University Osaka Japan
| | - Hirotaka Kida
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | - Ken-Ichi Tabei
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | - Chizuru Nakano
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | | | - Yuichiro Ii
- Department of Neurology Mie University Mie Japan
| | | | | | - Yugo Narita
- Department of Neurology Mie University Mie Japan
| | | | - Masayuki Satoh
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan
| | - Hidekazu Tomimoto
- Department of Dementia Prevention and Therapeutics Mie University Mie Japan.,Department of Neurology Mie University Mie Japan
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Yousuf F, Dupuy SL, Tauhid S, Chu R, Kim G, Tummala S, Khalid F, Weiner HL, Chitnis T, Healy BC, Bakshi R. A two-year study using cerebral gray matter volume to assess the response to fingolimod therapy in multiple sclerosis. J Neurol Sci 2017; 383:221-229. [DOI: 10.1016/j.jns.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/14/2017] [Accepted: 10/09/2017] [Indexed: 02/04/2023]
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Rocca MA, Comi G, Filippi M. The Role of T1-Weighted Derived Measures of Neurodegeneration for Assessing Disability Progression in Multiple Sclerosis. Front Neurol 2017; 8:433. [PMID: 28928705 PMCID: PMC5591328 DOI: 10.3389/fneur.2017.00433] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is characterised by the accumulation of permanent neurological disability secondary to irreversible tissue loss (neurodegeneration) in the brain and spinal cord. MRI measures derived from T1-weighted image analysis (i.e., black holes and atrophy) are correlated with pathological measures of irreversible tissue loss. Quantifying the degree of neurodegeneration in vivo using MRI may offer a surrogate marker with which to predict disability progression and the effect of treatment. This review evaluates the literature examining the association between MRI measures of neurodegeneration derived from T1-weighted images and disability in MS patients. Methods A systematic PubMed search was conducted in January 2017 to identify MRI studies in MS patients investigating the relationship between “black holes” and/or atrophy in the brain and spinal cord, and disability. Results were limited to human studies published in English in the previous 10 years. Results A large number of studies have evaluated the association between the previous MRI measures and disability. These vary considerably in terms of study design, duration of follow-up, size, and phenotype of the patient population. Most, although not all, have shown that there is a significant correlation between disability and black holes in the brain, as well as atrophy of the whole brain and grey matter. The results for brain white matter atrophy are less consistently positive, whereas studies evaluating spinal cord atrophy consistently showed a significant correlation with disability. Newer ways of measuring atrophy, thanks to the development of segmentation and voxel-wise methods, have allowed us to assess the involvement of strategic regions of the CNS (e.g., thalamus) and to map the regional distribution of damage. This has resulted in better correlations between MRI measures and disability and in the identification of the critical role played by some CNS structures for MS clinical manifestations. Conclusion The evaluation of MRI measures of atrophy as predictive markers of disability in MS is a highly active area of research. At present, measurement of atrophy remains within the realm of clinical studies, but its utility in clinical practice has been recognized and barriers to its implementation are starting to be addressed.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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18
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Tummala S, Singhal T, Oommen VV, Kim G, Khalid F, Healy BC, Bakshi R. Spinal Cord as an Adjunct to Brain Magnetic Resonance Imaging in Defining "No Evidence of Disease Activity" in Multiple Sclerosis. Int J MS Care 2017; 19:158-164. [PMID: 28603465 DOI: 10.7224/1537-2073.2016-068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Monitoring patients with multiple sclerosis (MS) for “no evidence of disease activity” (NEDA) may help guide disease-modifying therapy (DMT) management decisions. Whereas surveillance brain magnetic resonance imaging (MRI) is common, the role of spinal cord monitoring for NEDA is unknown. Objective To evaluate the role of brain and spinal cord 3T MRI in the 1-year evaluation of NEDA. Methods Of 61 study patients (3 clinically isolated syndrome, 56 relapsing-remitting, 2 secondary progressive), 56 (91.8%) were receiving DMT. The MRI included brain fluid-attenuated inversion recovery and cervical/thoracic T2-weighted fast spin echo images. On MRI, NEDA was defined as the absence of new or enlarging T2 lesions at 1 year. Results Thirty-nine patients (63.9%) achieved NEDA by brain MRI, only one of whom had spinal cord activity. This translates to a false-positive rate for NEDA based on the brain of 2.6% (95% CI, 0.1%–13.5%). Thirty-eight patients (62.3%) had NEDA by brain and spinal cord MRI. Fifty-five patients (90.2%) had NEDA by spinal cord MRI, 17 of whom had brain activity. Of the 22 patients (36.1%) with brain changes, 5 had spinal cord changes. No evidence of disease activity was sustained in 48.3% of patients at 1 year and was the same with the addition of spinal cord MRI. Patients with MRI activity in either the brain or the spinal cord only were more likely to have activity in the brain (P = .0001). Conclusions Spinal cord MRI had a low diagnostic yield as an adjunct to brain MRI at 3T in monitoring patients with MS for NEDA over 1 year. Studies with larger data sets are needed to confirm these findings.
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Regev K, Healy BC, Khalid F, Paul A, Chu R, Tauhid S, Tummala S, Diaz-Cruz C, Raheja R, Mazzola MA, von Glehn F, Kivisakk P, Dupuy SL, Kim G, Chitnis T, Weiner HL, Gandhi R, Bakshi R. Association Between Serum MicroRNAs and Magnetic Resonance Imaging Measures of Multiple Sclerosis Severity. JAMA Neurol 2017; 74:275-285. [PMID: 28114622 DOI: 10.1001/jamaneurol.2016.5197] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance MicroRNAs (miRNAs) are promising multiple sclerosis (MS) biomarkers. Establishing the association between miRNAs and magnetic resonance imaging (MRI) measures of disease severity will help define their significance and potential impact. Objective To correlate circulating miRNAs in the serum of patients with MS to brain and spinal MRI. Design, Setting, and Participants A cross-sectional study comparing serum miRNA samples with MRI metrics was conducted at a tertiary MS referral center. Two independent cohorts (41 and 79 patients) were retrospectively identified from the Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital. Expression of miRNA was determined by locked nucleic acid-based quantitative real-time polymerase chain reaction. Spearman correlation coefficients were used to test the association between miRNA and brain lesions (T2 hyperintense lesion volume [T2LV]), the ratio of T1 hypointense lesion volume [T1LV] to T2LV [T1:T2]), brain atrophy (whole brain and gray matter), and cervical spinal cord lesions (T2LV) and atrophy. The study was conducted from December 2013 to April 2016. Main Outcomes and Measures miRNA expression. Results Of the 120 patients included in the study, cohort 1 included 41 participants (7 [17.1%] men), with mean (SD) age of 47.7 (9.5) years; cohort 2 had 79 participants (26 [32.9%] men) with a mean (SD) age of 43.0 (7.5) years. Associations between miRNAs and MRIs were both protective and pathogenic. Regarding miRNA signatures, a topographic specificity differed for the brain vs the spinal cord, and the signature differed between T2LV and atrophy/destructive measures. Four miRNAs showed similar significant protective correlations with T1:T2 in both cohorts, with the highest for hsa.miR.143.3p (cohort 1: Spearman correlation coefficient rs = -0.452, P = .003; cohort 2: rs = -0.225, P = .046); the others included hsa.miR.142.5p (cohort 1: rs = -0.424, P = .006; cohort 2: rs = -0.226, P = .045), hsa.miR.181c.3p (cohort 1: rs = -0.383, P = .01; cohort 2: rs = -0.222, P = .049), and hsa.miR.181c.5p (cohort 1: rs = -0.433, P = .005; cohort 2: rs = -0.231, P = .04). In the 2 cohorts, hsa.miR.486.5p (cohort 1: rs = 0.348, P = .03; cohort 2: rs = 0.254, P = .02) and hsa.miR.92a.3p (cohort 1: rs = 0.392, P = .01; cohort 2: rs = 0.222, P = .049) showed similar significant pathogenic correlations with T1:T2; hsa.miR.375 (cohort 1: rs = -0.345, P = .03; cohort 2: rs = -0.257, P = .022) and hsa.miR.629.5p (cohort 1: rs = -0.350, P = .03; cohort 2: rs = -0.269, P = .02) showed significant pathogenic correlations with brain atrophy. Although we found several miRNAs associated with MRI outcomes, none of these associations remained significant when correcting for multiple comparisons, suggesting that further validation of our findings is needed. Conclusions and Relevance Serum miRNAs may serve as MS biomarkers for monitoring disease progression and act as surrogate markers to identify underlying disease processes.
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Affiliation(s)
- Keren Regev
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian C Healy
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Biostatistics Center, Massachusetts General Hospital, Boston
| | - Fariha Khalid
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anu Paul
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Renxin Chu
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shahamat Tauhid
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Subhash Tummala
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Camilo Diaz-Cruz
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Radhika Raheja
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria A Mazzola
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Felipe von Glehn
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pia Kivisakk
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sheena L Dupuy
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gloria Kim
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roopali Gandhi
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rohit Bakshi
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts3Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts4Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Healy BC, Buckle GJ, Ali EN, Egorova S, Khalid F, Tauhid S, Glanz BI, Chitnis T, Guttmann CRG, Weiner HL, Bakshi R. Characterizing Clinical and MRI Dissociation in Patients with Multiple Sclerosis. J Neuroimaging 2017; 27:481-485. [PMID: 28261936 PMCID: PMC5600109 DOI: 10.1111/jon.12433] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/25/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Two common approaches for measuring disease severity in multiple sclerosis (MS) are the clinical exam and brain magnetic resonance imaging (MRI) scan. Although most patients show similar disease severity on both measures, some patients have clinical/MRI dissociation. METHODS Subjects from a comprehensive care MS center who had a concurrent brain MRI, spinal cord MRI, clinical examination, and patient reported outcomes were classified into three groups based on the Expanded Disability Status Scale (EDSS) and cerebral T2 hyperintense lesion volume (T2LV). The first group was the low lesion load/high disability group (LL/HD) with T2LV < 2 ml and EDSS ≥ 3. The second group was the high lesion load/low disability group (HL/LD) with T2LV > 6 ml and EDSS ≤ 1.5. All remaining subjects were classified as not dissociated. The three groups were compared using regression techniques for unadjusted analyses and to adjust for age, disease duration, and gender. RESULTS Twenty‐two subjects were classified as LL/HD (4.1%; 95% CI: 2.6%, 6.2%), and 50 subjects were classified as HL/LD (9.4%; 95% CI: 7.0%, 12.2%). Subjects in the LL/HD group were more likely to have a progressive form of MS and had significantly lower physical quality of life in adjusted and unadjusted analysis. Subjects in HL/LD had significantly more gadolinium‐enhancing lesions, and subjects in the LL/HD group had significantly more cervical spinal cord lesions. CONCLUSIONS Our results indicate that dissociation may occur between physical disability and cerebral lesion volume in either direction in patients with MS. Type of MS, brain atrophy, and spinal cord lesions may help to bridge this dissociation.
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Affiliation(s)
- Brian C Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Guy J Buckle
- Neuroimaging Research, MS Institute at Shepard Center, Atlanta, GA
| | - Eman N Ali
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Svetlana Egorova
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Fariha Khalid
- Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Boston, MA
| | - Shahamat Tauhid
- Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Boston, MA
| | - Bonnie I Glanz
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Howard L Weiner
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rohit Bakshi
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Boston, MA
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21
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Uher T, Vaneckova M, Sormani MP, Krasensky J, Sobisek L, Dusankova JB, Seidl Z, Havrdova E, Kalincik T, Benedict RHB, Horakova D. Identification of multiple sclerosis patients at highest risk of cognitive impairment using an integrated brain magnetic resonance imaging assessment approach. Eur J Neurol 2016; 24:292-301. [PMID: 27873386 DOI: 10.1111/ene.13200] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE While impaired cognitive performance is common in multiple sclerosis (MS), it has been largely underdiagnosed. Here a magnetic resonance imaging (MRI) screening algorithm is proposed to identify patients at highest risk of cognitive impairment. The objective was to examine whether assessment of lesion burden together with whole brain atrophy on MRI improves our ability to identify cognitively impaired MS patients. METHODS Of the 1253 patients enrolled in the study, 1052 patients with all cognitive, volumetric MRI and clinical data available were included in the analysis. Brain MRI and neuropsychological assessment with the Brief International Cognitive Assessment for Multiple Sclerosis were performed. Multivariable logistic regression and individual prediction analysis were used to investigate the associations between MRI markers and cognitive impairment. The results of the primary analysis were validated at two subsequent time points (months 12 and 24). RESULTS The prevalence of cognitive impairment was greater in patients with low brain parenchymal fraction (BPF) (<0.85) and high T2 lesion volume (T2-LV) (>3.5 ml) than in patients with high BPF (>0.85) and low T2-LV (<3.5 ml), with an odds ratio (OR) of 6.5 (95% CI 4.4-9.5). Low BPF together with high T2-LV identified in 270 (25.7%) patients predicted cognitive impairment with 83% specificity, 82% negative predictive value, 51% sensitivity and 75% overall accuracy. The risk of confirmed cognitive decline over the follow-up was greater in patients with high T2-LV (OR 2.1; 95% CI 1.1-3.8) and low BPF (OR 2.6; 95% CI 1.4-4.7). CONCLUSIONS The integrated MRI assessment of lesion burden and brain atrophy may improve the stratification of MS patients who may benefit from cognitive assessment.
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Affiliation(s)
- T Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M P Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - J Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - L Sobisek
- Department of Statistics and Probability, University of Economics in Prague, Prague, Czech Republic
| | - J Blahova Dusankova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Z Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - E Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - T Kalincik
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - R H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - D Horakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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22
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Dupuy SL, Tauhid S, Hurwitz S, Chu R, Yousuf F, Bakshi R. The Effect of Dimethyl Fumarate on Cerebral Gray Matter Atrophy in Multiple Sclerosis. Neurol Ther 2016; 5:215-229. [PMID: 27744504 PMCID: PMC5130921 DOI: 10.1007/s40120-016-0054-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The objective of this pilot study was to compare cerebral gray matter (GM) atrophy over 1 year in patients starting dimethyl fumarate (DMF) for multiple sclerosis (MS) to that of patients on no disease-modifying treatment (noDMT). DMF is an established therapy for relapsing-remitting (RR) MS. METHODS We retrospectively analyzed 20 patients with RRMS at the start of DMF [age (mean ± SD) 46.1 ± 10.2 years, Expanded Disability Status Scale (EDSS) score 1.1 ± 1.2, timed 25-foot walk (T25FW) 4.6 ± 0.8 s] and eight patients on noDMT (age 42.5 ± 6.6 years, EDSS 1.7 ± 1.1, T25FW 4.4 ± 0.6 s). Baseline and 1-year 3D T1-weighted 3T MRI was processed with automated pipelines (SIENA, FSL-FIRST) to assess percentage whole brain volume change (PBVC) and deep GM (DGM) atrophy. Group differences were assessed by analysis of covariance, with time between MRI scans as a covariate. RESULTS Over 1 year, the DMF group showed a lower rate of whole brain atrophy than the noDMT group (PBVC: -0.37 ± 0.49% vs. -1.04 ± 0.67%, p = 0.005). The DMF group also had less change in putamen volume (-0.06 ± 0.22 vs. -0.32 ± 0.28 ml, p = 0.02). There were no significant on-study differences between groups in caudate, globus pallidus, thalamus, total DGM volume, T2 lesion volume, EDSS, or T25FW (all p > 0.20). CONCLUSIONS These results suggest a treatment effect of DMF on GM atrophy appearing at 1 year after starting therapy. However, due to the retrospective study design and sample size, these findings should be considered preliminary, and require confirmation in future investigations. FUNDING Biogen.
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Affiliation(s)
- Sheena L Dupuy
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Shelley Hurwitz
- Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Renxin Chu
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Fawad Yousuf
- Department of Neurology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Rohit Bakshi
- Departments of Neurology and Radiology, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
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23
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Yousuf F, Kim G, Tauhid S, Glanz BI, Chu R, Tummala S, Healy BC, Bakshi R. The Contribution of Cortical Lesions to a Composite MRI Scale of Disease Severity in Multiple Sclerosis. Front Neurol 2016; 7:99. [PMID: 27445966 PMCID: PMC4925661 DOI: 10.3389/fneur.2016.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/13/2016] [Indexed: 12/28/2022] Open
Abstract
Objective To test a new version of the Magnetic Resonance Disease Severity Scale (v.3 = MRDSS3) for multiple sclerosis (MS), incorporating cortical gray matter lesions (CLs) from 3T magnetic resonance imaging (MRI). Background MRDSS1 was a cerebral MRI-defined composite scale of MS disease severity combining T2 lesion volume (T2LV), the ratio of T1 to T2LV (T1/T2), and whole brain atrophy [brain parenchymal fraction (BPF)]. MRDSS2 expanded the scale to include cerebral gray matter fraction (GMF) and upper cervical spinal cord area (UCCA). We tested the contribution of CLs to the scale (MRDSS3) in modeling the MRI relationship to clinical status. Methods We studied 51 patients [3 clinically isolated syndrome, 43 relapsing-remitting, 5 progressive forms, age (mean ± SD) 40.7 ± 9.1 years, Expanded Disability Status Scale (EDSS) score 1.6 ± 1.7] and 20 normal controls by high-resolution cerebrospinal MRI. CLs required visibility on both fluid-attenuated inversion-recovery (FLAIR) and modified driven equilibrium Fourier transform sequences. The MACFIMS battery defined cognitively impaired (n = 18) vs. preserved (n = 33) MS subgroups. Results EDSS significantly correlated with only BPF, UCCA, MRDSS2, and MRDSS3 (all p < 0.05). After adjusting for depressive symptoms, the cognitively impaired group had higher severity of MRI metrics than the cognitively preserved group in regard to only BPF, GMF, T1/T2, MRDSS1, and MRDSS2 (all p < 0.05). CL number was not significantly related to EDSS score or cognition status. Conclusion CLs from 3T MRI did not appear to improve the validity of the MRDSS. Further studies employing advanced sequences or higher field strengths may show more utility for the incorporation of CLs into composite scales.
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Affiliation(s)
- Fawad Yousuf
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gloria Kim
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bonnie I Glanz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Renxin Chu
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Subhash Tummala
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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24
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Spring cleaning: time to rethink imaging research lines in MS? J Neurol 2016; 263:1893-902. [PMID: 26886204 DOI: 10.1007/s00415-016-8060-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 12/15/2022]
Abstract
Together with recently advanced MRI technological capability, new needs and updated questions are emerging in imaging research in multiple sclerosis (MS), especially with respect to the identification of novel in vivo biomarkers of MS-relevant pathological processes. Expected benefits will involve approaches to diagnosis and clinical classification. In detail, three main points of discussion are addressed in this review: (1) new imaging biomarkers (centrifugal/centripetal lesion enhancement, central vein, paramagnetic rims at the lesion edge, subpial cortical demyelination); (2) thinking about high-resolution MR from a pathological perspective (from postmortem to in vivo staging); and (3) the clinical utility of quantitative MRI. In this context, research efforts should increasingly be focused on the direct in vivo visualization of "hidden" inflammation, beyond what can be detected with conventional gadolinium-based methods, as well as remyelination and repair, since these are likely to represent critical pathological processes and potential therapeutic targets. Concluding remarks concern the limitations, challenges, and ultimately clinical role of non-conventional MRI techniques.
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25
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Bakshi R, Yeste A, Patel B, Tauhid S, Tummala S, Rahbari R, Chu R, Regev K, Kivisäkk P, Weiner HL, Quintana FJ. Serum lipid antibodies are associated with cerebral tissue damage in multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e200. [PMID: 26894204 PMCID: PMC4747479 DOI: 10.1212/nxi.0000000000000200] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/08/2015] [Indexed: 01/04/2023]
Abstract
Objective: To determine whether peripheral immune responses as measured by serum antigen arrays are linked to cerebral MRI measures of disease severity in multiple sclerosis (MS). Methods: In this cross-sectional study, serum samples were obtained from patients with relapsing-remitting MS (n = 21) and assayed using antigen arrays that contained 420 antigens including CNS-related autoantigens, lipids, and heat shock proteins. Normalized compartment-specific global brain volumes were obtained from 3-tesla MRI as surrogates of atrophy, including gray matter fraction (GMF), white matter fraction (WMF), and total brain parenchymal fraction (BPF). Total brain T2 hyperintense lesion volume (T2LV) was quantified from fluid-attenuated inversion recovery images. Results: We found serum antibody patterns uniquely correlated with BPF, GMF, WMF, and T2LV. Furthermore, we identified immune signatures linked to MRI markers of neurodegeneration (BPF, GMF, WMF) that differentiated those linked to T2LV. Each MRI measure was correlated with a specific set of antibodies. Strikingly, immunoglobulin G (IgG) antibodies to lipids were linked to brain MRI measures. Based on the association between IgG antibody reactivity and each unique MRI measure, we developed a lipid index. This comprised the reactivity directed against all of the lipids associated with each specific MRI measure. We validated these findings in an additional independent set of patients with MS (n = 14) and detected a similar trend for the correlations between BPF, GMF, and T2LV vs their respective lipid indexes. Conclusions: We propose serum antibody repertoires that are associated with MRI measures of cerebral MS involvement. Such antibodies may serve as biomarkers for monitoring disease pathology and progression.
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Affiliation(s)
- Rohit Bakshi
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ada Yeste
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bonny Patel
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shahamat Tauhid
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Subhash Tummala
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Roya Rahbari
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Renxin Chu
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Keren Regev
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Pia Kivisäkk
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Howard L Weiner
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Francisco J Quintana
- Partners Multiple Sclerosis Center (R.B., S. Tauhid, S. Tummala, R.C., H.L.W.) and Ann Romney Center for Neurologic Diseases (R.B., A.Y., B.P., R.R., K.R., P.K., H.L.W., F.J.Q.), Neurology (R.B., A.Y., B.P., S. Tauhid, S. Tummala, R.R., R.C., K.R., P.K., H.L.W., F.J.Q.) and Radiology (R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Arpín EC, Sobrino TG, Vivero CD, del Campo Amigo Jorrín M, Regal AR, González JP, Bouzas ML. Changes in brain atrophy indices in patients with relapsing-remitting multiple sclerosis treated with natalizumab. Neurodegener Dis Manag 2016; 6:5-12. [PMID: 26782312 DOI: 10.2217/nmt.15.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM To evaluate the effect of natalizumab on progression of brain atrophy in multiple sclerosis (MS) patients and to search for a clinical or radiological marker of progression of brain atrophy. PATIENTS AND METHODS We retrospectively recorded demographic and clinical data, as well as the corpus callosum index (CCI) using MRI, in MS patients treated with natalizumab for 1-4 years. RESULTS In the study population (n = 29), baseline mean CCI was 0.37 ± 0.04 and final CCI 0.36 ± 0.04. 17 patients did not develop brain atrophy during follow-up. There was no statistically significant relationship between progression of atrophy and clinical and radiological parameters. CONCLUSION Natalizumab may have a neuroprotective effect.
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Affiliation(s)
- Eva Costa Arpín
- Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Tania García Sobrino
- Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | | | - Ana Rodríguez Regal
- Department of Neurology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - José Prieto González
- Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Manuela Lema Bouzas
- Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
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Arnold DL, Li D, Hohol M, Chakraborty S, Chankowsky J, Alikhani K, Duquette P, Bhan V, Montanera W, Rabinovitch H, Morrish W, Vandorpe R, Guilbert F, Traboulsee A, Kremenchutzky M. Evolving role of MRI in optimizing the treatment of multiple sclerosis: Canadian Consensus recommendations. Mult Scler J Exp Transl Clin 2015; 1:2055217315589775. [PMID: 28607695 PMCID: PMC5433339 DOI: 10.1177/2055217315589775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/03/2015] [Indexed: 01/10/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is increasingly important for the early detection of suboptimal responders to disease-modifying therapy for relapsing–remitting multiple sclerosis. Treatment response criteria are becoming more stringent with the use of composite measures, such as no evidence of disease activity (NEDA), which combines clinical and radiological measures, and NEDA-4, which includes the evaluation of brain atrophy. Methods The Canadian MRI Working Group of neurologists and radiologists convened to discuss the use of brain and spinal cord imaging in the assessment of relapsing–remitting multiple sclerosis patients during the treatment course. Results Nine key recommendations were developed based on published sources and expert opinion. Recommendations addressed image acquisition, use of gadolinium, MRI requisitioning by clinicians, and reporting of lesions and brain atrophy by radiologists. Routine MRI follow-ups are recommended beginning at three to six months after treatment initiation, at six to 12 months after the reference scan, and annually thereafter. The interval between scans may be altered according to clinical circumstances. Conclusions The Canadian recommendations update the 2006 Consortium of MS Centers Consensus revised guidelines to assist physicians in their management of MS patients and to aid in treatment decision making.
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Affiliation(s)
| | - David Li
- University of British Columbia, Canada
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28
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McGee J, Minagar A. Utilization of brain MRI with focus on cerebral lesions and atrophy to better characterize MS phenotypes. J Neurol Sci 2014; 346:4-5. [PMID: 25218415 DOI: 10.1016/j.jns.2014.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/29/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Jeanie McGee
- Department of Neurology, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA
| | - Alireza Minagar
- Department of Neurology, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA.
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