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Leonard M, Renard F, Harsan L, Pottecher J, Braun M, Schneider F, Froehlig P, Blanc F, Roquet D, Achard S, Meyer N, Kremer S. Diffusion tensor imaging reveals diffuse white matter injuries in locked-in syndrome patients. PLoS One 2019; 14:e0213528. [PMID: 30969973 PMCID: PMC6457498 DOI: 10.1371/journal.pone.0213528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 02/22/2019] [Indexed: 12/03/2022] Open
Abstract
Locked-in syndrome (LIS) is a state of quadriplegia and anarthria with preserved consciousness, which is generally triggered by a disruption of specific white matter fiber tracts, following a lesion in the ventral part of the pons. However, the impact of focal lesions on the whole brain white matter microstructure and structural connectivity pathways remains unknown. We used diffusion tensor magnetic resonance imaging (DT-MRI) and tract-based statistics to characterise the whole white matter tracts in seven consecutive LIS patients, with ventral pontine injuries but no significant supratentorial lesions detected with morphological MRI. The imaging was performed in the acute phase of the disease (26 ± 13 days after the accident). DT-MRI-derived metrics were used to quantitatively assess global white matter alterations. All diffusion coefficient Z-scores were decreased for almost all fiber tracts in all LIS patients, with diffuse white matter alterations in both infratentorial and supratentorial areas. A mixture model of two multidimensional Gaussian distributions was fitted to cluster the white matter fiber tracts studied in two groups: the least (group 1) and most injured white matter fiber tracts (group 2). The greatest injuries were revealed along pathways crossing the lesion responsible for the LIS: left and right medial lemniscus (98.4% and 97.9% probability of belonging to group 2, respectively), left and right superior cerebellar peduncles (69.3% and 45.7% probability) and left and right corticospinal tract (20.6% and 46.5% probability). This approach demonstrated globally compromised white matter tracts in the acute phase of LIS, potentially underlying cognitive deficits.
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Affiliation(s)
- Mylene Leonard
- Service d’imagerie 2, Hopitaux Universitaires de Strasbourg, Strabourg, France
- Faculté de medecine, Université de Strasbourg, Strasbourg, France
- * E-mail:
| | - Felix Renard
- Unité IRM 3T-Recherche-IRMaGE-Inserm US 17/CNRS UMS 3552, Université de Grenoble-Alpes, Grenoble, France
- Laboratoire MATICE-Pôle Recherche, CHU de Grenoble, Grenoble, France
- EA AGEIS, Univ. Grenoble-Alpes, Grenoble, France
| | - Laura Harsan
- Faculté de medecine, Université de Strasbourg, Strasbourg, France
- Engineering science, computer science and imaging laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France
- Department of Biophysics and Nuclear Medicine, University Hospital Strasbourg, Strasbourg, France
| | - Julien Pottecher
- Service d’Anesthésie-Réanimation Chirurgicale, Hopitaux Universitaires de Strasbourg, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de medecine, Université de Strasbourg, Strasbourg, France
- EA3072, Université de Strasbourg, Strasbourg, France
| | - Marc Braun
- Service de Neuroradiologie, CHRU de Nancy, Nancy, France
- Département d’anatomie, Faculté de medecine, Université de Lorraine, Nancy, France
- Inserm U947, Université de Lorraine, Nancy, France
| | - Francis Schneider
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de medecine, Université de Strasbourg, Strasbourg, France
- Service de Réanimation Médicale, Hopitaux Universitaires de Strasbourg, Strasbourg, France
- Inserm U1121, Université de Strasbourg, Strasbourg, France
| | - Pierre Froehlig
- Service de neurochirurgie, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - Frederic Blanc
- Laboratoire ICube, Strasbourg, France
- Service de gériatrie, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | | | - Sophie Achard
- CNRS, Université de Grenoble Alpes, Grenoble, France
| | - Nicolas Meyer
- Laboratoire ICube, Strasbourg, France
- GMRC, Service de Santé Publique, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - Stephane Kremer
- Service d’imagerie 2, Hopitaux Universitaires de Strasbourg, Strabourg, France
- Faculté de medecine, Université de Strasbourg, Strasbourg, France
- Laboratoire ICube, Strasbourg, France
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Kremer S, Renard F, Achard S, Lana-Peixoto MA, Palace J, Asgari N, Klawiter EC, Tenembaum SN, Banwell B, Greenberg BM, Bennett JL, Levy M, Villoslada P, Saiz A, Fujihara K, Chan KH, Schippling S, Paul F, Kim HJ, de Seze J, Wuerfel JT, Cabre P, Marignier R, Tedder T, van Pelt D, Broadley S, Chitnis T, Wingerchuk D, Pandit L, Leite MI, Apiwattanakul M, Kleiter I, Prayoonwiwat N, Han M, Hellwig K, van Herle K, John G, Hooper DC, Nakashima I, Sato D, Yeaman MR, Waubant E, Zamvil S, Stüve O, Aktas O, Smith TJ, Jacob A, O'Connor K. Use of Advanced Magnetic Resonance Imaging Techniques in Neuromyelitis Optica Spectrum Disorder. JAMA Neurol 2015; 72:815-22. [PMID: 26010909 DOI: 10.1001/jamaneurol.2015.0248] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Brain parenchymal lesions are frequently observed on conventional magnetic resonance imaging (MRI) scans of patients with neuromyelitis optica (NMO) spectrum disorder, but the specific morphological and temporal patterns distinguishing them unequivocally from lesions caused by other disorders have not been identified. This literature review summarizes the literature on advanced quantitative imaging measures reported for patients with NMO spectrum disorder, including proton MR spectroscopy, diffusion tensor imaging, magnetization transfer imaging, quantitative MR volumetry, and ultrahigh-field strength MRI. It was undertaken to consider the advanced MRI techniques used for patients with NMO by different specialists in the field. Although quantitative measures such as proton MR spectroscopy or magnetization transfer imaging have not reproducibly revealed diffuse brain injury, preliminary data from diffusion-weighted imaging and brain tissue volumetry indicate greater white matter than gray matter degradation. These findings could be confirmed by ultrahigh-field MRI. The use of nonconventional MRI techniques may further our understanding of the pathogenic processes in NMO spectrum disorders and may help us identify the distinct radiographic features corresponding to specific phenotypic manifestations of this disease.
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Affiliation(s)
- Stephane Kremer
- ICube (UMR 7357, UdS, Centre National de la Recherche Scientifique), Fédération de médecine translationelle de Strasbourg, Université de Strasbourg, Strasbourg, France2Department of Radiology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Felix Renard
- Centre National de la Recherche Scientifique, Grenoble Image Parole Signal Automatique, Grenoble, France
| | - Sophie Achard
- Centre National de la Recherche Scientifique, Grenoble Image Parole Signal Automatique, Grenoble, France
| | | | - Jacqueline Palace
- Department of Neurology, Oxford University Hospital Trust, Oxford, England
| | - Nasrin Asgari
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense7Department of Neurology, Vejle Hospital, Vejle, Denmark
| | - Eric C Klawiter
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Silvia N Tenembaum
- Department of Neurology and Neurophysiology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - Brenda Banwell
- Department of Neurology, University of Pennsylvania, Philadelphia11Division of Child Neurology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benjamin M Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas13Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Jeffrey L Bennett
- Department of Neurology, University of Colorado Denver, Aurora15Department of Ophthalmology, University of Colorado Denver, Aurora
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Pablo Villoslada
- Institute of Biomedical Research August Pi Sunyer-Hospital Clínic de Barcelona, Barcelona, Spain
| | - Albert Saiz
- Institute of Biomedical Research August Pi Sunyer-Hospital Clínic de Barcelona, Barcelona, Spain
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koon Ho Chan
- University Department of Medicine, Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Sven Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, University Hospital Zurich, Zurich, Switzerland21Department of Neurology, University Hospital Zurich, Zurich, Switzerland22Neuroscience Center Zurich, Federal Technical High School Zurich, Zurich, S
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité University Medicine, Berlin, Germany25Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany26Department of Neurology, Charité University Medicine, Berlin, Ger
| | - Ho Jin Kim
- Department of Neurology, Research Institute, Goyang, Korea28Hospital of National Cancer Center, Goyang, Korea
| | - Jerome de Seze
- Neurology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France30Clinical Investigation Center (INSERM 1434), Hôpitaux Universitaires de Strasbourg, Strasbourg, France31UMR INSERM 1119 and Fédération de médecine translationelle, Strasbourg
| | - Jens T Wuerfel
- NeuroCure Clinical Research Center, Charité University Medicine, Berlin, Germany25Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin, Germany26Department of Neurology, Charité University Medicine, Berlin, Ger
| | | | | | | | - Thomas Tedder
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | | | - Maria Isabel Leite
- Department of Neurology, Oxford University Hospital Trust, Oxford, England
| | | | | | | | - May Han
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - Ichiro Nakashima
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Douglas Sato
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | | | - Olaf Stüve
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas13Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas
| | - Orhan Aktas
- University of Düsseldorf, Düsseldorf, Germany
| | | | | | - Kevin O'Connor
- Yale University School of Medicine, New Haven, Connecticut
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Laouchedi M, Galanaud D, Delmaire C, Fernandez-Vidal S, Messé A, Mesmoudi S, Oulebsir Boumghar F, Pélégrini-Issac M, Puybasset L, Benali H, Perlbarg V. Deafferentation in thalamic and pontine areas in severe traumatic brain injury. J Neuroradiol 2014; 42:202-11. [PMID: 24997478 DOI: 10.1016/j.neurad.2014.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Severe traumatic brain injury (TBI) is characterized mainly by diffuse axonal injuries (DAI). The cortico-subcortical disconnections induced by such fiber disruption play a central role in consciousness recovery. We hypothesized that these cortico-subcortical deafferentations inferred from diffusion MRI data could differentiate between TBI patients with favorable or unfavorable (death, vegetative state, or minimally conscious state) outcome one year after injury. METHODS Cortico-subcortical fiber density maps were derived by using probabilistic tractography from diffusion tensor imaging data acquired in 24 severe TBI patients and 9 healthy controls. These maps were compared between patients and controls as well as between patients with favorable (FO) and unfavorable (UFO) 1-year outcome to identify the thalamo-cortical and ponto-thalamo-cortical pathways involved in the maintenance of consciousness. RESULTS Thalamo-cortical and ponto-thalamo-cortical fiber density was significantly lower in TBI patients than in healthy controls. Comparing FO and UFO TBI patients showed thalamo-cortical deafferentation associated with unfavorable outcome for projections from ventral posterior and intermediate thalamic nuclei to the associative frontal, sensorimotor and associative temporal cortices. Specific ponto-thalamic deafferentation in projections from the upper dorsal pons (including the reticular formation) was also associated with unfavorable outcome. CONCLUSION Fiber density of cortico-subcortical pathways as measured from diffusion MRI tractography is a relevant candidate biomarker for early prediction of one-year favorable outcome in severe TBI.
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Affiliation(s)
- M Laouchedi
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France; ParIMed Team, LRPE, USTHB, Algiers, Algeria
| | - D Galanaud
- AP-HP, Pitié-Salpêtrière Hospital, Department of Neuroradiology, Paris, France
| | - C Delmaire
- CHRU de Lille, Department of Neuroradiology, Lille, France
| | - S Fernandez-Vidal
- Inserm and UPMC université Paris 06, UMR-S 975, CNRS, UMR 7225, centre de recherche de l'institut du cerveau et de la moelle épinière, Paris, France; Institut du cerveau et de la moelle épinière, centre de neuroimagerie de recherche, Paris, France
| | - A Messé
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France
| | - S Mesmoudi
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France; MATRICE Project University Paris 1 Panthéon-Sorbonne, Paris, France
| | | | - M Pélégrini-Issac
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France
| | - L Puybasset
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Surgical Neuro-Intensive Care Unit, Paris, France
| | - H Benali
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France
| | - V Perlbarg
- Inserm U1146, CNRS UMR7371, laboratoire d'imagerie biomédicale, Sorbonne universités, UPMC université Paris 06 UMCR2, CHU Pitié-Salpêtrière, 91, boulevard de l'hôpital, 75634 Paris, France.
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Lee AY, Shin DG, Park JS, Hong GR, Chang PH, Seo JP, Jang SH. Neural tracts injuries in patients with hypoxic ischemic brain injury: diffusion tensor imaging study. Neurosci Lett 2012; 528:16-21. [PMID: 22982143 DOI: 10.1016/j.neulet.2012.08.053] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 08/10/2012] [Accepted: 08/28/2012] [Indexed: 11/16/2022]
Abstract
Many studies have reported on vulnerable areas of the brain in hypoxic ischemic brain injury (HI-BI). However, little is known about the involvement of neural tracts following HI-BI. We investigated neural tract injuries in adult patients with HI-BI, using diffusion tensor tractography (DTT). Twelve consecutive patients with HI-BI and 12 control subjects were recruited for this study. We classified the patients into two subgroups according to the preservation of alertness: subgroup A-5 patients who had intact alertness and subgroup B-7 patients who had impaired alertness. DTI-Studio software was used for evaluation of seven neural tracts: corticospinal, cingulum, fornix, superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and optic radiation. We measured the DTT parameters (fractional anisotropy, apparent diffusion coefficient and voxel number) of each neural tract. In the individual analysis, all 12 patients showed injuries in all 24 neural tracts in terms of both DTT parameters and integrity, except for the corticospinal tract (75.0% injury). In the group analysis, the patient group showed neural injuries in all 24 neural tracts. In comparison of subgroups A and B, subgroup B showed more severe injuries: subgroup B showed a higher rate of disruption (39.8%) than subgroup A (12.9%) on individual DTTs and subgroup B had more severe injuries in both the cingulum and superior longitudinal fasciculus. In conclusion, we found that extensive injuries in the neural tracts were accompanied by HI-BI. Patients with impaired alertness appeared to show more severe injuries of neural tracts.
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Affiliation(s)
- Ah Young Lee
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Republic of Korea
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