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Siddiqui MI, Khan A, Memon KI, Farid MI, Kashif M, Mirjat D, Ahmad M, Raza T, Amjad MH. The Role of Advanced Magnetic Resonance Imaging Sequences in Multiple Sclerosis. Cureus 2024; 16:e67759. [PMID: 39323687 PMCID: PMC11422243 DOI: 10.7759/cureus.67759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2024] [Indexed: 09/27/2024] Open
Abstract
Background The neurological condition known as multiple sclerosis (MS) is crippling and has a complicated pathogenesis as well as a wide range of clinical symptoms, including fatigue, difficulty walking, numbness or tingling, muscle spasms and spasticity, weakness, vision problems, dizziness and vertigo, bladder and bowel dysfunction, cognitive impairment, and emotional changes. The complete scope of MS pathology cannot be fully captured by conventional magnetic resonance imaging (MRI) sequences, which has led to the investigation of sophisticated MRI methods for better diagnosis and treatment. Objective This study aims to evaluate the clinical relevance of advanced MRI sequences in multiple sclerosis. Methodology A retrospective cohort study was conducted across multiple specialized medical centers renowned for treating neurological disorders, particularly multiple sclerosis, and involved 310 patients with diverse geography seeking treatment throughout 2022. Records were searched to obtain patient information, demographics, and treatment history. Descriptive statistics and t-tests were among the statistical studies that investigated relationships between MRI biomarkers and clinical factors to help with the diagnosis and treatment of MS. A p-value of <0.05 was significant. Results The research group consisted of 310 MS patients, the majority of whom were female (67.42%) and had a mean age of 34.7 years. With hypertension (14.52%) and hyperlipidemia (19.35%) as prevalent comorbidities, the majority of patients (72.26%) were on disease-modifying treatments. The results of advanced MRI showed that lesions with white matter had higher mean diffusivity (1.25 ± 0.15 mm²/s) on DWI, lesions with reduced magnetization transfer ratio (MTR) (0.15 ± 0.03) on MTI, and lesions with reduced fractional anisotropy (FA) (0.40 ± 0.08) on diffusion tensor imaging (DTI). Additionally, the blood oxygen level-dependent (BOLD) signals in cognitive processing regions (0.75 ± 0.10) on functional MRI were different from those with normal-appearing white matter (0.40 ± 0.08). Conclusion Advanced MRI sequences are essential for bettering MS diagnosis, prognosis, and treatment because they link imaging biomarkers to important clinical parameters, which improves patient care and quality of life.
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Affiliation(s)
- Muhammad I Siddiqui
- Department of Diagnostic Radiology, North West General Hospital and Research Center, Peshawar, PAK
- Department of Clinical Imaging, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | | | - Kamran I Memon
- Department of Clinical Imaging, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | - Muhammad I Farid
- Department of Electrical and Computer Engineering, Air University, Islamabad, PAK
| | - Muhammad Kashif
- Department of Medicine, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, USA
| | - Dureali Mirjat
- Department of Medicine and Surgery, Arizona College of Osteopathic Medicine, Midwestern University, Glendale, USA
| | - Maryam Ahmad
- Department of Medicine and Surgery, Shalamar Medical and Dental College, Lahore, PAK
| | - Tauseef Raza
- Department of Orthopedics, Khyber Medical University (KMU) Institute of Medical Sciences, Kohat, PAK
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Mohamed AAB, Algahalan HA, Thabit MN. Correlation between functional MRI techniques and early disability in ambulatory patients with relapsing–remitting MS. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is a common neurological disorder which can lead to an occasional damage to the central nervous system. Conventional magnetic resonance imaging (cMRI) is an important modality in the diagnosis of MS; however, correlation between cMRI findings and clinical impairment is weak. Non-conventional MRI techniques including apparent diffusion coefficient (ADC) and magnetic resonance spectroscopy (MRS) investigate the metabolic changes over the course of MS and overcome the limits of cMRI.
A total of 80 patients with MS and 20 age and sex-matched healthy control subjects were enrolled in this cross-sectional study. Ambulatory patients with relapsing–remitting MS (RRMS) were recruited. Expanded Disability Status Scale (EDSS) was used to assess the disability and the patients were categorized into three groups “no disability”, “minimal disability” and “moderate disability”. All patients underwent cMRI techniques. ADC was measured in MS plaques and in normal appearing white matter (NAWM) adjacent and around the plaque. All metabolites concentrations were expressed as ratios including N-acetyl-aspartate/creatine (NAA/Cr), choline/N-acetyl-aspartate (Cho/NAA) and choline/creatine (Cho/Cr). ADC and metabolite concentrations were measured in the normal white matter of 20 healthy control subjects.
Results
The study was carried on 80 MS patients [36 males (45%) and 44 females (55%)] and 20 healthy control [8 males (40%) and 12 females (60%)]. The ADC values and MRS parameters in NAWM of patients with MS were significantly different from those of the control group. The number of the plaques on T2 images and black holes were significantly higher at “Minimal disability” group. Most of the enhanced plaques were at the “Moderate disability” group with P value < 0.001. The mean of ADC in the group 1, 2 and 3 of disability was 1.12 ± 0.19, 1.50 ± 0.35, 1.51 ± 0.36, respectively, with P value < 0. 001. In the group 1, 2 and 3 of disability, the mean of NAA/Cr ratio at the plaque was 1.34 ± 0.44, 1.59 ± 0.51 and 1.11 ± 0.15, respectively, with P value equal 0.001.
Conclusion
The non-conventional quantitative MRI techniques are useful tools for detection of early disability in MS patients.
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Gyori NG, Clark CA, Alexander DC, Kaden E. On the potential for mapping apparent neural soma density via a clinically viable diffusion MRI protocol. Neuroimage 2021; 239:118303. [PMID: 34174390 PMCID: PMC8363942 DOI: 10.1016/j.neuroimage.2021.118303] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/14/2022] Open
Abstract
B-tensor encoding enables estimation of spherical cellular structures in the brain. Spherical compartments may provide markers for apparent neural soma density. Model parameters can be estimated in a fast and robust way using deep learning. Practical acquisition times are achievable on widely available clinical scanners.
Diffusion MRI is a valuable tool for probing tissue microstructure in the brain noninvasively. Today, model-based techniques are widely available and used for white matter characterisation where their development is relatively mature. Conversely, tissue modelling in grey matter is more challenging, and no generally accepted models exist. With advances in measurement technology and modelling efforts, a clinically viable technique that reveals salient features of grey matter microstructure, such as the density of quasi-spherical cell bodies and quasi-cylindrical cell projections, is an exciting prospect. As a step towards capturing the microscopic architecture of grey matter in clinically feasible settings, this work uses a biophysical model that is designed to disentangle the diffusion signatures of spherical and cylindrical structures in the presence of orientation heterogeneity, and takes advantage of B-tensor encoding measurements, which provide additional sensitivity compared to standard single diffusion encoding sequences. For the fast and robust estimation of microstructural parameters, we leverage recent advances in machine learning and replace conventional fitting techniques with an artificial neural network that fits complex biophysical models within seconds. Our results demonstrate apparent markers of spherical and cylindrical geometries in healthy human subjects, and in particular an increased volume fraction of spherical compartments in grey matter compared to white matter. We evaluate the extent to which spherical and cylindrical geometries may be interpreted as correlates of neural soma and neural projections, respectively, and quantify parameter estimation errors in the presence of various departures from the modelling assumptions. While further work is necessary to translate the ideas presented in this work to the clinic, we suggest that biomarkers focussing on quasi-spherical cellular geometries may be valuable for the enhanced assessment of neurodevelopmental disorders and neurodegenerative diseases.
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Affiliation(s)
- Noemi G Gyori
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom; Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.
| | - Christopher A Clark
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Enrico Kaden
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, United Kingdom; Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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G H M, G PJ, A A, P G. Detection of Active Plaques in Multiple Sclerosis using 3 and 12 Directional Diffusion-weighted Imaging: Comparison with Gadolinium-enhanced MR Imaging. J Biomed Phys Eng 2020; 10:737-744. [PMID: 33364211 PMCID: PMC7753260 DOI: 10.31661/jbpe.v0i0.925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/10/2018] [Indexed: 11/16/2022]
Abstract
Background Multiple Sclerosis (MS), distinguished by aggravating the function of central nervous system because of inflammatory demyelination. The most sensitive method for MS diagnosis is Magnetic resonance imaging (MRI). To distinguish inactive and active MS lesions, contrast-enhanced T1-weighted imaging (CE T1WI) is being used as a gold standard. There are some contraindications in gadolinium based contrast agents (GBCAs) usage. Moreover, diffusion-weighted imaging (DWI) can discover diffusion changes involved inflammatory lesions. Objective The current research aims at investigating if typical DWI (3 directional) and 12 directional DWI could be a substitute for CE T1WI in order to show active lesions of MS. Material and Methods In this cross-sectional study, 138 patients with CNS symptoms were examined. For all patients, along with CE T1WI, 3 & 12 directional DWI were performed. Intraclass correlation coefficient (ICC), receiver operating characteristic (ROC), the sensitivity versus specificity plot and the area under the curve (AUC) were calculated. Results There was a contrast enhancement in CE T1WI for 114 patients (82.6%); in addition, hyper-intense lesions on DWI 3 and DWI 12 were shown in 107 (77.5%) and 117 patients (84.7%) in order. Sensitivity, specificity and AUC were 94.7%, 62.5% and 84% for DWI 12. Moreover, the results were 86%, 62.5 and 79% for the sensitivity, specificity and AUC for DWI 3 respectively. Conclusion In spite of lower sensitivity of 12 directional DWI compared to CE T1WI, it could be used as a diagnostic sequence in differentiating enhanced lesions from non-enhanced ones when CE-MRI is a worry.
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Affiliation(s)
- Meftahi G H
- PhD, Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Pirzad Jahromi G
- PhD, Neuroscience Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azari A
- BSc, Radiology Department, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ghaemmaghami P
- PhD, Biostatistics Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Damen FC, Scotti A, Damen FW, Saran N, Valyi-Nagy T, Vukelich M, Cai K. Multimodal apparent diffusion (MAD) weighted magnetic resonance imaging. Magn Reson Imaging 2020; 77:213-233. [PMID: 33309925 DOI: 10.1016/j.mri.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 11/17/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Frederick C Damen
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Alessandro Scotti
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Frederick W Damen
- Department of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
| | - Nitu Saran
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Tibor Valyi-Nagy
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Mirko Vukelich
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA.
| | - Kejia Cai
- Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA.
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Unal S, Peker E, Erdogan S, Erden MI. Is It Possible to Discriminate Active MS Lesions with Diffusion Weighted Imaging? Eurasian J Med 2019; 51:219-223. [PMID: 31692763 DOI: 10.5152/eurasianjmed.2019.18473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Patients with multiple sclerosis (MS) are at a risk of gadolinium deposition because of multiple control imaging. Therefore, it is important to determine biomarkers that can differentiate active and chronic lesions without using contrast agent. This study aimed to assess mean apparent diffusion coefficient (ADC) values and signal intensities (SI) on diffusion weighted imaging (DWI) values of active and nonactive lesions. Materials and Methods We included 25 patients in this study. We measured mean ADC values and SI on DWI of the randomly selected active and nonactive lesions and normal appearing white matter (NAWM) for all patients with MS. SI on DWI and ADC values were normalized to the SI of the CSF. We compared all of the measurements between active and nonactive lesions, active lesions and NAWM, and nonactive lesions and NAWM. SI on DWI and mean ADC values of normal healthy white matter (NHWM) of control group were measured. A comparison was made between NHWM and NAWM. Results For patients with active lesions, the mean nADC value was 0.35±0.06 for active lesions and 0.30±0.07 for nonactive lesions (p>0.050). The mean nDWI-SI value was 3.69±0.68 for active lesions was 3.39±0.68 for nonactive lesions (p<0.050). When patients with and without active lesions were compared, both nDWI values and nADC values for active and nonactive lesions were statistically insignificant (p>0.050). Discussion In MS lesions, diffusion alternations can be quantitatively evaluated with ADC mapping. Lesions seen in patients with MS have higher mean ADC values than NAWM and NHWM.
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Affiliation(s)
- Sena Unal
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Peker
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Seyda Erdogan
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Memet Ilhan Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
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Arashloo FT, Hanzaei FF, Sedighi B, Amjad G, Younesi L. Efficacy of diffusion-weighted imaging in symptomatic and asymptomatic multiple sclerotic plaques. J Family Med Prim Care 2019; 8:2409-2413. [PMID: 31463267 PMCID: PMC6691452 DOI: 10.4103/jfmpc.jfmpc_420_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Magnetic resonance imaging (MRI) currently accompanies clinical findings in disease diagnosis, patients’ follow-up, assessment of drugs complications, and evaluation of treatment response. Although contrast-enhanced MRI (CE-MRI) is considered as the imaging modality of choice for multiple sclerosis (MS), due to disease chronicity, applying multiple doses of gadolinium-based contrast agents (GBCAs) increases the risk of nephrogenic syndrome in patients with acute (ARF) and chronic renal syndromes (CRF). Moreover, the effect of gadolinium on the fetus is not well-known in pregnant patients. Therefore, this study evaluates the possibility of replacing postcontrast images with physiologically based MRI sequences such as diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC). Method: We prospectively evaluated 26 patients with known multiple sclerosis. The patients with MS attacks and the asymptomatic patients who were referred for follow-up were enrolled. Conventional MRI including postcontrast T1W, DWI, and ADC were performed for all patients. The signal intensity (SI) of all enhancing and nonenhancing plaques of more than 10 × 10 mm size were investigated in all sequences and analyzed. Results: A total of 83 plaques were detected in T2-FLAIR sequences of which 51 plaques were enhanced (68%) after gadolinium administration. While 42 MS plaques had hypersignal intensity in DWI (56%), 32 plaques had iso- or hyposignal intensities in DWI (44%). No statistically significant values were obtained. Conclusion: Although DWI could not replace CE-MRI, using these two modalities together could increase detection of active MS plaques and alter patients’ therapy and prognosis.
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Affiliation(s)
| | - Farnaz Fahimi Hanzaei
- Clinical Research Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Behnaz Sedighi
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazaleh Amjad
- Shahid Akbar Abadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
| | - Ladan Younesi
- Shahid Akbar Abadi Clinical Research Development Unit, Iran University of Medical Sciences, Tehran, Iran
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Vertinsky AT, Li DK, Vavasour IM, Miropolsky V, Zhao G, Zhao Y, Riddehough A, Moore GW, Traboulsee A, Laule C. Diffusely Abnormal White Matter, T2
Burden of Disease, and Brain Volume in Relapsing-Remitting Multiple Sclerosis. J Neuroimaging 2018; 29:151-159. [DOI: 10.1111/jon.12574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/09/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Alexandra T. Vertinsky
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - David K.B. Li
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
| | - Irene M. Vavasour
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Vladislav Miropolsky
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
| | - Guojun Zhao
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
| | - Yinshan Zhao
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
| | - Andrew Riddehough
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
| | - G.R. Wayne Moore
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver British Columbia Canada
| | - Anthony Traboulsee
- UBC MS/MRI Research Group; University of British Columbia; Vancouver British Columbia Canada
- Department of Medicine (Neurology); University of British Columbia; Vancouver British Columbia Canada
| | - Cornelia Laule
- Department of Radiology; University of British Columbia; Vancouver British Columbia Canada
- Department of Pathology and Laboratory Medicine; University of British Columbia; Vancouver British Columbia Canada
- International Collaboration on Repair Discoveries (ICORD); University of British Columbia; Vancouver British Columbia Canada
- Department of Physics and Astronomy; University of British Columbia; Vancouver British Columbia Canada
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Martín Noguerol T, Martínez Barbero J. Advanced diffusion MRI and biomarkers in the central nervous system: A new approach. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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10
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Martín Noguerol T, Martínez Barbero JP. Advanced diffusion MRI and biomarkers in the central nervous system: a new approach. RADIOLOGIA 2017; 59:273-285. [PMID: 28552216 DOI: 10.1016/j.rx.2017.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/13/2017] [Accepted: 04/16/2017] [Indexed: 01/08/2023]
Abstract
The introduction of diffusion-weighted sequences has revolutionized the detection and characterization of central nervous system (CNS) disease. Nevertheless, the assessment of diffusion studies of the CNS is often limited to qualitative estimation. Moreover, the pathophysiological complexity of the different entities that affect the CNS cannot always be correctly explained through classical models. The development of new models for the analysis of diffusion sequences provides numerous parameters that enable a quantitative approach to both diagnosis and prognosis as well as to monitoring the response to treatment; these parameters can be considered potential biomarkers of health and disease. In this update, we review the physical bases underlying diffusion studies and diffusion tensor imaging, advanced models for their analysis (intravoxel coherent motion and kurtosis), and the biological significance of the parameters derived.
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Affiliation(s)
- T Martín Noguerol
- Sección de Neurorradiología. Clínica las Nieves. SERCOSA. Grupo HealthTime, Jaén, España.
| | - J P Martínez Barbero
- Sección de Neurorradiología. Clínica las Nieves. SERCOSA. Grupo HealthTime, Jaén, España
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Igra MS, Paling D, Wattjes MP, Connolly DJA, Hoggard N. Multiple sclerosis update: use of MRI for early diagnosis, disease monitoring and assessment of treatment related complications. Br J Radiol 2017; 90:20160721. [PMID: 28362522 DOI: 10.1259/bjr.20160721] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
MRI has long been established as the most sensitive in vivo technique for detecting multiple sclerosis (MS) lesions. The 2010 revisions of the McDonald Criteria have simplified imaging criteria, such that a diagnosis of MS can be made on a single contrast-enhanced MRI scan in the appropriate clinical context. New disease-modifying therapies have proven effective in reducing relapse rate and severity. Several of these therapies, most particularly natalizumab, but also dimethyl fumarate and fingolimod, have been associated with progressive multifocal leukoencephalopathy (PML). PML-immune reconstitution inflammatory syndrome (IRIS) has been recognized in patients following cessation of natalizumab owing to PML, and discontinuation for other reasons can lead to the phenomenon of rebound MS. These complications often provide a diagnostic dilemma and have implications for imaging surveillance of patients. We demonstrate how the updated McDonald Criteria aid the diagnosis of MS and describe the imaging characteristics of conditions such as PML and PML-IRIS in the context of MS. Potential imaging surveillance protocols are considered for the diagnosis and assessment of complications. We will explain how changes in MS treatment are leading to new imaging demands in order to monitor patients for disease progression and treatment-related complications.
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Affiliation(s)
- Mark S Igra
- 1 Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield, UK
| | - David Paling
- 2 Department of Clinical Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Mike P Wattjes
- 3 Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | | | - Nigel Hoggard
- 4 Academic Unit of Radiology, University of Sheffield, Sheffield, UK
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12
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Cohen Y, Anaby D, Morozov D. Diffusion MRI of the spinal cord: from structural studies to pathology. NMR IN BIOMEDICINE 2017; 30:e3592. [PMID: 27598689 DOI: 10.1002/nbm.3592] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 06/01/2016] [Accepted: 07/05/2016] [Indexed: 05/27/2023]
Abstract
Diffusion MRI is extensively used to study brain microarchitecture and pathologies, and water diffusion appears highly anisotropic in the white matter (WM) of the spinal cord (SC). Despite these facts, the use of diffusion MRI to study the SC, which has increased in recent years, is much less common than that in the brain. In the present review, after a brief outline of early studies of diffusion MRI (DWI) and diffusion tensor MRI (DTI) of the SC, we provide a short survey on DTI and on diffusion MRI methods beyond the tensor that have been used to study SC microstructure and pathologies. After introducing the porous view of WM and describing the q-space approach and q-space diffusion MRI (QSI), we describe other methodologies that can be applied to study the SC. Selected applications of the use of DTI, QSI, and other more advanced diffusion MRI methods to study SC microstructure and pathologies are presented, with some emphasis on the use of less conventional diffusion methodologies. Because of length constraints, we concentrate on structural studies and on a few selected pathologies. Examples of the use of diffusion MRI to study dysmyelination, demyelination as in experimental autoimmune encephalomyelitis and multiple sclerosis, amyotrophic lateral sclerosis, and traumatic SC injury are presented. We conclude with a brief summary and a discussion of challenges and future directions for diffusion MRI of the SC. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yoram Cohen
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
- The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Anaby
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Darya Morozov
- The Sackler School of Chemistry, The Raymond and Beverly Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel
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Davoudi Y, Foroughipour M, Torabi R, Layegh P, Matin N, Shoeibi A. Diffusion Weighted Imaging in Acute Attacks of Multiple Sclerosis. IRANIAN JOURNAL OF RADIOLOGY 2016; 13:e21740. [PMID: 27679697 PMCID: PMC5035938 DOI: 10.5812/iranjradiol.21740] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 11/21/2022]
Abstract
Background Multiple sclerosis (MS) is one of the most common autoimmune disorders of the central nervous system. In spite of various imaging modalities, the definitive diagnosis of MS remains challenging. Objectives This study was designed to evaluate the usefulness of diffusion weighted imaging (DWI) in the diagnosis of acute MS attack and to compare its results with contrast enhanced MRI (CE-MRI). Patients and Methods In this cross sectional study, seventy patients with definite diagnosis of relapsing-remitting MS were included. CE-MRI using 0.1 mmol/kg gadolinium as well as DWI sequences were performed for all patients. The percentage of patients with positive DWI was compared with the results of CE-MRI and the consistency between the two imaging modalities was evaluated. Moreover, the relationship between the time of onset of patient’s symptoms and test results for both methods were investigated. Results CE-MRI yielded positive results for 61 (87%) patients and DWI yielded positive for 53 (76%) patients. In fifty patients (71.42%), both tests were positive and in six cases (8.57%), both were negative. The test results of three patients turned out to be positive in DWI, while they tested negative in CE-MRI. There was no significant relationship between the results of CE-MRI as well as DWI and the time of imaging from the onset of symptoms. Conclusion These data indicate that while CE-MRI will depict more positive results, there are cases in which DWI will show a positive result while CE-MRI is negative. We suggest that the combination of these two imaging modalities might yield more positive results in diagnosing acute MS attack giving rise to a more accurate diagnosis.
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Affiliation(s)
- Yasmin Davoudi
- Department of Radiology, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Foroughipour
- Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Torabi
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parvaneh Layegh
- Department of Radiology, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nassim Matin
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Shoeibi
- Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding author: Ali Shoeibi, Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, P. O. Box: 9197969764, Mashhad, Iran. Tel: +98-9155137344, Fax: +98-5138429828, E-mail:
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14
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Krishnan P, Muthusami P, Heyn C, Shroff M. Advances in pediatric neuroimaging. Indian J Pediatr 2015; 82:154-65. [PMID: 25557178 DOI: 10.1007/s12098-014-1657-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 12/03/2014] [Indexed: 12/19/2022]
Abstract
Conventional MRI protocols are an integral part of routine clinical imaging in pediatric patients. The advent of several newer MRI techniques provides crucial insight into the structural integrity and functional aspects of the developing brain, especially with the introduction of 3T MRI systems in clinical practice. The field of pediatric neuroimaging continues to evolve, with greater emphasis on high spatial resolution, faster scan time, as well as a quest for visualization of the functional aspects of the human brain. MR vendors are increasingly focusing on optimizing MR technology to make it suitable for children, in whom as compared to adults the head size is usually smaller and demonstrates inherent neuroanatomical differences relating to brain development. The eventual goal of these advances would be to evolve as potential biomarkers for predicting neurodevelopment outcomes and prognostication, in addition to their utility in routine diagnostic and therapeutic decision-making. Advanced MR techniques like diffusion tensor imaging, functional MRI, MR perfusion, spectroscopy, volumetric imaging and arterial spin labeling add to our understanding of normal brain development and pathophysiology of various neurological disease processes. This review is primarily focused on outlining advanced MR techniques and their current and potential pediatric neuroimaging applications as well as providing a brief overview of advances in hardware and machine design.
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Affiliation(s)
- Pradeep Krishnan
- Division of Pediatric Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada,
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15
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A macroscopic view of microstructure: Using diffusion-weighted images to infer damage, repair, and plasticity of white matter. Neuroscience 2014; 276:14-28. [DOI: 10.1016/j.neuroscience.2013.09.004] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/19/2013] [Accepted: 09/03/2013] [Indexed: 12/13/2022]
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16
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Alomair OI, Smith MT, Brereton IM, Galloway GJ, Kurniawan ND. Current developments in MRI for assessing rodent models of multiple sclerosis. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: MRI is a key radiological imaging technique that plays an important role in the diagnosis and characterization of heterogeneous multiple sclerosis (MS) lesions. Various MRI methodologies such as conventional T 1/T 2 contrast, contrast agent enhancement, diffusion-weighted imaging, magnetization transfer imaging and susceptibility weighted imaging have been developed to determine the severity of MS pathology, including demyelination/remyelination and brain connectivity impairment from axonal loss. The broad spectrum of MS pathology manifests in diverse patient MRI presentations and affects the accuracy of patient diagnosis. To study specific pathological aspects of the disease, rodent models such as experimental autoimmune encephalomyelitis, virus-induced and toxin-induced demyelination have been developed. This review aims to present key developments in MRI methodology for better characterization of rodent models of MS.
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Affiliation(s)
- Othman I Alomair
- Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
- College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia
| | - Maree T Smith
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Integrated Preclinical Drug Development, The University of Queensland, Brisbane, Queensland, Australia
| | - Ian M Brereton
- Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Graham J Galloway
- Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
| | - Nyoman D Kurniawan
- Centre for Advanced Imaging, University of Queensland, Brisbane, Queensland, Australia
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Diffusion-weighted imaging and demyelinating diseases: new aspects of an old advanced sequence. AJR Am J Roentgenol 2014; 202:W34-42. [PMID: 24370163 DOI: 10.2214/ajr.13.11400] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The purpose of this article is to discuss classic applications in diffusion-weighted imaging (DWI) in demyelinating disease and progression of DWI in the near future. CONCLUSION DWI is an advanced technique used in the follow-up of demyelinating disease patients, focusing on the diagnosis of a new lesion before contrast enhancement. With technical advances, diffusion-tensor imaging; new postprocessing techniques, such as tract-based spatial statistics; new ways of calculating diffusion, such as kurtosis; and new applications for DWI and its spectrum are about to arise.
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Fiber-driven resolution enhancement of diffusion-weighted images. Neuroimage 2013; 84:939-50. [PMID: 24060317 DOI: 10.1016/j.neuroimage.2013.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/02/2013] [Accepted: 09/10/2013] [Indexed: 11/22/2022] Open
Abstract
Diffusion-weighted imaging (DWI), while giving rich information about brain circuitry, is often limited by insufficient spatial resolution and low signal-to-noise ratio (SNR). This paper describes an algorithm that will increase the resolution of DW images beyond the scan resolution, allowing for a closer investigation of fiber structures and more accurate assessment of brain connectivity. The algorithm is capable of generating a dense vector-valued field, consisting of diffusion data associated with the full set of diffusion-sensitizing gradients. The fundamental premise is that, to best preserve information, interpolation should always be performed along axonal fibers. To achieve this, at each spatial location, we probe neighboring voxels in various directions to gather diffusion information for data interpolation. Based on the fiber orientation distribution function (ODF), directions that are more likely to be traversed by fibers will be given greater weights during interpolation and vice versa. This ensures that data interpolation is only contributed by diffusion data coming from fibers that are aligned with a specific direction. This approach respects local fiber structures and prevents blurring resulting from averaging of data from significantly misaligned fibers. Evaluations suggest that this algorithm yields results with significantly less blocking artifacts, greater smoothness in anatomical structures, and markedly improved structural visibility.
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Kim YW, Hwang YH, Kang DH, Park SP, Song HS, Kim JH, Kim YS. The diagnostic role of diffusion tensor imaging in multifocal inflammatory leukoencephalopathy. Int J Neurosci 2013; 124:383-6. [PMID: 23902530 DOI: 10.3109/00207454.2013.829473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Multifocal inflammatory leukoencephalopathy (MIL) is a rare syndrome that can occur in patients with colon cancer after chemotherapy with 5-fluorouracil (5-FU) and levamisole. Histologic diagnosis by brain biopsy is most effective, but there can be high surgical risks and technical limitations. Therefore, we introduce a noninvasive diagnostic technique using diffusion tensor imaging (DTI) for patients suspected to have MIL. A 45-year-old woman had been treated for 12 weeks with levamisole and 5-FU for adenocarcinoma of the cecum, when she complained of ataxia, diplopia and left ptosis. Brain MRI showed a nodular enhancing lesion in the left midbrain, using gadolinium enhanced T1-weighted imaging, and scattered multiple white matter lesions throughout the cerebral hemisphere. Instead of a brain biopsy, DTI was performed that revealed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) in the left midbrain lesion compared with the right midbrain denoting demyelination. Levamisole and 5-FU were discontinued, and she received intravenously 1 g of methylprednisolone daily for 5 d. After five weeks, follow-up DTI showed an increased FA and decreased RD, signifying the reversibility. DTI therefore may provide valuable information on diagnosing MIL and assessing the treatment response.
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Affiliation(s)
- Yong-Won Kim
- 1Department of Neurology and Radiology, Kyungpook National University Hospital, Daegu, Republic of Korea
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Ma D, Liu C, Kong Q, Xie Y, Chen X. Apparent diffusion coefficient and diffusion-weighted signal intensity of the interpeduncle region of the midbrain in adults: initial evaluation. Clin Imaging 2013; 37:645-8. [DOI: 10.1016/j.clinimag.2013.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 11/03/2012] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
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Bolcaen J, Acou M, Mertens K, Hallaert G, Van den Broecke C, Achten E, Goethals I. Structural and Metabolic Features of Two Different Variants of Multiple Sclerosis: A PET/MRI Study. J Neuroimaging 2012; 23:431-6. [DOI: 10.1111/j.1552-6569.2012.00760.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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