1
|
Kim M, Seo JW, Kim MS, Lee KH, Kim M. White matter tract density index is associated with disability in multiple sclerosis. Neurobiol Dis 2024; 198:106548. [PMID: 38825050 DOI: 10.1016/j.nbd.2024.106548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND The association between common neuroradiological markers of multiple sclerosis (MS) and clinical disability is weak. Given that the disability in patients with MS may depend on the underlying structural connectivity of the brain, our study aimed to examine the association between white matter tracts affected by MS and the patients' disability using a new tract density index (TDI). METHOD This study included 53 patients diagnosed with MS, examined between 2019 and 2020. Manual lesion segmentation was performed on fluid-attenuated inversion recovery (FLAIR) images, and the density of white matter tracts encompassing the lesion (i.e., TDI) was calculated. Correlation analysis was employed to assess the association between TDI and disability. Additionally, the relationship between disability, TDI, and lesion-derived network metrics was examined by computing a partial correlation network. RESULTS The TDI significantly correlated with the expanded disability status scale (EDSS) (r = 0.30, p = 0.03). Furthermore, the patient's disability is linked solely through TDI to lesion-derived network metrics -a key metric that 'bridges' the gap between the brain lesion and disability. CONCLUSIONS In this study, MS lesions encompassing regions with high white matter tract density were associated and linked with severe physical disability. These findings indicate that TDI may be an outcome predictor that may connect radiologic findings to clinical practice.
Collapse
Affiliation(s)
- Minhoe Kim
- Computer Convergence Software Department, Korea University, Sejong, Republic of Korea
| | - Ji Won Seo
- Department of Radiology, Research Institute and Hospital of National Cancer Center, Goyang-si, Republic of Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Hoon Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Minchul Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Pontillo G, Cepas MB, Broeders TAA, Koubiyr I, Schoonheim MM. Network Analysis in Multiple Sclerosis and Related Disorders. Neuroimaging Clin N Am 2024; 34:375-384. [PMID: 38942522 DOI: 10.1016/j.nic.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Multiple sclerosis (MS) is a neuroinflammatory and neurodegenerative disease of the central nervous system, commonly featuring disability and cognitive impairment. The pathologic hallmark of MS lies in demyelination and hence impaired structural and functional neuronal pathways. Recent studies have shown that MS shows extensive structural disconnection of key network hub areas like the thalamus, combined with a functional network reorganization that can mostly be related to poorer clinical functioning. As MS can, therefore, be considered a network disorder, this review outlines recent innovations in the field of network neuroscience in MS.
Collapse
Affiliation(s)
- Giuseppe Pontillo
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands; MS Center Amsterdam, Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Mar Barrantes Cepas
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Tommy A A Broeders
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Ismail Koubiyr
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- MS Center Amsterdam, Anatomy and Neurosciences, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam UMC Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Colato E, Stutters J, Narayanan S, Arnold DL, Chataway J, Gandini Wheeler-Kingshott CAM, Barkhof F, Ciccarelli O, Eshaghi A, Chard DT. Longitudinal network-based brain grey matter MRI measures are clinically relevant and sensitive to treatment effects in multiple sclerosis. Brain Commun 2024; 6:fcae234. [PMID: 39077376 PMCID: PMC11285187 DOI: 10.1093/braincomms/fcae234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 05/24/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024] Open
Abstract
In multiple sclerosis clinical trials, MRI outcome measures are typically extracted at a whole-brain level, but pathology is not homogeneous across the brain and so whole-brain measures may overlook regional treatment effects. Data-driven methods, such as independent component analysis, have shown promise in identifying regional disease effects but can only be computed at a group level and cannot be applied prospectively. The aim of this work was to develop a technique to extract longitudinal independent component analysis network-based measures of co-varying grey matter volumes, derived from T1-weighted volumetric MRI, in individual study participants, and assess their association with disability progression and treatment effects in clinical trials. We used longitudinal MRI and clinical data from 5089 participants (22 045 visits) with multiple sclerosis from eight clinical trials. We included people with relapsing-remitting, primary and secondary progressive multiple sclerosis. We used data from five negative clinical trials (2764 participants, 13 222 visits) to extract the independent component analysis-based measures. We then trained and cross-validated a least absolute shrinkage and selection operator regression model (which can be applied prospectively to previously unseen data) to predict the independent component analysis measures from the same regional MRI volume measures and applied it to data from three positive clinical trials (2325 participants, 8823 visits). We used nested mixed-effect models to determine how networks differ across multiple sclerosis phenotypes are associated with disability progression and to test sensitivity to treatment effects. We found 17 consistent patterns of co-varying regional volumes. In the training cohort, volume loss was faster in four networks in people with secondary progressive compared with relapsing-remitting multiple sclerosis and three networks with primary progressive multiple sclerosis. Volume changes were faster in secondary compared with primary progressive multiple sclerosis in four networks. In the combined positive trials cohort, eight independent component analysis networks and whole-brain grey matter volume measures showed treatment effects, and the magnitude of treatment-placebo differences in the network-based measures was consistently greater than with whole-brain grey matter volume measures. Longitudinal network-based analysis of grey matter volume changes is feasible using clinical trial data, showing differences cross-sectionally and longitudinally between multiple sclerosis phenotypes, associated with disability progression, and treatment effects. Future work is required to understand the pathological mechanisms underlying these regional changes.
Collapse
Affiliation(s)
- Elisa Colato
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
| | - Jonathan Stutters
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
| | - Sridar Narayanan
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada
| | - Douglas L Arnold
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, H3A 2B4, Canada
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
| | - Claudia A M Gandini Wheeler-Kingshott
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- Brain Connectivity Centre, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Mondino Foundation, Pavia, 27100, Italy
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, 27100, Italy
| | - Frederik Barkhof
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
- Department of Radiology and Nuclear Medicine, Vrije Universiteit (VU) Medical Centre, Amsterdam, 1081 HZ, The Netherlands
- Centre for Medical Image Computing (CMIC), Department of Medical Physics and Biomedical Engineering, University College London, London, WC1V 6LJ, UK
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
| | - Arman Eshaghi
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- Centre for Medical Image Computing (CMIC), Department of Computer Science, University College London, London, WC1V 6LJ, UK
| | - Declan T Chard
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London (UCL) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, WC1N 3BG, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, W1T 7DN, UK
| |
Collapse
|
4
|
Ravano V, Piredda GF, Krasensky J, Andelova M, Uher T, Srpova B, Havrdova EK, Vodehnalova K, Horakova D, Nytrova P, Disselhorst JA, Hilbert T, Maréchal B, Thiran JP, Kober T, Richiardi J, Vaneckova M. Tract-wise microstructural analysis informs on current and future disability in early multiple sclerosis. J Neurol 2024; 271:631-641. [PMID: 37819462 PMCID: PMC10827809 DOI: 10.1007/s00415-023-12023-3] [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: 07/07/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES Microstructural characterization of patients with multiple sclerosis (MS) has been shown to correlate better with disability compared to conventional radiological biomarkers. Quantitative MRI provides effective means to characterize microstructural brain tissue changes both in lesions and normal-appearing brain tissue. However, the impact of the location of microstructural alterations in terms of neuronal pathways has not been thoroughly explored so far. Here, we study the extent and the location of tissue changes probed using quantitative MRI along white matter (WM) tracts extracted from a connectivity atlas. METHODS We quantified voxel-wise T1 tissue alterations compared to normative values in a cohort of 99 MS patients. For each WM tract, we extracted metrics reflecting tissue alterations both in lesions and normal-appearing WM and correlated these with cross-sectional disability and disability evolution after 2 years. RESULTS In early MS patients, T1 alterations in normal-appearing WM correlated better with disability evolution compared to cross-sectional disability. Further, the presence of lesions in supratentorial tracts was more strongly associated with cross-sectional disability, while microstructural alterations in infratentorial pathways yielded higher correlations with disability evolution. In progressive patients, all major WM pathways contributed similarly to explaining disability, and correlations with disability evolution were generally poor. CONCLUSIONS We showed that microstructural changes evaluated in specific WM pathways contribute to explaining future disability in early MS, hence highlighting the potential of tract-wise analyses in monitoring disease progression. Further, the proposed technique allows to estimate WM tract-specific microstructural characteristics in clinically compatible acquisition times, without the need for advanced diffusion imaging.
Collapse
Affiliation(s)
- Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland.
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Petra Nytrova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jonathan A Disselhorst
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jean-Philippe Thiran
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthineers International AG, Lausanne, Switzerland
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- LTS5, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Jonas Richiardi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| |
Collapse
|
5
|
Kim M, Choi KS, Hyun RC, Hwang I, Kwon YN, Sung JJ, Kim SM, Kim JH. Structural disconnection is associated with disability in the neuromyelitis optica spectrum disorder. Brain Imaging Behav 2023; 17:664-673. [PMID: 37676409 DOI: 10.1007/s11682-023-00792-4] [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] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system. Accumulating evidence suggests there is a distinct pattern of brain lesions characteristic of NMOSD, and brain MRI has potential prognostic implications. However, the question of how the brain lesions in NMOSD are associated with its distinct clinical course remains incompletely understood. Here, we aimed to investigate the association between neurological impairment and brain lesions via brain structural disconnection. METHODS Twenty patients were diagnosed with NMOSD according to the 2015 International Panel for NMO Diagnosis criteria. The white matter lesions were manually drawn section by section. Whole-brain structural disconnection was estimated, and connectome-based predictive modeling (CPM) was used to estimate the patient's Expanded Disability Status Scale score (EDSS) from their disconnection severity matrix. Furthermore, correlational tractography was performed to assess the fractional anisotropy (FA) and axial diffusivity (AD) of white matter fibers, which negatively correlated with the EDSS score. RESULTS CPM successfully predicted the EDSS using the disconnection severity matrix (r = 0.506, p = 0.028; q2 = 0.274). Among the important edges in the prediction process, the majority of edges connected the motor to the frontoparietal network. Correlational tractography identified a decreased FA and AD value according to EDSS scores in periependymal white matter tracts. DISCUSSION Structural disconnection-based predictive modeling and local connectome analysis showed that frontoparietal and periependymal white matter disconnection is predictive and associated with the EDSS score of NMOSD patients.
Collapse
Affiliation(s)
- Minchul Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Ryoo Chang Hyun
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Sung Min Kim
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea.
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea.
| |
Collapse
|
6
|
White matter substrates of functional connectivity dynamics in the human brain. Neuroimage 2022; 258:119391. [PMID: 35716842 DOI: 10.1016/j.neuroimage.2022.119391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
The contribution of structural connectivity to functional connectivity dynamics is still far from being elucidated. Herein, we applied track-weighted dynamic functional connectivity (tw-dFC), a model integrating structural, functional, and dynamic connectivity, on high quality diffusion weighted imaging and resting-state fMRI data from two independent repositories. The tw-dFC maps were analyzed using independent component analysis, aiming at identifying spatially independent white matter components which support dynamic changes in functional connectivity. Each component consisted of a spatial map of white matter bundles that show consistent fluctuations in functional connectivity at their endpoints, and a time course representative of such functional activity. These components show high intra-subject, inter-subject, and inter-cohort reproducibility. We provided also converging evidence that functional information about white matter activity derived by this method can capture biologically meaningful features of brain connectivity organization, as well as predict higher-order cognitive performance.
Collapse
|