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Madsen MA, Považan M, Wiggermann V, Lundell H, Blinkenberg M, Romme Christensen J, Sellebjerg F, Siebner HR. Association of Cortical Lesions With Regional Glutamate, GABA, N-Acetylaspartate, and Myoinositol Levels in Patients With Multiple Sclerosis. Neurology 2024; 103:e209543. [PMID: 38870443 DOI: 10.1212/wnl.0000000000209543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cortical lesions contribute to disability in multiple sclerosis (MS), but their impact on regional neurotransmitter levels remains to be clarified. We tested the hypothesis that cortical lesions are associated with regional glutamate and gamma-aminobutyric acid (GABA) concentrations within the affected cortical region. METHODS In this cross-sectional study, we used structural 7T MRI to segment cortical lesions and 7T proton MR-spectroscopy of the bilateral sensorimotor hand areas to quantify regional GABA, glutamate, N-acetylaspartate, and myoinositol concentrations in patients with MS (inclusion criteria: diagnosis of relapsing-remitting [RR] or secondary progressive MS [SPMS]; age 18-80 years) and age and sex-matched healthy controls. Data were collected at a single center between August 2018 and September 2020. Linear mixed-effects models were used to test for associations between metabolite concentrations and cortical lesion volumes within the same MR-spectroscopy voxel. RESULTS Forty-seven patients with MS (34 RRMS, 13 SPMS; 45.1 ± 12.5 years; 31 women) and 23 healthy controls (44.4 ± 13 years, 15 women) were studied. In patients, higher regional glutamate and lower regional GABA concentrations were associated with larger cortical lesion volume within the MR-spectroscopy voxel [glutamate: 0.61 (95% CI 0.19-1.03) log(mm3), p = 0.005, GABA: -0.71 (-1.24 to -0.18) log(mm3), p = 0.01]. In addition, lower N-acetylaspartate levels [-0.37 (-0.67 to -0.07) log(mm3), p = 0.016] and higher myoinositol levels [0.48 (0.03-0.93) log(mm3), p = 0.037] were associated with a larger regional cortical lesion volume. Furthermore, glutamate concentrations were reduced in patients with SPMS compared with healthy participants [-0.75 (-1.3 to -0.19) mM, p = 0.005] and patients with RRMS [-0.55 (-1.07 to -0.02) mM, p = 0.04]. N-acetylaspartate levels were lower in both patients with RRMS [-0.81 (-1.39 to -0.24) mM, p = 0.003] and SPMS [-1.31 (-2.07 to -0.54) mM, p < 0.001] when compared with healthy controls. Creatine-normalized N-acetylaspartate levels were associated with performance in the 9-hole peg test of the contralateral hand [-0.004 (-0.007 to -0.002) log(s), p = 0.002], and reduced mean creatine-normalized glutamate was associated with increased Expanded Disability Status Scale (R = -0.39, p = 0.02). DISCUSSION Cortical lesions are associated with local increases in glutamate and a reduction in GABA concentration within the lesional or perilesional tissue. Further studies are needed to investigate the causal relationship between cortical lesions and changes in neurotransmitter concentrations.
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Affiliation(s)
- Mads A Madsen
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Michal Považan
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Vanessa Wiggermann
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Lundell
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Morten Blinkenberg
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jeppe Romme Christensen
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Finn Sellebjerg
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Hartwig R Siebner
- From the Danish Research Centre for Magnetic Resonance (M.A.M., M.P., V.W., H.L., H.R.S.), Copenhagen University Hospital - Amager and Hvidovre; Department of Health Technology (H.L.), Technical University of Denmark, Kgs. Lyngby; Danish Multiple Sclerosis Center (M.B., J.R.C., F.S.), Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Glostrup; Department of Neurology (H.R.S.), Copenhagen University Hospital - Bispebjerg and Frederiksberg; and Department of Clinical Medicine (F.S., H.R.S.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Durozard P, Maarouf A, Zaaraoui W, Stellmann JP, Boutière C, Rico A, Demortière S, Guye M, Le Troter A, Dary H, Ranjeva JP, Audoin B, Pelletier J. Cortical Lesions as an Early Hallmark of Multiple Sclerosis: Visualization by 7 T MRI. Invest Radiol 2024:00004424-990000000-00214. [PMID: 38889240 DOI: 10.1097/rli.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Compelling evidence indicates a significant involvement of cortical lesions in the progressive phase of multiple sclerosis (MS), significantly contributing to late-stage disability. Despite the promise of ultra-high-field magnetic resonance imaging (MRI) in detecting cortical lesions, current evidence falls short in providing insights into the existence of such lesions during the early stages of MS or their underlying cause. This study delineated, at the early stage of MS, (1) the prevalence and spatial distribution of cortical lesions identified by 7 T MRI, (2) their relationship with white matter lesions, and (3) their clinical implications. MATERIALS AND METHODS Twenty individuals with early-stage relapsing-remitting MS (disease duration <1 year) underwent a 7 T MRI session involving T1-weighted MP2RAGE, T2*-weighted multiGRE, and T2-weighted FLAIR sequences for cortical and white matter segmentation. Disability assessments included the Expanded Disability Status Scale, the Multiple Sclerosis Functional Composite, and an extensive evaluation of cognitive function. RESULTS Cortical lesions were detected in 15 of 20 patients (75%). MP2RAGE revealed a total of 190 intracortical lesions (median, 4 lesions/case [range, 0-44]) and 216 leukocortical lesions (median, 2 lesions/case [range, 0-75]). Although the number of white matter lesions correlated with the total number of leukocortical lesions (r = 0.91, P < 0.001), no correlation was observed between the number of white matter or leukocortical lesions and the number of intracortical lesions. Furthermore, the number of leukocortical lesions but not intracortical or white-matter lesions was significantly correlated with cognitive impairment (r = 0.63, P = 0.04, corrected for multiple comparisons). CONCLUSIONS This study highlights the notable prevalence of cortical lesions at the early stage of MS identified by 7 T MRI. There may be a potential divergence in the underlying pathophysiological mechanisms driving distinct lesion types, notably between intracortical lesions and white matter/leukocortical lesions. Moreover, during the early disease phase, leukocortical lesions more effectively accounted for cognitive deficits.
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Affiliation(s)
- Pierre Durozard
- From the Aix Marseille Univ, CNRS, CRMBM, Marseille, France (P.D., A.M., W.Z., J.-P.S., A.R., M.G., A.T., H.D., J.-P.R., B.A., J.P.); Aix Marseille Univ, APHM, Pôle de Neurosciences Cliniques, MICeME, Marseille, France (A.M., C.B., A.R., S.D., B.A., J.P.); Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle d'Imagerie Médicale, CEMEREM, Marseille, France (J.-P.S., M.G.); and CRC-SEP Corse, Centre Hospitalier d'Ajaccio, Ajaccio, France (P.D.)
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Nguyen P, Rempe T, Forghani R. Multiple Sclerosis: Clinical Update and Clinically-Oriented Radiologic Reporting. Magn Reson Imaging Clin N Am 2024; 32:363-374. [PMID: 38555146 DOI: 10.1016/j.mric.2024.01.001] [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: 04/02/2024]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease of the nervous system. MR imaging findings play an integral part in establishing diagnostic hallmarks of the disease during initial diagnosis and evaluating disease status. Multiple iterations of diagnostic criteria and consensus guidelines are put forth by various expert groups incorporating imaging of the brain and spine, and efforts have been made to standardize imaging protocols for MS. Emerging ancillary imaging findings have also attracted increasing interests and should be sought for on radiologic examination. In this paper, the authors review the clinical guidelines and approach to imaging of MS and related disorders, focusing on clinically impactful image interpretation and MR imaging reporting.
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Affiliation(s)
- Phuong Nguyen
- Department of Radiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0374, USA
| | - Torge Rempe
- Department of Neurology, University of Florida College of Medicine, Norman Fixel Institute for Neurological Diseases, 3009 SW Williston Road, Gainesville, FL 32608, USA
| | - Reza Forghani
- Department of Radiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0374, USA; Division of Movement Disorders, Department of Neurology, University of Florida College of Medicine, Norman Fixel Institute for Neurological Diseases, 3009 SW Williston Road, Gainesville, FL 32608, USA; Division of Medical Physics, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610-0374, USA; Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Room 221.1, 3011 SW Williston Road, Gainesville, FL 32608, USA.
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Ananthavarathan P, Sahi N, Chard DT. An update on the role of magnetic resonance imaging in predicting and monitoring multiple sclerosis progression. Expert Rev Neurother 2024; 24:201-216. [PMID: 38235594 DOI: 10.1080/14737175.2024.2304116] [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: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION While magnetic resonance imaging (MRI) is established in diagnosing and monitoring disease activity in multiple sclerosis (MS), its utility in predicting and monitoring disease progression is less clear. AREAS COVERED The authors consider changing concepts in the phenotypic classification of MS, including progression independent of relapses; pathological processes underpinning progression; advances in MRI measures to assess them; how well MRI features explain and predict clinical outcomes, including models that assess disease effects on neural networks, and the potential role for machine learning. EXPERT OPINION Relapsing-remitting and progressive MS have evolved from being viewed as mutually exclusive to having considerable overlap. Progression is likely the consequence of several pathological elements, each important in building more holistic prognostic models beyond conventional phenotypes. MRI is well placed to assess pathogenic processes underpinning progression, but we need to bridge the gap between MRI measures and clinical outcomes. Mapping pathological effects on specific neural networks may help and machine learning methods may be able to optimize predictive markers while identifying new, or previously overlooked, clinically relevant features. The ever-increasing ability to measure features on MRI raises the dilemma of what to measure and when, and the challenge of translating research methods into clinically useable tools.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Nitin Sahi
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Declan T Chard
- Clinical Research Associate & Consultant Neurologist, Institute of Neurology - Queen Square Multiple Sclerosis Centre, London, UK
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Silva RV, Morr AS, Herthum H, Koch SP, Mueller S, Batzdorf CS, Bertalan G, Meyer T, Tzschätzsch H, Kühl AA, Boehm-Sturm P, Braun J, Scheel M, Paul F, Infante-Duarte C, Sack I. Cortical matrix remodeling as a hallmark of relapsing-remitting neuroinflammation in MR elastography and quantitative MRI. Acta Neuropathol 2024; 147:8. [PMID: 38175305 PMCID: PMC10766667 DOI: 10.1007/s00401-023-02658-x] [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: 08/08/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024]
Abstract
Multiple sclerosis (MS) is a chronic neuroinflammatory disease that involves both white and gray matter. Although gray matter damage is a major contributor to disability in MS patients, conventional clinical magnetic resonance imaging (MRI) fails to accurately detect gray matter pathology and establish a clear correlation with clinical symptoms. Using magnetic resonance elastography (MRE), we previously reported global brain softening in MS and experimental autoimmune encephalomyelitis (EAE). However, it needs to be established if changes of the spatiotemporal patterns of brain tissue mechanics constitute a marker of neuroinflammation. Here, we use advanced multifrequency MRE with tomoelastography postprocessing to investigate longitudinal and regional inflammation-induced tissue changes in EAE and in a small group of MS patients. Surprisingly, we found reversible softening in synchrony with the EAE disease course predominantly in the cortex of the mouse brain. This cortical softening was associated neither with a shift of tissue water compartments as quantified by T2-mapping and diffusion-weighted MRI, nor with leukocyte infiltration as seen by histopathology. Instead, cortical softening correlated with transient structural remodeling of perineuronal nets (PNNs), which involved abnormal chondroitin sulfate expression and microgliosis. These mechanisms also appear to be critical in humans with MS, where tomoelastography for the first time demonstrated marked cortical softening. Taken together, our study shows that neuroinflammation (i) critically affects the integrity of PNNs in cortical brain tissue, in a reversible process that correlates with disease disability in EAE, (ii) reduces the mechanical integrity of brain tissue rather than leading to water accumulation, and (iii) shows similar spatial patterns in humans and mice. These results raise the prospect of leveraging MRE and quantitative MRI for MS staging and monitoring treatment in affected patients.
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Affiliation(s)
- Rafaela V Silva
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC - Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - Anna S Morr
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Helge Herthum
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Advanced Neuroimaging, Berlin, Germany
| | - Stefan P Koch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRI, Berlin, Germany
| | - Susanne Mueller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRI, Berlin, Germany
| | - Clara S Batzdorf
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC - Experimental and Clinical Research Center, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Gergely Bertalan
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tom Meyer
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Heiko Tzschätzsch
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anja A Kühl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, iPATH.Berlin, Berlin, Germany
| | - Philipp Boehm-Sturm
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Experimental Neurology and Center for Stroke Research Berlin, Berlin, Germany
- Charité-Universitätsmedizin Berlin, NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRI, Berlin, Germany
| | - Jürgen Braun
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Michael Scheel
- Charité - Universitätsmedizin Berlin Corporate, Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Neuroradiology, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carmen Infante-Duarte
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ECRC - Experimental and Clinical Research Center, Berlin, Germany.
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
| | - Ingolf Sack
- Charité - Universitätsmedizin Berlin, Department of Radiology, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
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Okromelidze L, Patel V, Singh RB, Lopez Chiriboga AS, Tao S, Zhou X, Straub S, Westerhold EM, Gupta V, Agarwal AK, Murray JV, Desai A, Sandhu SJS, Marin Collazo IV, Middlebrooks EH. Central Vein Sign in Multiple Sclerosis: A Comparison Study of the Diagnostic Performance of 3T versus 7T MRI. AJNR Am J Neuroradiol 2023; 45:76-81. [PMID: 38164557 PMCID: PMC10756573 DOI: 10.3174/ajnr.a8083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND PURPOSE An early and accurate diagnosis of multiple sclerosis remains challenging in clinical neurology. Established diagnostic methods have less than desirable sensitivity and specificity. An accurate, noninvasive diagnostic test for MS could have a major impact on diagnostic criteria. We compared the frequency of detection of the central vein sign (CVS) in white matter lesions of MS and controls on 7T T2*-weighted and SWI to 3T SWI. Additionally, we assessed the diagnostic performance of 7T T2*, 7T SWI, and 3T SWI for MS. MATERIALS AND METHODS A retrospective case-control study was performed of patients with MS having both 7T MRI and 3T MRI. A control group of patients without MS was selected. Diagnosis of MS was established by board-certified neurologists with fellowship training in autoimmune neurology in line with the 2017 McDonald criteria. Percentage of lesions with a CVS was blindly measured for each technique. Diagnostic performance was computed by sensitivity, specificity, and positive and negative likelihood ratios (LRs). RESULTS Sixty-one patients with MS (903 lesions) and 39 controls (1088 lesions) were included. 7T T2* showed significantly more CVS (87%) than both 7T SWI (73%) and 3T SWI (31%) (all P < .001). CVS was identified in the control group in ≤6% of lesions on all sequences. Using a threshold of >40% of lesions with CVS on 7T T2* and >15% on 7T SWI, both sequences had an accuracy = 100%, sensitivity = 100%, specificity = 100%, infinite positive LR, and zero negative LR. Using an optimal threshold of >12%, 3T SWI had an accuracy = 96.0%, sensitivity = 93.4%, specificity = 100%, infinite positive LR, and negative LR = 0.066. CONCLUSIONS 7T MRI had 100% sensitivity and specificity for the diagnosis of MS and is superior to 3T. Future revisions to MS diagnostic criteria may consider recommendations for 7T MRI and inclusion of CVS as a biomarker.
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Affiliation(s)
- Lela Okromelidze
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Vishal Patel
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Rahul B Singh
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | | | - Shengzhen Tao
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Xiangzhi Zhou
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Sina Straub
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Erin M Westerhold
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Vivek Gupta
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Amit K Agarwal
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - John V Murray
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - Amit Desai
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | - S J S Sandhu
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
| | | | - Erik H Middlebrooks
- From the Departments of Radiology (L.O., V.P., R.B.S., S.T., X.Z., S.S., E.M.W., V.G., A.K.A., J.V.M., A.D., S.J.S.S., E.H.M.), Mayo Clinic, Jacksonville, Florida
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Straub S, El-Sanosy E, Emmerich J, Sandig FL, Ladd ME, Schlemmer HP. Quantitative magnetic resonance imaging biomarkers for cortical pathology in multiple sclerosis at 7 T. NMR IN BIOMEDICINE 2023; 36:e4847. [PMID: 36259249 DOI: 10.1002/nbm.4847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Substantial cortical gray matter tissue damage, which correlates with clinical disease severity, has been revealed in multiple sclerosis (MS) using advanced magnetic resonance imaging (MRI) methods at 3 T and the use of ultra-high field, as well as in histopathology studies. While clinical assessment mainly focuses on lesions using T 1 - and T 2 -weighted MRI, quantitative MRI (qMRI) methods are capable of uncovering subtle microstructural changes. The aim of this ultra-high field study is to extract possible future MR biomarkers for the quantitative evaluation of regional cortical pathology. Because of their sensitivity to iron, myelin, and in part specifically to cortical demyelination, T 1 , T 2 , R 2 * , and susceptibility mapping were performed including two novel susceptibility markers; in addition, cortical thickness as well as the volumes of 34 cortical regions were computed. Data were acquired in 20 patients and 16 age- and sex-matched healthy controls. In 18 cortical regions, large to very large effect sizes (Cohen's d ≥ 1) and statistically significant differences in qMRI values between patients and controls were revealed compared with only four regions when using more standard MR measures, namely, volume and cortical thickness. Moreover, a decrease in all susceptibility contrasts ( χ , χ + , χ - ) and R 2 * values indicates that the role of cortical demyelination might outweigh inflammatory processes in the form of iron accumulation in cortical MS pathology, and might also indicate iron loss. A significant association between susceptibility contrasts as well as R 2 * of the caudal middle frontal gyrus and disease duration was found (adjusted R2 : 0.602, p = 0.0011). Quantitative MRI parameters might be more sensitive towards regional cortical pathology compared with the use of conventional markers only and therefore may play a role in early detection of tissue damage in MS in the future.
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Affiliation(s)
- Sina Straub
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Edris El-Sanosy
- Division Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julian Emmerich
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frederik L Sandig
- Division Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
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Madsen MAJ, Wiggermann V, Marques MFM, Lundell H, Cerri S, Puonti O, Blinkenberg M, Christensen JR, Sellebjerg F, Siebner HR. Linking lesions in sensorimotor cortex to contralateral hand function in multiple sclerosis: a 7 T MRI study. Brain 2022; 145:3522-3535. [PMID: 35653498 PMCID: PMC9586550 DOI: 10.1093/brain/awac203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cortical lesions constitute a key manifestation of multiple sclerosis and contribute to clinical disability and cognitive impairment. Yet it is unknown whether local cortical lesions and cortical lesion subtypes contribute to domain-specific impairments attributable to the function of the lesioned cortex.
In this cross-sectional study, we assessed how cortical lesions in the primary sensorimotor hand area (SM1-HAND) relate to corticomotor physiology and sensorimotor function of the contralateral hand. 50 relapse-free patients with relapsing-remitting or secondary-progressive multiple sclerosis and 28 healthy age- and sex-matched participants underwent whole-brain 7 T MRI to map cortical lesions. Brain scans were also used to estimate normalized brain volume, pericentral cortical thickness, white matter lesion fraction of the corticospinal tract, infratentorial lesion volume and the cross-sectional area of the upper cervical spinal cord. We tested sensorimotor hand function and calculated a motor and sensory composite score for each hand. In 37 patients and 20 healthy controls, we measured maximal motor evoked potential (MEP) amplitude, resting motor threshold and corticomotor conduction time with transcranial magnetic stimulation (TMS) and the N20 latency from somatosensory evoked potentials (SSEPs).
Patients showed at least one cortical lesion in the SM1-HAND in 47 of 100 hemispheres. The presence of a lesion was associated with worse contralateral sensory (P = 0.014) and motor (P = 0.009) composite scores. TMS of a lesion-positive SM1-HAND revealed a decreased maximal MEP amplitude (P < 0.001) and delayed corticomotor conduction (P = 0.002) relative to a lesion-negative SM1-HAND. Stepwise mixed linear regressions showed that the presence of an SM1-HAND lesion, higher white-matter lesion fraction of the corticospinal tract, reduced spinal cord cross-sectional area and higher infratentorial lesion volume were associated with reduced contralateral motor hand function. Cortical lesions in SM1-HAND, spinal cord cross-sectional area and normalized brain volume were also associated with smaller maximal MEP amplitude and longer corticomotor conduction times. The effect of cortical lesions on sensory function was no longer significant when controlling for MRI-based covariates. Lastly, we found that intracortical and subpial lesions had the largest effect on reduced motor hand function, intracortical lesions on reduced MEP amplitude and leukocortical lesions on delayed corticomotor conduction.
Together, this comprehensive multi-level assessment of sensorimotor brain damage shows that the presence of a cortical lesion in SM1-HAND is associated with impaired corticomotor function of the hand, after accounting for damage at the subcortical level. The results also provide preliminary evidence that cortical lesion types may affect the various facets of corticomotor function differentially.
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Affiliation(s)
- Mads A. J. Madsen
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Vanessa Wiggermann
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Marta F. M. Marques
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Henrik Lundell
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Stefano Cerri
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Technical University of Denmark Department of Health Technology, , 2800 Kgs. Lyngby, Denmark
| | - Oula Puonti
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
| | - Morten Blinkenberg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Jeppe Romme Christensen
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Copenhagen University Hospital – Rigshospitalet Danish Multiple Sclerosis Center, Department of Neurology, , 2600 Glostrup, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
| | - Hartwig R. Siebner
- Copenhagen University Hospital - Amager & Hvidovre Danish Research Centre for Magnetic Resonance, , 2650 Hvidovre, Denmark
- Copenhagen University Hospital - Bispebjerg & Frederiksberg Department of Neurology, , 2400 Copenhagen, Denmark
- University of Copenhagen Department of Clinical Medicine, , 2200 Copenhagen, Denmark
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