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Maarouf A, Audoin B, Pariollaud F, Gherib S, Rico A, Soulier E, Confort-Gouny S, Guye M, Schad L, Pelletier J, Ranjeva JP, Zaaraoui W. Increased total sodium concentration in gray matter better explains cognition than atrophy in MS. Neurology 2016; 88:289-295. [PMID: 27974643 DOI: 10.1212/wnl.0000000000003511] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/06/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To investigate whether brain total sodium accumulation assessed by 23Na MRI is associated with cognitive deficit in relapsing-remitting multiple sclerosis (RRMS). METHODS Eighty-nine participants were enrolled in the study (58 patients with RRMS with a disease duration ≤10 years and 31 matched healthy controls). Patients were classified as cognitively impaired if they failed at least 2 tasks on the Brief Repeatable Battery. MRI was performed at 3T using 23Na MRI to obtain total sodium concentration (TSC) in the different brain compartments (lesions, normal-appearing white matter [NAWM], gray matter [GM]) and 1H- magnetization-prepared rapid gradient echo to assess GM atrophy (GM fraction). RESULTS The mean disease duration was 3.1 years and the median Expanded Disability Status Scale score was 1 (range 0-4.5). Thirty-seven patients were classified as cognitively preserved and 21 as cognitively impaired. TSC was increased in GM and NAWM in cognitively impaired patients compared to cognitively preserved patients and healthy controls. Voxel-wise analysis demonstrated that sodium accumulation was mainly located in the neocortex in cognitively impaired patients. Regression analysis evidenced than the 2 best independent predictors of cognitive impairment were GM TSC and age. Receiver operating characteristic analyses demonstrated that sensitivity and specificity of the GM TSC to classify patients according to their cognitive status were 76% and 71%, respectively. CONCLUSIONS This study provides 2 main findings. (1) In RRMS, total sodium accumulation in the GM is better associated with cognitive impairment than GM atrophy; and (2) total sodium accumulation in patients with cognitive impairment is mainly located in the neocortex.
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Affiliation(s)
- Adil Maarouf
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany.
| | - Bertrand Audoin
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Fanelly Pariollaud
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Soraya Gherib
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Audrey Rico
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Elisabeth Soulier
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Sylviane Confort-Gouny
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Maxime Guye
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Lothar Schad
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Jean Pelletier
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Jean-Philippe Ranjeva
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
| | - Wafaa Zaaraoui
- From CNRS (A.M., B.A., F.P., S.G., A.R., E.S., S.C.-G., M.G., J.P., J.-P.R., W.Z.), CRMBM UMR 7339, Aix-Marseille Université, Marseille; Service de Neurologie (A.M.), Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes; Service de Neurologie (A.M., B.A., A.R., J.P.) and CEMEREM (M.G., A.M.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille, France; and Computer Assisted Clinical Medicine (L.S.), Heidelberg University, Mannheim, Germany
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Wetterling F, Chatzikonstantinou E, Tritschler L, Meairs S, Fatar M, Schad LR, Ansar S. Investigating potentially salvageable penumbra tissue in an in vivo model of transient ischemic stroke using sodium, diffusion, and perfusion magnetic resonance imaging. BMC Neurosci 2016; 17:82. [PMID: 27927188 PMCID: PMC5143461 DOI: 10.1186/s12868-016-0316-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffusion magnetic resonance imaging (MRI) is the current-state-of-the-art technique to clinically investigate acute (0-24 h) ischemic stroke tissue. However, reduced apparent diffusion coefficient (ADC)-considered a marker of tissue damage-was observed to reverse spontaneously during the subacute stroke phase (24-72 h) which means that low ADC cannot be used to reflect the damaged tissue after 24 h in experimental and clinical studies. One reason for the change in ADC is that ADC values drop with cytotoxic edema (acute phase) and rise when vasogenic edema begins (subacute phase). Recently, combined 1H- and 23Na-MRI was proposed as a more accurate approach to improve delineation between reversible (penumbra) and irreversible ischemic injury (core). The aim of this study was to investigate the effects of reperfusion on the ADC and the sodium MRI signal after experimental ischemic stroke in rats in well-defined areas of different viability levels of the cerebral lesion, i.e. core and penumbra as defined via perfusion and histology. Transient middle cerebral artery occlusion was induced in male rats by using the intraluminal filament technique. MRI sodium, perfusion and diffusion measurement was recorded before reperfusion, shortly after reperfusion and 24 h after reperfusion. The animals were reperfused after 90 min of ischemia. RESULTS Sodium signal in core did not change before reperfusion, increased after reperfusion while sodium signal in penumbra was significantly reduced before reperfusion, but showed no changes after reperfusion compared to control. The ADC was significantly decreased in core tissue at all three time points compared to contralateral side. This decrease recovered above commonly applied viability thresholds in the core after 24 h. CONCLUSIONS Reduced sodium-MRI signal in conjunction with reduced ADC can serve as a viability marker for penumbra detection and complement hydrogen diffusion- and perfusion-MRI in order to facilitate time-independent assessment of tissue fate and cellular bioenergetics failure in stroke patients.
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Affiliation(s)
- Friedrich Wetterling
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany.,Trinity Institute of Neuroscience, University of Dublin, Dublin, Ireland
| | - Eva Chatzikonstantinou
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Laurent Tritschler
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany.,CESP, INSERM UMRS1178, Faculté de Pharmacie, University Paris-Sud, Université Paris-Saclay, 92296, Chatenay-Malabry, France
| | - Stephen Meairs
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Marc Fatar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim, Germany
| | - Saema Ansar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany. .,Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University, Sölvegatan 17, BMC A13, 22184, Lund, Sweden.
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