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Reduced Myelin Signal in Normal-appearing White Matter in Neuromyelitis Optica Measured by 7T Magnetic Resonance Imaging. Sci Rep 2019; 9:14378. [PMID: 31591424 PMCID: PMC6779889 DOI: 10.1038/s41598-019-50928-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 09/18/2019] [Indexed: 12/22/2022] Open
Abstract
Whether the integrity of normal-appearing white matter (NAWM) is preserved in neuromyelitis optica spectrum disorders (NMOSD) is open to debate. To examine whether the tissue integrity of NAWM in NMOSD is compromised compared to that in healthy controls and patients with multiple sclerosis (MS), we prospectively enrolled 14 patients with NMOSD, 12 patients with MS, and 10 controls for clinical functional assessments and quantitative imaging, including T1 relaxation time (T1) and magnetization transfer ratio (MTR) at 7 Tesla. Cognitive performance on the Paced Auditory Serial Addition Test with a 3-second interstimulus interval (PASAT-3) was significantly lower in the NMOSD compared to the MS group (mean number of correct answers, 34.1 vs. 47.6; p = 0.006), but there were no differences in disease duration or disability. Histograms of T1 and MTR maps of NAWM demonstrated a decreased peak height in patients with NMOSD compared to the healthy controls, but not compared to patients with MS. Using 7T quantitative magnetic resonance imaging (MRI), this study showed that the NAWM in patients with NMOSD is abnormal, with reduced myelin signal; this was not previously observed using MRI at a lower field strength.
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Karakaya Z, Saritas A, Yeşim Akyol P, Esad Topal F, Payza U, Bilgin S. Evaluation of Chronic Subdural Hematoma Volume Calculated via Cavalieri’s Principle. KONURALP TIP DERGISI 2019. [DOI: 10.18521/ktd.469173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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3
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Baş O, Kayacı S, Beyza Çeliker F, Üçüncü Y, Özveren MF, Yilmaz A, Altas H, Sahin B. A comparison of lateral ventricle volume estimation on magnetic resonance and cadaveric section images using the planimetry method. J Clin Neurosci 2019; 64:264-268. [DOI: 10.1016/j.jocn.2019.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/25/2019] [Indexed: 11/16/2022]
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4
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Vavasour IM, Meyers SM, Mädler B, Harris T, Fu E, Li DK, Traboulsee A, MacKay AL, Laule C. Multicenter Measurements of T1
Relaxation and Diffusion Tensor Imaging: Intra and Intersite Reproducibility. J Neuroimaging 2018; 29:42-51. [DOI: 10.1111/jon.12559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/20/2018] [Accepted: 08/26/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Irene M. Vavasour
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
| | - Sandra M. Meyers
- Department of Physics and Astronomy; University of British Columbia; Vancouver British Columbia Canada
| | | | - Trudy Harris
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
| | - Eric Fu
- Department of Statistics; University of British Columbia; Vancouver British Columbia Canada
| | - David K.B. Li
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
- Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Anthony Traboulsee
- Department of Medicine; University of British Columbia; Vancouver British Columbia Canada
| | - Alex L. MacKay
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
- Department of Physics and Astronomy; University of British Columbia; Vancouver British Columbia Canada
| | - Cornelia Laule
- Department of Radiology; University of British Columbia, UBC MRI Research Centre; Vancouver British Columbia Canada
- Department of Physics and Astronomy; 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
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5
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Davies GR, Hadjiprocopis A, Altmann DR, Chard DT, Griffin CM, Rashid W, Parker GJ, Tofts PS, Kapoor R, Thompson AJ, Miller DH. Normal-appearing grey and white matter T1 abnormality in early relapsing–remitting multiple sclerosis: a longitudinal study. Mult Scler 2017; 13:169-77. [PMID: 17439881 DOI: 10.1177/1352458506070726] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To investigate the presence and evolution of T1 relaxation time abnormalities in normal-appearing white matter (NAWM) and grey matter (GM), early in the course of relapsing–remitting multiple sclerosis (MS). Methods Twenty-three patients with early relapsing–remitting MS and 14 healthy controls were imaged six monthly for up to three years. Mean follow-up was 26 months for MS patients and 24 months for controls. Dual-echo fast-spin echo and gradient-echo proton-density and T1-weighted data sets (permitting the calculation of a T1 map) were acquired in all subjects. GM and NAWM T1 histograms were produced and a hierarchical regression model was used to investigate changes in T1 over time. Results At baseline, significant patient-control differences were seen, both in NAWM (P = 0.001) and in GM (P = 0.01). At follow-up, there was no evidence for a serial change in either mean T1 or peak-location for either NAWM or GM. There was weak evidence for a decline in patient NAWM peak-height and also evidence for a decline in control GM peak-height. Conclusion There are significant and persistent abnormalities of NAWM and GM T1 in early relapsing-remitting MS. Further studies should address whether such T1 measures have a role in prognosis or therapeutic monitoring. Multiple Sclerosis 2007; 13:169–177. http://msj.sagepub.com
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Affiliation(s)
- G R Davies
- NMR Research Unit, Institute of Neurology, University College London, Queen Square, London, UK
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6
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Castriota-Scanderbeg A, Fasano F, Filippi M, Caltagirone C. T1 relaxation maps allow differentiation between pathologic tissue subsets in relapsing-remitting and secondary progressive multiple sclerosis. Mult Scler 2016; 10:556-61. [PMID: 15471373 DOI: 10.1191/1352458504ms1073oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In an attempt to clarify whether T1 relaxation time mapping may assist in characterizing the pathological brain tissue substrate of multiple sclerosis (MS), we compared the T1 relaxation times of lesions, areas of normal-appearing white matter (NAWM) located proximal to lesions, and areas of NAWM located distant from lesions in 12 patients with the relapsing-remitting and 12 with the secondary progressive (SP) subtype of disease. Nine healthy volunteers served as controls. Calculated mean T1 values were averaged across all patients within each clinical group, and comparisons were made by means of the Mann-Whitney U-test. Significant differences were found between all investigated brain regions within each clinical subgroup. Significant differences were also detected for each investigated brain region among clinical subgroups. While T1 values of NAWM were significantly higher in patients with SP disease than in normal white matter (NWM) of controls, no differences were detected when corresponding brain areas of patients with RR MS were compared with NWM of controls. T1 maps identify areas of the brain that are damaged to a different extent in patients with MS, and may be of help in monitoring disease progression.
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7
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Mejia AF, Sweeney EM, Dewey B, Nair G, Sati P, Shea C, Reich DS, Shinohara RT. Statistical estimation of T1 relaxation times using conventional magnetic resonance imaging. Neuroimage 2015; 133:176-188. [PMID: 26732403 DOI: 10.1016/j.neuroimage.2015.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 12/11/2022] Open
Abstract
Quantitative T1 maps estimate T1 relaxation times and can be used to assess diffuse tissue abnormalities within normal-appearing tissue. T1 maps are popular for studying the progression and treatment of multiple sclerosis (MS). However, their inclusion in standard imaging protocols remains limited due to the additional scanning time and expert calibration required and susceptibility to bias and noise. Here, we propose a new method of estimating T1 maps using four conventional MR images, which are intensity-normalized using cerebellar gray matter as a reference tissue and related to T1 using a smooth regression model. Using cross-validation, we generate statistical T1 maps for 61 subjects with MS. The statistical maps are less noisy than the acquired maps and show similar reproducibility. Tests of group differences in normal-appearing white matter across MS subtypes give similar results using both methods.
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Affiliation(s)
- Amanda F Mejia
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Elizabeth M Sweeney
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, USA; Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Blake Dewey
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Govind Nair
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Pascal Sati
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Colin Shea
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel S Reich
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, USA; Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Al-Radaideh A, Mougin OE, Lim SY, Chou IJ, Constantinescu CS, Gowland P. Histogram analysis of quantitative T1 and MT maps from ultrahigh field MRI in clinically isolated syndrome and relapsing-remitting multiple sclerosis. NMR IN BIOMEDICINE 2015; 28:1374-1382. [PMID: 26346925 DOI: 10.1002/nbm.3385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/19/2015] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
This study used quantitative MRI to study normal appearing white matter (NAWM) in patients with clinically isolated syndromes suggestive of multiple sclerosis and relapsing-remitting multiple sclerosis (RRMS). This was done at ultrahigh field (7 T) for greater spatial resolution and sensitivity. 17 CIS patients, 11 RRMS patients, and 20 age-matched healthy controls were recruited. They were scanned using a 3D inversion recovery turbo field echo sequence to measure the longitudinal relaxation time (T1). A 3D magnetization transfer prepared turbo field echo (MT-TFE) sequence was also acquired, first without a presaturation pulse and then with the MT presaturation pulse applied at -1.05 kHz and +1.05 kHz off resonance from water to produce two magnetization transfer ratio maps (MTR(-) and MTR(+)). Histogram analysis was performed on the signal from the voxels in the NAWM mask. The upper quartile cut-off of the T1 histogram was significantly higher in RRMS patients than in controls (p < 0.05), but there was no difference in CIS. In contrast, MTR was significantly different between CIS or RRMS patients and controls (p < 0.05) for most histogram measures considered. The difference between MTR(+) and MTR(-) signals showed that NOE contributions dominated the changes found. There was a weak negative correlation (r = -0.46, p < 0.05) between the mode of T1 distributions and healthy controls' age; this was not significant for MTR(+) (r = -0.34, p > 0.05) or MTR(-) (r = 0.13, p > 0.05). There was no significant correlation between the median of T1, MTR(-), or MTR(+) and the age of healthy controls. Furthermore, no significant correlation was observed between EDSS or disease duration and T1, MTR(-), or MTR(+) for either CIS or RRMS patients. In conclusion, MTR was found to be more sensitive to early changes in MS disease than T1.
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Affiliation(s)
- Ali Al-Radaideh
- Medical Imaging, The Hashemite University, Zarqa, Jordan
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Olivier E Mougin
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Su-Yin Lim
- Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - I-Jun Chou
- Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Paediatric Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Penny Gowland
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
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9
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Lund H, Krakauer M, Skimminge A, Sellebjerg F, Garde E, Siebner HR, Paulson OB, Hesse D, Hanson LG. Blood-brain barrier permeability of normal appearing white matter in relapsing-remitting multiple sclerosis. PLoS One 2013; 8:e56375. [PMID: 23441184 PMCID: PMC3575471 DOI: 10.1371/journal.pone.0056375] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/08/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) affects the integrity of the blood-brain barrier (BBB). Contrast-enhanced T1 weighted magnetic resonance imaging (MRI) is widely used to characterize location and extent of BBB disruptions in focal MS lesions. We employed quantitative T1 measurements before and after the intravenous injection of a paramagnetic contrast agent to assess BBB permeability in the normal appearing white matter (NAWM) in patients with relapsing-remitting MS (RR-MS). METHODOLOGY/PRINCIPAL FINDINGS Fifty-nine patients (38 females) with RR-MS undergoing immunomodulatory treatment and nine healthy controls (4 females) underwent quantitative T1 measurements at 3 tesla before and after injection of a paramagnetic contrast agent (0.2 mmol/kg Gd-DTPA). Mean T1 values were calculated for NAWM in patients and total cerebral white matter in healthy subjects for the T1 measurements before and after injection of Gd-DTPA. The pre-injection baseline T1 of NAWM (945±55 [SD] ms) was prolonged in RR-MS relative to healthy controls (903±23 ms, p = 0.028). Gd-DTPA injection shortened T1 to a similar extent in both groups. Mean T1 of NAWM was 866±47 ms in the NAWM of RR-MS patients and 824±13 ms in the white matter of healthy controls. The regional variability of T1 values expressed as the coefficient of variation (CV) was comparable between the two groups at baseline, but not after injection of the contrast agent. After intravenous Gd-DTPA injection, T1 values in NAWM were more variable in RR-MS patients (CV = 0.198±0.046) compared to cerebral white matter of healthy controls (CV = 0.166±0.018, p = 0.046). CONCLUSIONS/SIGNIFICANCE We found no evidence of a global BBB disruption within the NAWM of RR-MS patients undergoing immunomodulatory treatment. However, the increased variation of T1 values in NAWM after intravenous Gd-DTPA injection points to an increased regional inhomogeneity of BBB function in NAWM in relapsing-remitting MS.
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Affiliation(s)
- Henrik Lund
- Danish Research Centre for Magnetic Resonance, Copenhagen University Hospital, Hvidovre, Denmark.
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10
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Messroghli DR, Rudolph A, Abdel-Aty H, Wassmuth R, Kühne T, Dietz R, Schulz-Menger J. An open-source software tool for the generation of relaxation time maps in magnetic resonance imaging. BMC Med Imaging 2010; 10:16. [PMID: 20673350 PMCID: PMC2919441 DOI: 10.1186/1471-2342-10-16] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Accepted: 07/30/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In magnetic resonance (MR) imaging, T1, T2 and T2* relaxation times represent characteristic tissue properties that can be quantified with the help of specific imaging strategies. While there are basic software tools for specific pulse sequences, until now there is no universal software program available to automate pixel-wise mapping of relaxation times from various types of images or MR systems. Such a software program would allow researchers to test and compare new imaging strategies and thus would significantly facilitate research in the area of quantitative tissue characterization. RESULTS After defining requirements for a universal MR mapping tool, a software program named MRmap was created using a high-level graphics language. Additional features include a manual registration tool for source images with motion artifacts and a tabular DICOM viewer to examine pulse sequence parameters. MRmap was successfully tested on three different computer platforms with image data from three different MR system manufacturers and five different sorts of pulse sequences: multi-image inversion recovery T1; Look-Locker/TOMROP T1; modified Look-Locker (MOLLI) T1; single-echo T2/T2*; and multi-echo T2/T2*. Computing times varied between 2 and 113 seconds. Estimates of relaxation times compared favorably to those obtained from non-automated curve fitting. Completed maps were exported in DICOM format and could be read in standard software packages used for analysis of clinical and research MR data. CONCLUSIONS MRmap is a flexible cross-platform research tool that enables accurate mapping of relaxation times from various pulse sequences. The software allows researchers to optimize quantitative MR strategies in a manufacturer-independent fashion. The program and its source code were made available as open-source software on the internet.
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Affiliation(s)
- Daniel R Messroghli
- Cardiac MRI Unit, Franz-Volhard-Klinik, Charité University Medicine, Berlin, Germany.
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11
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Sati P, Cross AH, Luo J, Hildebolt CF, Yablonskiy DA. In vivo quantitative evaluation of brain tissue damage in multiple sclerosis using gradient echo plural contrast imaging technique. Neuroimage 2010; 51:1089-97. [PMID: 20338247 DOI: 10.1016/j.neuroimage.2010.03.045] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 03/11/2010] [Accepted: 03/16/2010] [Indexed: 01/19/2023] Open
Abstract
Conventional MRI based on weighted spin-echo (SE) images aids in the diagnosis of multiple sclerosis (MS); however, MRI markers derived from SE sequences provide limited information about lesion severity and correlate poorly with patient disability assessed with clinical tests. In this study, we introduced a novel method [based on quantitative R2* (1/T2*) histograms] for estimating the severity of brain tissue damage in MS lesions. We applied at 1.5T an advanced, multi-gradient echo MRI technique [gradient echo plural contrast imaging (GEPCI)] to obtain images of the brains of healthy control subjects and subjects with MS. GEPCI is a simple yet robust technique allowing simultaneous acquisition of inherently co-registered quantitative T2* and FLAIR-like maps, along with T1-weighted images within a clinically acceptable time frame. Images obtained with GEPCI appear highly similar to standard scans; hence, they can be used in a reliable and conventional way for a clinical evaluation of the disease. Yet, the main advantage of GEPCI approach is its quantitative nature. Analysis of R2* histograms of white matter revealed a difference in the distribution between healthy subjects and subjects with MS. Based on this difference, we developed a new method for grading the severity of tissue damage [tissue damage score (TDS)] in MS lesions. This method also provides a tissue damage load (TDL) assessing both lesion load and lesion severity, and a mean tissue damage score (MTDS) estimating the average MS lesion damage. We found promising correlations between the results derived from this method and the standard measure of clinical disability.
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Affiliation(s)
- Pascal Sati
- Department of Radiology, Washington University in St.Louis, One Brookings Drive, Saint Louis, MO 63130, USA
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12
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MacKay AL, Vavasour IM, Rauscher A, Kolind SH, Mädler B, Moore GRW, Traboulsee AL, Li DKB, Laule C. MR relaxation in multiple sclerosis. Neuroimaging Clin N Am 2009; 19:1-26. [PMID: 19064196 DOI: 10.1016/j.nic.2008.09.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article provides an overview of relaxation times and their application to normal brain and brain and cord affected by multiple sclerosis. The goal is to provide readers with an intuitive understanding of what influences relaxation times, how relaxation times can be accurately measured, and how they provide specific information about the pathology of MS. The article summarizes significant results from relaxation time studies in the normal human brain and cord and from people who have multiple sclerosis. It also reports on studies that have compared relaxation time results with results from other MR techniques.
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Affiliation(s)
- A L MacKay
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada.
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Neema M, Stankiewicz J, Arora A, Guss ZD, Bakshi R. MRI in multiple sclerosis: what's inside the toolbox? Neurotherapeutics 2007; 4:602-17. [PMID: 17920541 PMCID: PMC7479680 DOI: 10.1016/j.nurt.2007.08.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Magnetic resonance imaging (MRI) has played a central role in the diagnosis and management of multiple sclerosis (MS). In addition, MRI metrics have become key supportive outcome measures to explore drug efficacy in clinical trials. Conventional MRI measures have contributed to the understanding of MS pathophysiology at the macroscopic level yet have failed to provide a complete picture of underlying MS pathology. They also show relatively weak relationships to clinical status such as predictive strength for clinical progression. Advanced quantitative MRI measures such as magnetization transfer, spectroscopy, diffusion imaging, and relaxometry techniques are somewhat more specific and sensitive for underlying pathology. These measures are particularly useful in revealing diffuse damage in cerebral white and gray matter and therefore may help resolve the dissociation between clinical and conventional MRI findings. In this article, we provide an overview of the array of tools available with brain and spinal cord MRI technology as it is applied to MS. We review the most recent data regarding the role of conventional and advanced MRI techniques in the assessment of MS. We focus on the most relevant pathologic and clinical correlation studies relevant to these measures.
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Affiliation(s)
- Mohit Neema
- Department of Neurology, Center for Neurological Imaging, Partners MS Center, Brigham and Women’s Hospital, Harvard Medical School, 02115 Boston, Massachusetts
| | - James Stankiewicz
- Department of Neurology, Center for Neurological Imaging, Partners MS Center, Brigham and Women’s Hospital, Harvard Medical School, 02115 Boston, Massachusetts
| | - Ashish Arora
- Department of Neurology, Center for Neurological Imaging, Partners MS Center, Brigham and Women’s Hospital, Harvard Medical School, 02115 Boston, Massachusetts
| | - Zachary D. Guss
- Department of Neurology, Center for Neurological Imaging, Partners MS Center, Brigham and Women’s Hospital, Harvard Medical School, 02115 Boston, Massachusetts
| | - Rohit Bakshi
- Department of Neurology, Center for Neurological Imaging, Partners MS Center, Brigham and Women’s Hospital, Harvard Medical School, 02115 Boston, Massachusetts
- Department of Radiology, Center for Neurological Imaging, Partners MS Center, Brigham and Women’s Hospital, Harvard Medical School, 02115 Boston, Massachusetts
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14
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Neema M, Stankiewicz J, Arora A, Dandamudi VSR, Batt CE, Guss ZD, Al-Sabbagh A, Bakshi R. T1- and T2-Based MRI Measures of Diffuse Gray Matter and White Matter Damage in Patients with Multiple Sclerosis. J Neuroimaging 2007; 17 Suppl 1:16S-21S. [PMID: 17425729 DOI: 10.1111/j.1552-6569.2007.00131.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) has emerged as a powerful noninvasive tool to assist in the diagnosis and monitoring of multiple sclerosis (MS). In addition, investigators have used MRI metrics as supportive outcome measures to explore drug efficacy in clinical trials. Conventional MRI surrogates provide information at the macroscopic level but lack sensitivity and specificity in identifying the full extent of underlying MS pathology. They also show relatively weak relationships to clinical status such as predictive strength for clinical change. Advanced MRI techniques involving quantitative measures of diffuse damage in normal appearing (NA) white matter (WM) and gray matter (GM) may help in resolving this apparent clinical MRI paradox. T2 hypointensity has been described in the GM of patients with MS and has been linked to physical disability, cognitive dysfunction, and brain atrophy. While this T2 hypointensity is thought to represent iron deposition, this awaits pathologic confirmation. Advanced MRI measures of iron deposition such as R2, R2*, R2' relaxometry, 3T imaging and other new approaches are beginning to be applied to studies of MS and should yield interesting information. Both T1 and T2 relaxometry have a role in detecting damage in NA brain tissue that escapes detection by conventional MRI lesion measures. For example, T2 mapping may allow an assessment of myelin content in NAWM. In this review, we will focus on MRI advances in the last 10 years pertaining to T1 and T2 measures of diffuse GM and WM damage.
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Affiliation(s)
- Mohit Neema
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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15
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Vrenken H, Geurts JJG. Gray and normal-appearing white matter in multiple sclerosis: an MRI perspective. Expert Rev Neurother 2007; 7:271-9. [PMID: 17341175 DOI: 10.1586/14737175.7.3.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Besides focal white matter lesions, multiple sclerosis brain tissue also displays abnormalities in the gray matter and the normal-appearing white matter. Recent advances in magnetic resonance imaging studies of both types of tissue are discussed. Herein, normal-appearing white matter abnormalities are being found in quantitative magnetic resonance investigations, consistent with a limited degree of axonal damage and/or demyelination, and an increase of glial cells, but the specific nature of the histopathological changes underlying the quantitative magnetic resonance abnormalities remains unclear. Gray matter studies have demonstrated that much of the disease process remains undetected by conventional magnetic resonance imaging. Although newly developed techniques, such as 3D double-inversion recovery, may greatly improve detection of cortical pathology, it remains important to investigate the resultant effects on the cortical tissue alongside this, by studying integrity of normal-appearing cortical tissue through quantitative magnetic resonance studies, as well as the net neurodegenerative effect through measurements of cortical thickness and cortical atrophy (rates). To improve our understanding of normal-appearing white and gray matter changes, their mutual relations, and their relations to clinical changes, further in vivo magnetic resonance imaging studies are required. Specifically, it is proposed that more spatially specific investigations, ideally utilizing subject-specific anatomical information from, for example, diffusion fiber-tracking techniques, could be used to gain more insight into the relations between normal-appearing white matter changes, cortical changes, magnetic resonance visible focal-lesions, and physical and cognitive deficits.
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Affiliation(s)
- Hugo Vrenken
- MS Center Amsterdam, VU University Medical Center, Department of Physics & Medical Technology, De Boelelaan, Amsterdam, The Netherlands.
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16
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Vrenken H, Pouwels PJW, Ropele S, Knol DL, Geurts JJG, Polman CH, Barkhof F, Castelijns JA. Magnetization transfer ratio measurement in multiple sclerosis normal-appearing brain tissue: limited differences with controls but relationships with clinical and MR measures of disease. Mult Scler 2007; 13:708-16. [PMID: 17613597 DOI: 10.1177/1352458506075521] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the magnetization transfer ratio (MTR) of normal-appearing white (NAWM) and grey matter (NAGM) in a relatively large group of multiple sclerosis (MS) patients, and the relations of MTR changes with clinical disability. MTR was measured in 66 MS patients (12 PP, 35 RR, 19 SP) and 23 healthy controls, using a whole-brain 3D-FLASH technique corrected post-hoc for B1-induced variation. Histogram parameters of conservatively selected NAWM and cortical NAGM were analysed using Bonferroni-corrected ANOVA with age as covariate. Additionally, manually outlined regions of interest were analysed using a multilevel method. Lesions had low MTR (mean 22.7±6.9%), but NAWM exhibited limited changes: MTR histogram peak position was 32.8±1.0% in controls and 32.4±0.9% in MS patients, with a significant decrease compared to controls only in SPMS patients (31.9±1.1%, p=0.045). Cortical NAGM histograms did not differ significantly between patients and controls. In SPMS, regional mean MTR was significantly decreased in corpus callosum and hippocampus. MTR histogram parameters of NAGM and NAWM were correlated with EDSS and MSFC scores, with lesion volume and with normalized brain volume. We conclude that disease-induced MTR changes were small in MS NAWM and NAGM, but did correlate with clinical decline, lesion volume and overall cerebral atrophy. Multiple Sclerosis 2007; 13: 708-716. http://msj.sagepub.com
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Affiliation(s)
- H Vrenken
- Department of Radiology, MR Center for MS Research, VU University Medical Center, Amsterdam, The Netherlands.
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Pouwels PJW, Kuijer JPA, Mugler JP, Guttmann CRG, Barkhof F. Human gray matter: feasibility of single-slab 3D double inversion-recovery high-spatial-resolution MR imaging. Radiology 2006; 241:873-9. [PMID: 17053197 DOI: 10.1148/radiol.2413051182] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this study was to develop and prospectively evaluate the feasibility of a single-slab three-dimensional (3D) double inversion-recovery, or DIR, sequence for magnetic resonance imaging at 1.5 T. The study was approved by the local ethics committee, and informed consent was obtained from six healthy control subjects (one woman, five men; age range, 26-47 years) and two patients with multiple sclerosis (one woman, aged 39; one man, aged 56). Gray matter (GM)-only images were obtained by selectively suppressing cerebrospinal fluid (CSF) and white matter (WM) signals. Whole-brain high-spatial-resolution 3D images (1.2 x 1.2 x 1.3 mm) were acquired within 10 minutes. Cortical and deep GM structures were clearly delineated from WM and CSF, and there were regional differences in GM signal intensity. No flow artifacts from blood or CSF were observed. These GM images with high spatial resolution are suitable to identify cortical pathologic conditions and can potentially be used for segmentation purposes to determine cortical thickness or volume.
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Affiliation(s)
- Petra J W Pouwels
- MS Research Center, Department of Physics and Medical Technology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
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Vrenken H, Geurts JJG, Knol DL, van Dijk LN, Dattola V, Jasperse B, van Schijndel RA, Polman CH, Castelijns JA, Barkhof F, Pouwels PJW. Whole-Brain T1 Mapping in Multiple Sclerosis: Global Changes of Normal-appearing Gray and White Matter. Radiology 2006; 240:811-20. [PMID: 16868279 DOI: 10.1148/radiol.2403050569] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively investigate whether T1 changes in normal-appearing white matter (WM) and normal-appearing gray matter (GM) in multiple sclerosis (MS) are global or regional and their relationship to disease type. MATERIALS AND METHODS The institutional ethics review board approved study; written informed consent was obtained. Whole-brain T1 maps were obtained in 67 patients with MS and 24 healthy control subjects with three-dimensional fast low-angle shot flip angle-array method, with correction for B(1) imperfections. Analysis of variance was performed on T1 histogram parameters of global normal-appearing WM and GM. Regional mean T1 values were analyzed with a multilevel approach. Multiple linear regression analysis was performed to investigate associations with clinical disability and overall atrophy. For patients, T2 lesion load was determined. RESULTS T1 histograms of normal-appearing WM had significantly higher peak positions for patients with MS (792 msec +/- 36 in secondary progressive [SP] MS) than for control subjects (746 msec +/- 23) and were significantly broader and lower (all P < .001). Histograms for cortical normal-appearing GM were significantly shifted (peak positions, 1263 msec +/- 44 in control subjects and 1355 msec +/- 62 in patients with SP MS) (P < .001). Histogram peak positions were significantly higher in SP MS than in relapsing-remitting (RR) and primary progressive MS (P < .05). In SP disease, at least 31% of normal-appearing WM and 20% of cortical normal-appearing GM were affected. In MS, T1 was significantly elevated in all normal-appearing WM and cortical normal-appearing GM regions (all P < .01) but was elevated only in the thalamus in deep GM (P < .05). Cortical T1 histogram peak position was associated with clinical disability; T2 lesion load was not. CONCLUSION Results suggest that a global disease process affects large parts of both normal-appearing WM and GM in MS and effects are worse for SP MS than for RR MS.
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Affiliation(s)
- Hugo Vrenken
- Departments of Radiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Alper F, Gundogdu C, Varoglu A, Kantarci M, Bulucu Z, Malkoc I, Unal B. Determination of Brain Volumes Using Quantitative MR Imaging in Patients with Multiple Sclerosis. Neuroradiol J 2006; 19:283-8. [DOI: 10.1177/197140090601900302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 05/11/2006] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to determine the amount of atrophy occurring in the cerebrum of patients with multiple sclerosis compared with controls, and to show the relationship between clinical status and distribution of atrophy. MR images were obtained on 12 relapsing-remitting (RR) and 11 secondary progressive (SP) multiple sclerosis patients and 24 control subjects (all patients and controls were female). The Cavalieri method by modern design stereology was used to measure the cerebral volume. It was found that volumes for RR and SP with multiple sclerosis and control subjects were 757242 mm3, 716867 mm3 and 912499 mm3 respectively. Mean estimates of volume loss in RR and SP were 20.5% and 27.2% respectively compared to controls for the cerebrum. In addition the volume difference between RR and SP was 5.6%. There were statistically significant differences between both RR (P<0.05) and SP (P<0.05) compared with control subjects but no differences between RR and SP volumes. MRI-estimated cerebrum volumes may be help to evaluate patients' clinical status and provide a simple index to assess the efficiency of therapy.
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Affiliation(s)
- F. Alper
- Department of Radiology, Atatürk University; Erzurum, Turkey
| | - C. Gundogdu
- Department of Pathology, Atatürk University; Erzurum, Turkey
| | - A.O. Varoglu
- Department of Neurology, Atatürk University; Erzurum, Turkey
| | - M. Kantarci
- Department of Radiology, Atatürk University; Erzurum, Turkey
| | - Z. Bulucu
- Department of Histology and Embryology, Atatürk University; Erzurum, Turkey
| | - I. Malkoc
- Department of Anatomy, Medical School, Atatürk University; Erzurum, Turkey
| | - B. Unal
- Department of Histology and Embryology, Atatürk University; Erzurum, Turkey
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van Walderveen MAA, van Schijndel RA, Pouwels PJW, Polman CH, Barkhof F. Multislice T1 relaxation time measurements in the brain using IR-EPI: Reproducibility, normal values, and histogram analysis in patients with multiple sclerosis. J Magn Reson Imaging 2003; 18:656-64. [PMID: 14635150 DOI: 10.1002/jmri.10417] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To perform T(1) measurements using inversion recovery (IR) echoplanar imaging (EPI) to evaluate reproducibility, normal values, and T(1) histogram analysis as a measure of disease progression in multiple sclerosis (MS) patients. MATERIALS AND METHODS Multislice IR-EPI was performed in 10 controls and 36 MS patients. Region-of-interest (ROI) and T(1) histogram analysis were performed on T(1) maps and compared to hypointense T(1) lesions and brain atrophy in MS patients. RESULTS Coefficient of variation (COV) varied from 1.6% to 4.9%. Callosal normal (appearing) white matter (N(A)WM) showed the lowest and cortical gray matter the highest T(1) values. T(1) histogram analysis in controls showed a sharp WM peak centered on a T(1) value of 729 msec (range = 679-765) with extension into a shoulder of higher T(1) values. In MS patients, a shift toward higher T(1) values (mean = 788 msec, range = 700-957) with a lower relative peak amplitude was present, predominantly resulting from T(1) prolongation in NAWM. T(1) histogram parameters strongly related to hypointense T(1) lesion volume and brain atrophy in MS patients. CONCLUSIONS IR-EPI provides a reproducible method to obtain T(1) values in the brain. Regional variation in T(1) values is present in N(A)WM of volunteers and MS patients. Since T(1) histogram parameters reflect changes in NAWM and correlate with conventional measures of disease burden in MS patients, T(1) histogram analysis may provide a global measure of disease progression in MS.
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Quarantelli M, Ciarmiello A, Morra VB, Orefice G, Larobina M, Lanzillo R, Schiavone V, Salvatore E, Alfano B, Brunetti A. Brain tissue volume changes in relapsing-remitting multiple sclerosis: correlation with lesion load. Neuroimage 2003; 18:360-6. [PMID: 12595189 DOI: 10.1016/s1053-8119(02)00018-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to simultaneously measure in vivo volumes of gray matter (GM), normal white matter (WM), abnormal white matter (aWM), and cerebro-spinal fluid (CSF), and to assess their relationship in 50 patients with relapsing-remitting multiple sclerosis (RR-MS) (age range, 21-59; mean EDSS, 2.5; mean disease duration, 9.9 years), using an unsupervised multiparametric segmentation procedure applied to brain MR studies. Tissue volumes were normalized to total intracranial volume providing corresponding fractional volumes (fGM, faWM, fWM, and fCSF), subsequently corrected for aWM-related segmentation inaccuracies and adjusted to mean patients' age according to age-related changes measured in 54 normal volunteers (NV) (age range 16-70). In MS patients aWM was 23.8 +/- 29.8 ml (range 0.4-138.8). A significant decrease in fGM was present in MS patients as compared to NV (49.5 +/- 3.2% vs 53.3 +/- 2.1%; P < 0.0001), with a corresponding increase in fCSF (13.0 +/- 3.8% vs 9.1 +/- 2.4%; P < 0.0001). No difference could be detected between the two groups for fWM (37.5 +/- 2.6% vs 37.6 +/- 2.2%). faWM correlated inversely with fGM (R = -0.434, P < 0.001 at regression analysis), and directly with fCSF (R = 0.473, P < 0.001), but not with fWM. There was a significant correlation between disease duration and EDSS, while no relationship was found between EDSS or disease duration and fractional volumes. Brain atrophy in RR-MS is mainly related to GM loss, which correlates with faWM. Both measures do not appear to significantly affect EDSS, which correlates to disease duration.
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Affiliation(s)
- Mario Quarantelli
- Biostructure and Bioimaging Institute, National Council for Research, Building 10, Via Pansini 5, 80131 Naples, Italy.
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