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Schröter N, Arnold PG, Hosp JA, Reisert M, Rijntjes M, Kellner E, Jost WH, Weiller C, Urbach H, Rau A. Complemental Value of Microstructural and Macrostructural MRI in the Discrimination of Neurodegenerative Parkinson Syndromes. Clin Neuroradiol 2024; 34:411-420. [PMID: 38289378 PMCID: PMC11130007 DOI: 10.1007/s00062-023-01377-w] [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: 10/19/2023] [Accepted: 12/24/2023] [Indexed: 05/29/2024]
Abstract
PURPOSE Various MRI-based techniques were tested for the differentiation of neurodegenerative Parkinson syndromes (NPS); the value of these techniques in direct comparison and combination is uncertain. We thus compared the diagnostic performance of macrostructural, single compartmental, and multicompartmental MRI in the differentiation of NPS. METHODS We retrospectively included patients with NPS, including 136 Parkinson's disease (PD), 41 multiple system atrophy (MSA) and 32 progressive supranuclear palsy (PSP) and 27 healthy controls (HC). Macrostructural tissue probability values (TPV) were obtained by CAT12. The microstructure was assessed using a mesoscopic approach by diffusion tensor imaging (DTI), neurite orientation dispersion and density imaging (NODDI), and diffusion microstructure imaging (DMI). After an atlas-based read-out, a linear support vector machine (SVM) was trained on a training set (n = 196) and validated in an independent test cohort (n = 40). The diagnostic performance of the SVM was compared for different inputs individually and in combination. RESULTS Regarding the inputs separately, we observed the best diagnostic performance for DMI. Overall, the combination of DMI and TPV performed best and correctly classified 88% of the patients. The corresponding area under the receiver operating characteristic curve was 0.87 for HC, 0.97 for PD, 1.0 for MSA, and 0.99 for PSP. CONCLUSION We were able to demonstrate that (1) MRI parameters that approximate the microstructure provided substantial added value over conventional macrostructural imaging, (2) multicompartmental biophysically motivated models performed better than the single compartmental DTI and (3) combining macrostructural and microstructural information classified NPS and HC with satisfactory performance, thus suggesting a complementary value of both approaches.
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Affiliation(s)
- Nils Schröter
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philipp G Arnold
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Department of Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Würtemberger U, Rau A, Diebold M, Becker L, Hohenhaus M, Beck J, Reinacher PC, Erny D, Reisert M, Urbach H, Demerath T. Advanced diffusion MRI provides evidence for altered axonal microstructure and gradual peritumoral infiltration in GBM in comparison to brain metastases. Clin Neuroradiol 2024:10.1007/s00062-024-01416-0. [PMID: 38683350 DOI: 10.1007/s00062-024-01416-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE In contrast to peritumoral edema in metastases, GBM is histopathologically characterized by infiltrating tumor cells within the T2 signal alterations. We hypothesized that depending on the distance from the outline of the contrast-enhancing tumor we might reveal imaging evidence of gradual peritumoral infiltration in GBM and predominantly vasogenic edema around metastases. We thus investigated the gradual change of advanced diffusion metrics with the peritumoral zone in metastases and GBM. METHODS In 30 patients with GBM and 28 with brain metastases, peritumoral T2 hyperintensity was segmented in 33% partitions based on the total volume beginning at the enhancing tumor margin and divided into inner, middle and outer zones. Diffusion Tensor Imaging (DTI)-derived fractional anisotropy and mean diffusivity as well as Diffusion Microstructure Imaging (DMI)-based parameters Dax-intra, Dax-extra, V‑CSF and V-intra were employed to assess group-wise differences between inner and outer zones as well as within-group gradients between the inner and outer zones. RESULTS In metastases, fractional anisotropy and Dax-extra were significantly reduced in the inner zone compared to the outer zone (FA p = 0.01; Dax-extra p = 0.03). In GBM, we noted a reduced Dax-extra and significantly lower intraaxonal volume fraction (Dax-extra p = 0.008, V‑intra p = 0.006) accompanied by elevated axial intraaxonal diffusivity in the inner zone (p = 0.035). Between-group comparison of the outer to the inner zones revealed significantly higher gradients in metastases over GBM for FA (p = 0.04) as well as the axial diffusivity in the intra- (p = 0.02) and extraaxonal compartment (p < 0.001). CONCLUSION Our findings provide evidence of gradual alterations within the peritumoral zone of brain tumors. These are compatible with predominant (vasogenic) edema formation in metastases, whereas our findings in GBM are in line with an axonal destructive component in the immediate peritumoral area and evidence of tumor cell infiltration with accentuation in the tumor's vicinity.
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Affiliation(s)
- U Würtemberger
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
- Dept. of Neuroradiology, University Medical Center Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
| | - A Rau
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - M Diebold
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - L Becker
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - M Hohenhaus
- Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - J Beck
- Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - P C Reinacher
- Department of Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Fraunhofer Institute for Laser Technology, 52074, Aachen, Germany
| | - D Erny
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - M Reisert
- Department of Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - T Demerath
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
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3
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Switzer AR, Graff-Radford J, Gunter JL, Elder BD, Jones DT, Huston J, Jack CR, Cogswell PM. Patients with normal pressure hydrocephalus have fewer enlarged perivascular spaces in the centrum semiovale compared to cognitively unimpaired individuals. Clin Neurol Neurosurg 2024; 237:108123. [PMID: 38262154 DOI: 10.1016/j.clineuro.2024.108123] [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: 10/20/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION Enlarged perivascular spaces (ePVS) may be an indicator of glymphatic dysfunction. Limited studies have evaluated the role of ePVS in idiopathic normal pressure hydrocephalus (iNPH). We aimed to characterize the distribution and number of ePVS in iNPH compared to controls. METHODS Thirty-eight patients with iNPH and a pre-shunt MRI were identified through clinical practice. Age- and sex-matched controls who had negative MRIs screening for intracranial metastases were identified through a medical record linkage system. The number of ePVS were counted in the basal nuclei (BN) and centrum semiovale (CS) using the Wardlaw method blinded to clinical diagnosis. Imaging features of disproportionately enlarged subarachnoid space hydrocephalus (DESH), callosal angle, Fazekas white matter hyperintensity (WMH) grade, and the presence of microbleeds and lacunes were also evaluated. RESULTS Both iNPH patients and controls had a mean age of 74 ± 7 years and were 34% female with equal distributions of hypertension, dyslipidemia, diabetes, stroke, and history of smoking. There were fewer ePVS in the CS of patients with iNPH compared to controls (12.66 vs. 20.39, p < 0.001) but the same in the BN (8.95 vs. 11.11, p = 0.08). This remained significant in models accounting for vascular risk factors (p = 0.002) and MRI features of DESH and WMH grade (p = 0.03). CONCLUSIONS Fewer centrum semiovale ePVS may be a biomarker for iNPH. This pattern may be caused by mechanical obstruction due to upward displacement of the brain leading to reduced glymphatic clearance.
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Affiliation(s)
- Aaron R Switzer
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | | | | | - Benjamin D Elder
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, 55905, USA; Department of Orthopedics, Mayo Clinic, Rochester, MN 55905, USA; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
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Würtemberger U, Erny D, Rau A, Hosp JA, Akgün V, Reisert M, Kiselev VG, Beck J, Jankovic S, Reinacher PC, Hohenhaus M, Urbach H, Diebold M, Demerath T. Mesoscopic Assessment of Microstructure in Glioblastomas and Metastases by Merging Advanced Diffusion Imaging with Immunohistopathology. AJNR Am J Neuroradiol 2023; 44:1262-1269. [PMID: 37884304 PMCID: PMC10631536 DOI: 10.3174/ajnr.a8022] [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: 06/08/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Glioblastomas and metastases are the most common malignant intra-axial brain tumors in adults and can be difficult to distinguish on conventional MR imaging due to similar imaging features. We used advanced diffusion techniques and structural histopathology to distinguish these tumor entities on the basis of microstructural axonal and fibrillar signatures in the contrast-enhancing tumor component. MATERIALS AND METHODS Contrast-enhancing tumor components were analyzed in 22 glioblastomas and 21 brain metastases on 3T MR imaging using DTI-fractional anisotropy, neurite orientation dispersion and density imaging-orientation dispersion, and diffusion microstructural imaging-micro-fractional anisotropy. Available histopathologic specimens (10 glioblastomas and 9 metastases) were assessed for the presence of axonal structures and scored using 4-level scales for Bielschowsky staining (0: no axonal structures, 1: minimal axonal fragments preserved, 2: decreased axonal density, 3: no axonal loss) and glial fibrillary acid protein expression (0: no glial fibrillary acid protein positivity, 1: limited expression, 2: equivalent to surrounding parenchyma, 3: increased expression). RESULTS When we compared glioblastomas and metastases, fractional anisotropy was significantly increased and orientation dispersion was decreased in glioblastomas (each P < .001), with a significant shift toward increased glial fibrillary acid protein and Bielschowsky scores. Positive associations of fractional anisotropy and negative associations of orientation dispersion with glial fibrillary acid protein and Bielschowsky scores were revealed, whereas no association between micro-fractional anisotropy with glial fibrillary acid protein and Bielschowsky scores was detected. Receiver operating characteristic curves revealed high predictive values of both fractional anisotropy (area under the curve = 0.8463) and orientation dispersion (area under the curve = 0.8398) regarding the presence of a glioblastoma. CONCLUSIONS Diffusion imaging fractional anisotropy and orientation dispersion metrics correlated with histopathologic markers of directionality and may serve as imaging biomarkers in contrast-enhancing tumor components.
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Affiliation(s)
- Urs Würtemberger
- From the Department of Neuroradiology (U.W., A.R., V.A., H.U., T.D.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Daniel Erny
- Institute of Neuropathology (D.E., M.D.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Program for Advanced Clinician Scientists (D.E.), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- From the Department of Neuroradiology (U.W., A.R., V.A., H.U., T.D.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology (A.R.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Neurophysiology (J.A.H.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Veysel Akgün
- From the Department of Neuroradiology (U.W., A.R., V.A., H.U., T.D.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Medical Physics (M.R., V.G.K.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery (M.R., P.C.R.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Valerij G Kiselev
- Department of Medical Physics (M.R., V.G.K.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery (J.B., M.H.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Sonja Jankovic
- Department of Radiology (S.J.), Faculty of Medicine, University Clinical Center Nis, University of Nis, Nis, Serbia
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery (M.R., P.C.R.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for Laser Technology (P.C.R.), Aachen, Germany
| | - Marc Hohenhaus
- Department of Neurosurgery (J.B., M.H.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- From the Department of Neuroradiology (U.W., A.R., V.A., H.U., T.D.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Martin Diebold
- Institute of Neuropathology (D.E., M.D.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- IMM-PACT Clinician Scientist Program (M.D.), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- From the Department of Neuroradiology (U.W., A.R., V.A., H.U., T.D.), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
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Pyrgelis ES, Velonakis G, Papageorgiou SG, Stefanis L, Kapaki E, Constantinides VC. Imaging Markers for Normal Pressure Hydrocephalus: An Overview. Biomedicines 2023; 11:biomedicines11051265. [PMID: 37238936 DOI: 10.3390/biomedicines11051265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Idiopathic bormal pressure hydrocephalus (iNPH) is a neurological syndrome that clinically presents with Hakim's triad, namely cognitive impairment, gait disturbances, and urinary incontinence. The fact that iNPH is potentially reversible makes its accurate and early diagnosis of paramount importance. Its main imaging characteristic is the dilation of the brain's ventricular system and the imaging parameters are also included in its diagnostic criteria along with clinical data. There is a variety of different modalities used and a great number of imaging markers that have been described while assessing iNPH patients. The present literature review attempts to describe the most important of these imaging markers and to shed some light on their role in diagnosis, differential diagnosis, and possibly prognosis of this potentially reversible neurological syndrome.
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Affiliation(s)
- Efstratios-Stylianos Pyrgelis
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Rimini 1, Chaidari, 12462 Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Elisabeth Kapaki
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
| | - Vasilios C Constantinides
- 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
- Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Vass. Sophias Ave. 74, 11528 Athens, Greece
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Rau A, Jungmann PM, Diallo TD, Reisert M, Kellner E, Eisenblaetter M, Bamberg F, Jung M. Application of diffusion microstructure imaging in musculoskeletal radiology - translation from head to shoulders. Eur Radiol 2023; 33:1565-1574. [PMID: 36307552 PMCID: PMC9935724 DOI: 10.1007/s00330-022-09202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Quantitative MRI techniques, such as diffusion microstructure imaging (DMI), are increasingly applied for advanced tissue characterization. We determined its value in rotator cuff (RC) muscle imaging by studying the association of DMI parameters to isometric strength and fat fraction (FF). METHODS Healthy individuals prospectively underwent 3T-MRI of the shoulder using DMI and chemical shift encoding-based water-fat imaging. RC muscles were segmented and quantitative MRI metrics (V-ISO, free fluid; V-intra, compartment inside of muscle fibers; V-extra, compartment outside of muscle fibers, and FF) were extracted. Isometric shoulder strength was quantified using specific clinical tests. Sex-related differences were assessed with Student's t. Association of DMI-metrics, FF, and strength was tested. A factorial two-way ANOVA was performed to compare the main effects of sex and external/internal strength-ratio and their interaction effects on quantitative imaging parameters ratios of infraspinatus/subscapularis. RESULTS Among 22 participants (mean age: 26.7 ± 3.1 years, 50% female, mean BMI: 22.6 ± 1.9 kg/m2), FF of the individual RC muscles did not correlate with strength or DMI parameters (all p > 0.05). Subjects with higher V-intra (r = 0.57 to 0.87, p < 0.01) and lower V-ISO (r = -0.6 to -0.88, p < 0.01) had higher internal and external rotation strength. Moreover, V-intra was higher and V-ISO was lower in all RC muscles in males compared to female subjects (all p < 0.01). There was a sex-independent association of external/internal strength-ratio with the ratio of V-extra of infraspinatus/subscapularis (p = 0.02). CONCLUSIONS Quantitative DMI parameters may provide incremental information about muscular function and microstructure in young athletes and may serve as a potential biomarker. KEY POINTS • Diffusion microstructure imaging was successfully applied to non-invasively assess the microstructure of rotator cuff muscles in healthy volunteers. • Sex-related differences in the microstructural composition of the rotator cuff were observed. • Muscular microstructural metrics correlated with rotator cuff strength and may serve as an imaging biomarker of muscular integrity and function.
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Affiliation(s)
- Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
- Department of Neuroradiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany.
| | - Pia M Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Thierno D Diallo
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Michel Eisenblaetter
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany
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7
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Würtemberger U, Rau A, Reisert M, Kellner E, Diebold M, Erny D, Reinacher PC, Hosp JA, Hohenhaus M, Urbach H, Demerath T. Differentiation of Perilesional Edema in Glioblastomas and Brain Metastases: Comparison of Diffusion Tensor Imaging, Neurite Orientation Dispersion and Density Imaging and Diffusion Microstructure Imaging. Cancers (Basel) 2022; 15:cancers15010129. [PMID: 36612127 PMCID: PMC9817519 DOI: 10.3390/cancers15010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/12/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
Although the free water content within the perilesional T2 hyperintense region should differ between glioblastomas (GBM) and brain metastases based on histological differences, the application of classical MR diffusion models has led to inconsistent results regarding the differentiation between these two entities. Whereas diffusion tensor imaging (DTI) considers the voxel as a single compartment, multicompartment approaches such as neurite orientation dispersion and density imaging (NODDI) or the recently introduced diffusion microstructure imaging (DMI) allow for the calculation of the relative proportions of intra- and extra-axonal and also free water compartments in brain tissue. We investigate the potential of water-sensitive DTI, NODDI and DMI metrics to detect differences in free water content of the perilesional T2 hyperintense area between histopathologically confirmed GBM and brain metastases. Respective diffusion metrics most susceptible to alterations in the free water content (MD, V-ISO, V-CSF) were extracted from T2 hyperintense perilesional areas, normalized and compared in 24 patients with GBM and 25 with brain metastases. DTI MD was significantly increased in metastases (p = 0.006) compared to GBM, which was corroborated by an increased DMI V-CSF (p = 0.001), while the NODDI-derived ISO-VF showed only trend level increase in metastases not reaching significance (p = 0.060). In conclusion, diffusion MRI metrics are able to detect subtle differences in the free water content of perilesional T2 hyperintense areas in GBM and metastases, whereas DMI seems to be superior to DTI and NODDI.
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Affiliation(s)
- Urs Würtemberger
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Correspondence:
| | - Alexander Rau
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Department of Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Elias Kellner
- Department of Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Martin Diebold
- Institute of Neuropathology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- IMM-PACT Clinician Scientist Program, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Daniel Erny
- Institute of Neuropathology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Berta-Ottenstein-Program for Advanced Clinician Scientists, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
- Fraunhofer Institute for Laser Technology, 52074 Aachen, Germany
| | - Jonas A. Hosp
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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Rau A, Jost WH, Demerath T, Kellner E, Reisert M, Urbach H. Diffusion microstructure imaging in progressive supranuclear palsy: reduced axonal volumes in the superior cerebellar peduncles, dentato-rubro-thalamic tracts, ventromedial thalami, and frontomesial white matter. Cereb Cortex 2022; 32:5628-5636. [PMID: 35165694 DOI: 10.1093/cercor/bhac041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 01/25/2023] Open
Abstract
Differentiating between Parkinson's disease (PD) and atypical Parkinson syndromes such as progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal degeneration is challenging. Diffusion microstructure imaging (DMI) was analyzed in patients with clinically suspected atypical Parkinson syndromes and healthy controls. In an exploration cohort, the spatial distribution of PSP-related changes of DMI parameters were evaluated in a voxel-wise analysis and a region-of-interest (ROI)-based approach was established. The diagnostic performance was subsequently tested in an independent validation cohort. In the exploration cohort, 53 PSP patients were compared to a pooled comparison group of 19 patients with PD, 26 patients with MSA, 7 patients with corticobasal syndrome, and 25 healthy controls. PSP patients showed widespread axonal loss in the superior cerebellar peduncles, the dentato-rubro-thalamic tracts, the thalami and the frontal white matter (each P < 0.001). In the validation cohort consisting of 12 patients with PSP vs. 13 patients with other movement disorders, the accuracy of this ROI-based approach for identifying the PSP was highest in the thalamus and the frontal white matter (accuracy 0.96 each). This DMI approach can identify PSP patients on an individual level in a collective with suspected atypical Parkinson syndromes and allows further insight on microstructural alterations in vivo.
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Affiliation(s)
- Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
| | - Wolfgang H Jost
- Parkinson-Klinik Ortenau, Center for Movement Disorders, 77709 Wolfach, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, 79106 Freiburg, Germany
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Lan H, Lei X, Xu Z, Chen S, Gong W, Cai Y. New insights in addressing cerebral small vessel disease: Associated with extracellular fluid in white matter. Front Neurosci 2022; 16:1042824. [PMID: 36340793 PMCID: PMC9631816 DOI: 10.3389/fnins.2022.1042824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the role of extracellular fluid, assessed by diffusion tensor imaging (DTI) metrics of free water (FW), in the white matter of patients with cerebral small vessel disease (CSVD). Materials and methods The baseline clinical and imaging data of 129 patients with CSVD were collected and reviewed. CSVD MR markers, including periventricular white matter hyperintensity (PWMH), deep white matter hyperintensity (DWMH), cerebral microbleed (CMB), enlarged perivascular space (PVS), and lacunar infarction (LI), were identified, and CSVD burden was calculated. According to total CSVD MR marker score, cases were classified as mild, moderate, or severe. The mean FW and fractional anisotropy (FA) values were calculated using DTI images. Results The mean white matter FW was associated with the CSVD MR markers, including PWMH, DWMH, LI and PVS (P < 0.05). Moreover, age, hypertension, diabetes mellitus, and FW value were associated with total CSVD MR marker score (P < 0.05). Ordinal logistic regression analysis revealed that FW and age were independently associated with CSVD burden (P < 0.05). Finally, FW in white matter was associated with FA (r = –0.334, P < 0.001). Conclusion Extracellular fluid changes, assessed by DTI metrics of FW in white matter, were associated with CSVD markers and burden. An increased extracellular fluid volume in the white matter was associated with lower FA.
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Affiliation(s)
- Haiyuan Lan
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
| | - Xinjun Lei
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
| | - Zhihua Xu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
- *Correspondence: Zhihua Xu,
| | - Songkuan Chen
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Wanfeng Gong
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yunqi Cai
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
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Kellner E, Reisert M, Rau A, Hosp J, Demerath T, Weiller C, Urbach H. Clinical feasibility of diffusion microstructure imaging (DMI) in acute ischemic stroke. Neuroimage Clin 2022; 36:103189. [PMID: 36126516 PMCID: PMC9486659 DOI: 10.1016/j.nicl.2022.103189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Diffusion microstructure imaging (DMI) is a fast approach to higher-order diffusion-weighted magnetic resonance imaging that allows robust decomposition and characterization of diffusion properties of brain tissue into intra-axonal, extra-axonal, and a free water-compartment. We now report the application of this technique to acute ischemic stroke and demonstrate its potential applicability to the daily clinical routine. METHODS Thirty-eight patients diagnosed with acute ischemic stroke were scanned using an accelerated multi-shell diffusion-weighted imaging protocol (median delay between onset and MRI scan of 113 min). DMI metrics were calculated and the apparent diffusion coefficient (ADC) derived from conventional diffusion-weighted imaging was used for comparison. The resulting DMI parameter maps were analysed for their potential to improve infarct core delineation, and a receiver-operating characteristic (ROC) analysis was subsequently performed for automated infarct segmentation. RESULTS Robust parameter maps for diffusion microstructure properties were obtained in all cases. Within the ischemic tissue, an increase in the volume fraction of the intra-axonal compartment was accompanied by a volume fraction reduction in the other two compartments. Moreover, diffusivity was reduced in all three compartments, with intra-axonal diffusivity showing the highest degree of contrast. The intra-axonal diffusion coefficient maps were subsequently found to perform better than single-shell ADC-derived segmentation in terms of automatic segmentation of the infarct core (area under the curve = 0.98 vs 0.92). CONCLUSIONS The alterations to the ischemic core detected by DMI are in line with the "beading-model" of non-uniform neurite swelling under ischemic conditions. When compared to conventional single-shell diffusion-weighted imaging, DMI metrics are associated with improved discriminative power for delineating and characterizing ischemic changes. This might allow a more detailed assessment of infarct age, severity of damage, the degree of reversibility, and outcome.
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Affiliation(s)
- E Kellner
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Reisert
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Stereotactic and Functional Neurosurgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - A Rau
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Hosp
- Department of Neurology and Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - T Demerath
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Weiller
- Department of Neurology and Neuroscience, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Würtemberger U, Diebold M, Erny D, Hosp JA, Schnell O, Reinacher PC, Rau A, Kellner E, Reisert M, Urbach H, Demerath T. Diffusion Microstructure Imaging to Analyze Perilesional T2 Signal Changes in Brain Metastases and Glioblastomas. Cancers (Basel) 2022; 14:cancers14051155. [PMID: 35267463 PMCID: PMC8908999 DOI: 10.3390/cancers14051155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: Glioblastomas (GBM) and brain metastases are often difficult to differentiate in conventional MRI. Diffusion microstructure imaging (DMI) is a novel MR technique that allows the approximation of the distribution of the intra-axonal compartment, the extra-axonal cellular, and the compartment of interstitial/free water within the white matter. We hypothesize that alterations in the T2 hyperintense areas surrounding contrast-enhancing tumor components may be used to differentiate GBM from metastases. Methods: DMI was performed in 19 patients with glioblastomas and 17 with metastatic lesions. DMI metrics were obtained from the T2 hyperintense areas surrounding contrast-enhancing tumor components. Resected brain tissue was assessed in six patients in each group for features of an edema pattern and tumor infiltration in the perilesional interstitium. Results: Within the perimetastatic T2 hyperintensities, we observed a significant increase in free water (p < 0.001) and a decrease in both the intra-axonal (p = 0.006) and extra-axonal compartments (p = 0.024) compared to GBM. Perilesional free water fraction was discriminative regarding the presence of GBM vs. metastasis with a ROC AUC of 0.824. Histologically, features of perilesional edema were present in all assessed metastases and absent or marginal in GBM. Conclusion: Perilesional T2 hyperintensities in brain metastases and GBM differ significantly in DMI-values. The increased free water fraction in brain metastases suits the histopathologically based hypothesis of perimetastatic vasogenic edema, whereas in glioblastomas there is additional tumor infiltration.
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Affiliation(s)
- Urs Würtemberger
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.R.); (H.U.); (T.D.)
- Correspondence: urs.wü; Tel.: +49-761-270-51810; Fax: +49-761-270-51950
| | - Martin Diebold
- Institute of Neuropathology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.D.); (D.E.)
- IMM-PACT Clinician Scientist Program, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Daniel Erny
- Institute of Neuropathology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (M.D.); (D.E.)
- Berta-Ottenstein-Program for Advanced Clinician Scientists, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Jonas A. Hosp
- Department of Neurology and Neurophysiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Peter C. Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (P.C.R.); (M.R.)
- Fraunhofer Institute for Laser Technology, 52074 Aachen, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.R.); (H.U.); (T.D.)
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Elias Kellner
- Department of Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (P.C.R.); (M.R.)
- Department of Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;
| | - Horst Urbach
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.R.); (H.U.); (T.D.)
| | - Theo Demerath
- Department of Neuroradiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (A.R.); (H.U.); (T.D.)
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Turkin AM, Afandiev RM, Melnikova-Pitskhelauri TV, Fadeeva LM, Solozhentseva KD, Pogosbekyan EL, Oshorov AV, Pronin IN. [Periventricular changes following hydrocephalus: quantitative MR-based assessment of tissue characteristics]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:41-49. [PMID: 35942836 DOI: 10.17116/neiro20228604141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study tissue characteristics of periventricular white matter in patients with open hydrocephalus using DWI MRI and their correlations with CSF flow parameters. MATERIAL AND METHODS MRI was performed in 55 patients (35 women and 20 men) with open normal pressure hydrocephalus, as well as 16 patients with malignant occlusive hydrocephalus and interstitial edema (control group). We determined the correlations between severity of hydrocephalus, periventricular lesions and CSF flow parameters considering MR data. Dimensions of ventricular system were assessed using the Evans' index, periventricular changes - using visual four-level scale with calculation of apparent diffusion coefficient (ADC) and fractional anisotropy coefficient (FA). RESULTS Among patients with open hydrocephalus, ACD range for periventricular white matter was 1.57±0.15·10-3 mm2/s in subgroup of patients without periventricular changes (n=29) and 1.62±0.11×10-3 mm2/s in patients with periventricular changes (n=26). In the control group, mean ADC was 1.76±0.18·10-3 mm2/s (p<0.05). In patients with open hydrocephalus, FA coefficient in the areas of periventricular changes was 0.70-0.80, in case of occlusive hydrocephalus - 0.68-0.82. There was a significant relationship between the Evans' index and CSF pulsation velocity amplitude, Evans' index and stroke volume, Evans' index and cerebral aqueduct cross-sectional area in patients with open hydrocephalus. Periventricular changes were pronounced in patients with open hydrocephalus and Evans' index > 0.4 (p<0.05). CONCLUSION According to MR data, periventricular changes in patients with open hydrocephalus differ from true periventricular interstitial edema following occlusive hydrocephalus. Severity of periventricular changes in patients with open hydrocephalus depends on patient age and width of the ventricles, but does not correlate with CSF flow parameters. In our opinion, periventricular changes are associated with dysfunction of glymphatic system. Further research is required to study the functioning of glymphatic system and related processes.
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Affiliation(s)
- A M Turkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - L M Fadeeva
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | - A V Oshorov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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