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Oender D, Faber J, Wilke C, Schaprian T, Lakghomi A, Mengel D, Schöls L, Traschütz A, Fleszar Z, Dufke C, Vielhaber S, Machts J, Giordano I, Grobe-Einsler M, Klopstock T, Stendel C, Boesch S, Nachbauer W, Timmann-Braun D, Thieme AG, Kamm C, Dudesek A, Tallaksen C, Wedding I, Filla A, Schmid M, Synofzik M, Klockgether T. Evolution of Clinical Outcome Measures and Biomarkers in Sporadic Adult-Onset Degenerative Ataxia. Mov Disord 2023; 38:654-664. [PMID: 36695111 DOI: 10.1002/mds.29324] [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: 09/12/2022] [Revised: 11/11/2022] [Accepted: 12/22/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Sporadic adult-onset ataxias without known genetic or acquired cause are subdivided into multiple system atrophy of cerebellar type (MSA-C) and sporadic adult-onset ataxia of unknown etiology (SAOA). OBJECTIVES To study the differential evolution of both conditions including plasma neurofilament light chain (NfL) levels and magnetic resonance imaging (MRI) markers. METHODS SPORTAX is a prospective registry of sporadic ataxia patients with an onset >40 years. Scale for the Assessment and Rating of Ataxia was the primary outcome measure. In subgroups, blood samples were taken and MRIs performed. Plasma NfL was measured via a single molecule assay. Regional brain volumes were automatically measured. To assess signal changes, we defined the pons and middle cerebellar peduncle abnormality score (PMAS). Using mixed-effects models, we analyzed changes on a time scale starting with ataxia onset. RESULTS Of 404 patients without genetic diagnosis, 130 met criteria of probable MSA-C at baseline and 26 during follow-up suggesting clinical conversion to MSA-C. The remaining 248 were classified as SAOA. At baseline, NfL, cerebellar white matter (CWM) and pons volume, and PMAS separated MSA-C from SAOA. NfL decreased in MSA-C and did not change in SAOA. CWM and pons volume decreased faster, whereas PMAS increased faster in MSA-C. In MSA-C, pons volume had highest sensitivity to change, and PMAS was a predictor of faster progression. Fulfillment of possible MSA criteria, NfL and PMAS were risk factors, CWM and pons volume protective factors for conversion to MSA-C. CONCLUSIONS This study provides detailed information on differential evolution and prognostic relevance of biomarkers in MSA-C and SAOA. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Demet Oender
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Jennifer Faber
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Carlo Wilke
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tamara Schaprian
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Asadeh Lakghomi
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - David Mengel
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Andreas Traschütz
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Zofia Fleszar
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Claudia Dufke
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Stefan Vielhaber
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Judith Machts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Ilaria Giordano
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurodegeneration and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Marcus Grobe-Einsler
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Thomas Klopstock
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Claudia Stendel
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University, Munich, Germany
| | - Sylvia Boesch
- Department of Neurology and Center for Rare Movement Disorders, Medical University Innsbruck, Austria
| | - Wolfgang Nachbauer
- Department of Neurology and Center for Rare Movement Disorders, Medical University Innsbruck, Austria
| | - Dagmar Timmann-Braun
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Essen, Germany
| | - Andreas Gustafsson Thieme
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Essen University Hospital, Essen, Germany
| | - Christoph Kamm
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Neurology, University of Rostock, Germany
| | - Ales Dudesek
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Neurology, University of Rostock, Germany
| | | | - Iselin Wedding
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alessandro Filla
- Department of Neurosciences Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Centre for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.,Department of Neurology, University Hospital Bonn, Bonn, Germany
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Öz G, Harding IH, Krahe J, Reetz K. MR imaging and spectroscopy in degenerative ataxias: toward multimodal, multisite, multistage monitoring of neurodegeneration. Curr Opin Neurol 2021; 33:451-461. [PMID: 32657886 DOI: 10.1097/wco.0000000000000834] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Degenerative ataxias are rare and currently untreatable movement disorders, primarily characterized by neurodegeneration in the cerebellum and brainstem. We highlight MRI studies with the most potential for utility in pending ataxia trials and underscore advances in disease characterization and diagnostics in the field. RECENT FINDINGS With availability of advanced MRI acquisition methods and specialized software dedicated to the analysis of MRI of the cerebellum, patterns of cerebellar atrophy in different degenerative ataxias are increasingly well defined. The field further embraced rigorous multimodal investigations to study network-level microstructural and functional brain changes and their neurochemical correlates. MRI and magnetic resonance spectroscopy were shown to be more sensitive to disease progression than clinical scales and to detect abnormalities in premanifest mutation carriers. SUMMARY Magnetic resonance techniques are increasingly well placed for characterizing the expression and progression of degenerative ataxias. The most impactful work has arguably come through multi-institutional studies that monitor relatively large cohorts, multimodal investigations that assess the sensitivity of different measures and their interrelationships, and novel imaging approaches that are targeted to known pathophysiology (e.g., iron and spinal imaging in Friedreich ataxia). These multimodal, multi-institutional studies are paving the way to clinical trial readiness and enhanced understanding of disease in degenerative ataxias.
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Affiliation(s)
- Gülin Öz
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Ian H Harding
- Department of Neuroscience, Central Clinical School.,Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Janna Krahe
- Department of Neurology.,JARA Brain Institute Molecular Neuroscience and Neuroimaging, Research Centre Ju[Combining Diaeresis]lich, RWTH Aachen University, Aachen, Germany
| | - Kathrin Reetz
- Department of Neurology.,JARA Brain Institute Molecular Neuroscience and Neuroimaging, Research Centre Ju[Combining Diaeresis]lich, RWTH Aachen University, Aachen, Germany
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3
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Faber J, Giordano I, Jiang X, Kindler C, Spottke A, Acosta-Cabronero J, Nestor PJ, Machts J, Düzel E, Vielhaber S, Speck O, Dudesek A, Kamm C, Scheef L, Klockgether T. Prominent White Matter Involvement in Multiple System Atrophy of Cerebellar Type. Mov Disord 2020; 35:816-824. [PMID: 31994808 DOI: 10.1002/mds.27987] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Sporadic degenerative ataxia patients fall into 2 major groups: multiple system atrophy with predominant cerebellar ataxia (MSA-C) and sporadic adult-onset ataxia (SAOA). Both groups have cerebellar volume loss, but little is known about the differential involvement of gray and white matter in MSA-C when compared with SAOA. OBJECTIVES The objective of this study was to identify structural differences of brain gray and white matter between both patient groups. METHODS We used magnetic resonance imaging to acquire T1-weighted images and diffusion tensor images from 12 MSA-C patients, 31 SAOA patients, and 55 healthy controls. Magnetic resonance imaging data were analyzed with voxel-based-morphometry, tract-based spatial statistics, and tractography-based regional diffusion tensor images analysis. RESULTS Whole-brain and cerebellar-focused voxel-based-morphometry analysis showed gray matter volume loss in both patient groups when compared with healthy controls, specifically in the cerebellar areas subserving sensorimotor functions. When compared with controls, the SAOA and MSA-C patients showed white matter loss in the cerebellum, whereas brainstem white matter was reduced only in the MSA-C patients. The tract-based spatial statistics revealed reduced fractional anisotropy within the pons and cerebellum in the MSA-C patients both in comparison with the SAOA patients and healthy controls. In addition, tractography-based regional analysis showed reduced fractional anisotropy along the corticospinal tracts in MSA-C, but not SAOA. CONCLUSION Although in our cohort extent and distribution of gray and white matter loss were similar between the MSA-C and SAOA patients, magnetic resonance imaging data showed prominent microstructural white matter involvement in the MSA-C patients that was not present in the SAOA patients. Our findings highlight the significance of microstructural white matter changes in the differentiation between both conditions. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jennifer Faber
- Clinical Research, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Germany
| | - Ilaria Giordano
- Clinical Research, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Germany
| | - Xueyan Jiang
- Clinical Research, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Christine Kindler
- Clinical Research, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Germany
| | - Annika Spottke
- Clinical Research, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Germany
| | | | - Peter J Nestor
- Queensland Brain Institute, University of Queensland, Brisbane, Australia.,Neuroscience and Cognitive Health Program, Mater Hospital, South Brisbane, Australia
| | - Judith Machts
- German Center for Neurodegenerative Diseases, Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases, Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Stefan Vielhaber
- German Center for Neurodegenerative Diseases, Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Oliver Speck
- German Center for Neurodegenerative Diseases, Magdeburg, Germany.,Department of Biomedical Magnetic Resonance, Faculty for Natural Sciences, Otto-von-Guericke University, Magdeburg, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Ales Dudesek
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Christoph Kamm
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Lukas Scheef
- Clinical Research, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Radiology, University of Bonn, Bonn, Germany
| | - Thomas Klockgether
- Clinical Research, German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurology, University Hospital Bonn, Germany
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Carré G, Dietemann JL, Gebus O, Montaut S, Lagha-Boukbiza O, Wirth T, Kremer S, Namer IJ, Anheim M, Tranchant C. Brain MRI of multiple system atrophy of cerebellar type: a prospective study with implications for diagnosis criteria. J Neurol 2020; 267:1269-1277. [PMID: 31938861 DOI: 10.1007/s00415-020-09702-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/27/2022]
Abstract
AIM The second consensus statement for the diagnosis of multiple system atrophy type cerebellar (MSA-C) includes pons and middle cerebellar peduncle (MCP) atrophy as MRI features. However, other MRI abnormalities such as MCP hyperintensity, hot cross bun sign (HCB), putaminal hypointensity and hyperintense putaminal rim have been described. OBJECTIVES To evaluate, in patients with sporadic late-onset cerebellar ataxia (SLOCA), the discriminative value of several MRI features for the diagnosis of MSA-C, to follow their evolution during the course of MSA-C, and to search for correlations between these MRI features and clinical signs. METHODS Consecutive patients referred for SLOCA underwent comprehensive clinical evaluation and laboratory investigations, brain MRI, DaTscan and a 1-year follow-up. RESULTS Among 80 patients, 26 had MSA-C, 22 another diagnosis, and 32 no diagnosis at the end of the follow-up. At baseline, MCP hyperintensity and HCB were more frequent in patients finally diagnosed with MSA-C than in other patients with SLOCA (p < 0.0001), and had the highest specificity (98.5%) and positive predictive value (91.7%) for the diagnosis of MSA-C, compared to all other MRI signs. The most relevant MRI sequence regarding HCB sign was the T2-proton density (DP) weighted. All MRI features were more frequent with disease duration. No correlation was found between any MRI feature and neither clinical data, nor dopaminergic neuronal loss (p = 0.5008), except between vermis atrophy and UPDRSIII score. CONCLUSION MCP hyperintensity and HCB sign should be added into the list of additional features of possible MSA-C. MRI signal abnormalities suggestive of MSA-C should be searched for in suitable sequence.
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Affiliation(s)
- G Carré
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
- Service de Neurologie, Hôpitaux Civils de Colmar, Hôpital Louis Pasteur, 39 avenue de la Liberté, 68024, Colmar, France
| | - J L Dietemann
- Service d'imagerie 2, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg Cedex, France
| | - O Gebus
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - S Montaut
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - O Lagha-Boukbiza
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - T Wirth
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - S Kremer
- Service d'imagerie 2, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg Cedex, France
| | - I J Namer
- Service de Médecine Nucléaire, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
| | - M Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
| | - C Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67098 Cedex, Strasbourg, France.
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France.
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Differentiation Between Multiple System Atrophy and Other Spinocerebellar Degenerations Using Diffusion Kurtosis Imaging. Acad Radiol 2019; 26:e333-e339. [PMID: 30658931 DOI: 10.1016/j.acra.2018.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVE Differentiation between multiple system atrophy (MSA) and other spinocerebellar degenerations showing cerebellar ataxia is often difficult. Hence, we investigated whether magnetic resonance diffusion kurtosis imaging (DKI) could detect pathological changes that occur in these patients and be used for differential diagnosis. METHODS Thirty-six subjects (12 patients with MSA accompanied by predominant cerebellar ataxia [MSA-C], 10 patients with spinocerebellar ataxias [SCAs] or sporadic adult-onset ataxia of unknown etiology [SAOA], and 14 healthy controls) were examined using 1.5- or 3-T magnetic resonance scanners. From the DKI data, the mean kurtosis, fractional anisotropy, and mean diffusivity values of the pontine crossing tract (PCT), middle cerebellar peduncle, and cerebellum were automatically measured, and the ratios against the values of the corpus callosum were calculated. RESULTS We found significant decreases in mean kurtosis and fractional anisotropy ratios in the PCT and middle cerebellar peduncle, and a significant increase in the mean diffusivity ratio in the PCT in the MSA-C group, as compared with the SCA/SAOA and control groups (p < 0.027-0.001). Among these metrics, there were no significant differences in the diagnostic performance. By contrast, the ratios in the cerebellum showed no significant differences between the MSA-C and SCA/SAOA groups but were significantly altered when compared with the controls (p < 0.001). CONCLUSION Quantitative DKI analyses can be used to differentiate between patients with MSA-C and those with SCA/SAOA.
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Kadodwala VH, Hadjivassiliou M, Currie S, Skipper N, Hoggard N. Is 1H-MR spectroscopy useful as a diagnostic aid in MSA-C? CEREBELLUM & ATAXIAS 2019; 6:7. [PMID: 31321064 PMCID: PMC6612153 DOI: 10.1186/s40673-019-0099-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/26/2019] [Indexed: 02/08/2023]
Abstract
Background Multiple system atrophy (MSA) is a sporadic adult-onset neurodegenerative disease with a cerebellar subtype where ataxic symptoms predominate (MSA-C) associated with autonomic dysfunction and a grave prognosis. The purpose of this analysis was to identify if cerebellar volumetry and MR spectroscopy obtained as part of routine clinical work up of patients with sporadic ataxia differentiates patients with multiple system atrophy- cerebellar type (MSA-C) from those with sporadic adult-onset ataxia of unknown etiology (SAOA) who’s condition follows a more benign course. Methods Retrospective comparison was undertaken of 20 clinically probable or possible MSA-C patients, 20 age and sex matched patients with SAOA and 20 healthy control subjects. Single voxel 1H-MR spectroscopy of the cerebellar hemisphere and vermis and volumetric analysis of the cerebellum and brainstem were undertaken on baseline scans, comparing all groups. Results There was significant reduction in NAA/Cr levels in patients with MSA-C when compared to those with ISA (p = 0.005) and healthy controls (p < 0.001) in both the hemisphere and vermis. Brainstem volume was significantly reduced in MSA-C patients compared to SAOA patients (p < 0.001) and healthy controls (p < 0.001). There was no difference in cerebellar volume between MSA-C patients and SAOA patients. Conclusion This paper demonstrates that at presentation, MSA-C patients have a significant reduction of NAA/Cr in the cerebellum and significant decrease in brainstem volume when compared to SAOA and healthy controls. This is the first study to sucessfully show clinical utility of MR spectroscopy of the cerebellum for differentiating MSA-C from patients with SAOA. Electronic supplementary material The online version of this article (10.1186/s40673-019-0099-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Viren H Kadodwala
- Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Marios Hadjivassiliou
- Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Stuart Currie
- Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Nicholas Skipper
- Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Nigel Hoggard
- Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
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Lieto M, Roca A, Santorelli FM, Fico T, De Michele G, Bellofatto M, Saccà F, De Michele G, Filla A. Degenerative and acquired sporadic adult onset ataxia. Neurol Sci 2019; 40:1335-1342. [PMID: 30927137 DOI: 10.1007/s10072-019-03856-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/18/2019] [Indexed: 01/31/2023]
Abstract
The diagnosis of sporadic adult onset ataxia is a challenging task since a large collection of hereditary and non-hereditary disorders should be taken into consideration. Sporadic adult onset ataxias include degenerative non-hereditary, hereditary, and acquired ataxias. Multiple system atrophy and idiopathic late cerebellar ataxia are degenerative non-hereditary ataxias. Late-onset Friedreich's ataxia, spinocerebellar ataxia type 6 and 2, and fragile X-associated tremor/ataxia syndrome account for most sporadic hereditary ataxias. Alcoholic cerebellar degeneration, paraneoplastic and other autoimmune cerebellar degeneration, vitamin deficiencies, and toxic-induced and infectious cerebellar syndrome are the main causes of acquired cerebellar degeneration. The diagnostic approach should include a history taking, disease progression, general and neurological examination, brain MRI, and laboratory and genetic tests. Novel opportunities in massive gene sequencing will increase the likelihood to define true etiologies.
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Affiliation(s)
- Maria Lieto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Alessandro Roca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - Tommasina Fico
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giovanna De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Marta Bellofatto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Francesco Saccà
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Giuseppe De Michele
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Alessandro Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
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Mascalchi M, Vella A. Neuroimaging Applications in Chronic Ataxias. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 143:109-162. [PMID: 30473193 DOI: 10.1016/bs.irn.2018.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET) are the main instruments for neuroimaging investigation of patients with chronic ataxia. MRI has a predominant diagnostic role in the single patient, based on the visual detection of three patterns of atrophy, namely, spinal atrophy, cortical cerebellar atrophy and olivopontocerebellar atrophy, which correlate with the aetiologies of inherited or sporadic ataxia. In fact spinal atrophy is observed in Friedreich ataxia, cortical cerebellar atrophy in Ataxia Telangectasia, gluten ataxia and Sporadic Adult Onset Ataxia and olivopontocerebellar atrophy in Multiple System Atrophy cerebellar type. The 39 types of dominantly inherited spinocerebellar ataxias show either cortical cerebellar atrophy or olivopontocerebellar atrophy. T2 or T2* weighted MR images can contribute to the diagnosis by revealing abnormally increased or decreased signal with a characteristic distribution. These include symmetric T2 hyperintensity of the posterior and lateral columns of the cervical spinal cord in Friedreich ataxia, diffuse and symmetric hyperintensity of the cerebellar cortex in Infantile Neuro-Axonal Dystrophy, symmetric hyperintensity of the peridentate white matter in Cerebrotendineous Xanthomatosis, and symmetric hyperintensity of the middle cerebellar peduncles and peridentate white matter, cerebral white matter and corpus callosum in Fragile X Tremor Ataxia Syndrome. Abnormally decreased T2 or T2* signal can be observed with a multifocal distribution in Ataxia Telangectasia and with a symmetric distribution in the basal ganglia in Multiple System Atrophy. T2 signal hypointensity lining diffusely the outer surfaces of the brainstem, cerebellum and cerebrum enables diagnosis of superficial siderosis of the central nervous system. The diagnostic role of nuclear medicine techniques is smaller. SPECT and PET show decreased uptake of radiotracers investigating the nigrostriatal system in Multiple System Atrophy and in patients with Fragile X Tremor Ataxia Syndrome. Semiquantitative or quantitative MRI, SPECT and PET data describing structural, microstructural and functional changes of the cerebellum, brainstem, and spinal cord have been widely applied to investigate physiopathological changes in patients with chronic ataxias. Moreover they can track diseases progression with a greater sensitivity than clinical scales. So far, a few small-size and single center studies employed neuroimaging techniques as surrogate markers of treatment effects in chronic ataxias.
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Affiliation(s)
- Mario Mascalchi
- Meyer Children Hospital, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy.
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Palma JA, Norcliffe-Kaufmann L, Kaufmann H. Diagnosis of multiple system atrophy. Auton Neurosci 2018; 211:15-25. [PMID: 29111419 PMCID: PMC5869112 DOI: 10.1016/j.autneu.2017.10.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 02/08/2023]
Abstract
Multiple system atrophy (MSA) may be difficult to distinguish clinically from other disorders, particularly in the early stages of the disease. An autonomic-only presentation can be indistinguishable from pure autonomic failure. Patients presenting with parkinsonism may be misdiagnosed as having Parkinson disease. Patients presenting with the cerebellar phenotype of MSA can mimic other adult-onset ataxias due to alcohol, chemotherapeutic agents, lead, lithium, and toluene, or vitamin E deficiency, as well as paraneoplastic, autoimmune, or genetic ataxias. A careful medical history and meticulous neurological examination remain the cornerstone for the accurate diagnosis of MSA. Ancillary investigations are helpful to support the diagnosis, rule out potential mimics, and define therapeutic strategies. This review summarizes diagnostic investigations useful in the differential diagnosis of patients with suspected MSA. Currently used techniques include structural and functional brain imaging, cardiac sympathetic imaging, cardiovascular autonomic testing, olfactory testing, sleep study, urological evaluation, and dysphagia and cognitive assessments. Despite advances in the diagnostic tools for MSA in recent years and the availability of consensus criteria for clinical diagnosis, the diagnostic accuracy of MSA remains sub-optimal. As other diagnostic tools emerge, including skin biopsy, retinal biomarkers, blood and cerebrospinal fluid biomarkers, and advanced genetic testing, a more accurate and earlier recognition of MSA should be possible, even in the prodromal stages. This has important implications as misdiagnosis can result in inappropriate treatment, patient and family distress, and erroneous eligibility for clinical trials of disease-modifying drugs.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, NY, USA
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, NY, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, NY, USA.
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Yoshida K, Kuwabara S, Nakamura K, Abe R, Matsushima A, Beppu M, Yamanaka Y, Takahashi Y, Sasaki H, Mizusawa H. Idiopathic cerebellar ataxia (IDCA): Diagnostic criteria and clinical analyses of 63 Japanese patients. J Neurol Sci 2018; 384:30-35. [PMID: 29249373 DOI: 10.1016/j.jns.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/18/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022]
Abstract
Cortical cerebellar atrophy (CCA) and multiple system atrophy with predominant cerebellar ataxia (MSA-C) are the two major forms of adult-onset sporadic ataxia. Contrary to MSA-C, there are neither diagnostic criteria nor neuroimaging features pathognomonic for CCA. Therefore, it is assumed that the category of CCA in the Japanese national registry include heterogeneous cerebellar ataxic disorders. To refine this category in more detail, we here used a clinical-based term, "idiopathic cerebellar ataxia (IDCA)", and proposed its diagnostic criteria. We collected 346 consecutive patients with the core features of the criteria (sporadic, insidious-onset and slowly progressive cerebellar ataxia in adults, and cerebellar atrophy on brain imaging). Of these, 212 (61.3%) were diagnosed with probable or possible MSA, and 30, who did not meet the diagnostic criteria for MSA at examination, were also excluded because of MRI findings suggestive of MSA. Twenty two were proven to have hereditary spinocerebellar ataxias by genetic testing, and 19 had secondary ataxias. Finally, the remaining 63 (18.2%) were diagnosed with IDCA. The mean (standard deviation) age at onset was 57.2 (10.8) years. Of these, 25 (39.7%) showed pure cerebellar ataxia, and the remaining 38 (60.3%) had some of extracerebellar features including abnormal tendon reflexes (46.0%), positive Babinski sign (9.5%), sensory disturbance (12.7%), cognitive impairment (9.5%), and involuntary movements (7.9%). Our results show that IDCA refined by the diagnostic criteria still includes clinically and genetically heterogeneous ataxic disorders. More extensive genetic analyses will be of significance for further clarification of this group.
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Affiliation(s)
- Kunihiro Yoshida
- Department of Brain Disease Research, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Katsuya Nakamura
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Ryuta Abe
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Akira Matsushima
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Minako Beppu
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yoshitaka Yamanaka
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan
| | - Yuji Takahashi
- Department of Neurology, The National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
| | - Hidenao Sasaki
- Department of Neurology, Hokkaido University Graduate School of Medicine, N15 W7 Kita-ku, Sapporo 060-8638, Japan
| | - Hidehiro Mizusawa
- Department of Neurology, The National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo 187-8551, Japan
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The Diagnosis and Natural History of Multiple System Atrophy, Cerebellar Type. THE CEREBELLUM 2017; 15:663-679. [PMID: 26467153 DOI: 10.1007/s12311-015-0728-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of this study was to identify key features differentiating multiple system atrophy cerebellar type (MSA-C) from idiopathic late-onset cerebellar ataxia (ILOCA). We reviewed records of patients seen in the Massachusetts General Hospital Ataxia Unit between 1992 and 2013 with consensus criteria diagnoses of MSA-C or ILOCA. Twelve patients had definite MSA-C, 53 had possible/probable MSA-C, and 12 had ILOCA. Autonomic features, specifically urinary urgency, frequency, and incontinence with erectile dysfunction in males, differentiated MSA-C from ILOCA throughout the disease course (p = 0.005). Orthostatic hypotension developed later and differentiated MSA-C from ILOCA (p < 0.01). REM sleep behavior disorder (RBD) occurred early in possible/probable MSA-C (p < 0.01). Late MSA-C included pathologic laughing and crying (PLC, p < 0.01), bradykinesia (p = 0.01), and corticospinal findings (p = 0.01). MRI distinguished MSA-C from ILOCA by atrophy of the brainstem (p < 0.01) and middle cerebellar peduncles (MCP, p = 0.02). MSA-C progressed faster than ILOCA: by 6 years, MSA-C walker dependency was 100 % and ILOCA 33 %. MSA-C survival was 8.4 ± 2.5 years. Mean length of ILOCA illness to date is 15.9 ± 6.4 years. A sporadic onset, insidiously developing cerebellar syndrome in midlife, with autonomic features of otherwise unexplained bladder dysfunction with or without erectile dysfunction in males, and atrophy of the cerebellum, brainstem, and MCP points strongly to MSA-C. RBD and postural hypotension confirm the diagnosis. Extrapyramidal findings, corticospinal tract signs, and PLC are helpful but not necessary for diagnosis. Clarity in early MSA-C diagnosis can prevent unnecessary investigations and facilitate therapeutic trials.
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Sasaki R, Maki F, Hara D, Tanaka S, Hasegawa Y. Stratification of disease progression in a broad spectrum of degenerative cerebellar ataxias with a clustering method using MRI-based atrophy rates of brain structures. CEREBELLUM & ATAXIAS 2017; 4:9. [PMID: 28680650 PMCID: PMC5492905 DOI: 10.1186/s40673-017-0068-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/21/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The rate of disease progression differs among patients with degenerative cerebellar ataxia. The uncertain natural course in individual patients hinders clinical trials of promising treatments. In this study, we analyzed atrophy changes in brain structures with cluster analysis to find sub-groups of patients with homogenous symptom progression in a broad spectrum of degenerative cerebellar ataxias. METHODS We examined 48 patients including 21 cases of spinocerebellar ataxia (SCA), 17 cases of the cerebellar type of multiple system atrophy (MSA-C), and 10 cases of cortical cerebellar ataxia (CCA). In all patients, at least two sets of evaluations including magnetic resonance imaging (MRI) and the International Cooperative Ataxia Rating Scale (ICARS) scoring were performed. The median number (min-max) of follow-up studies in each patient was three (2-6), and the mean follow-up period was 3.1 ± 1.6 years. The area of the corpus callosum on midsagittal images and the cerebellar volume were measured using MRI, and these values were divided by the cranial antero-posterior diameter of each patient to correct for individual head size differences as an area index (Adx) and a volume index (Vdx), respectively. The annual changes in Adx, Vdx, and ICARS score were calculated in each patient, and atrophy patterns in patients were categorized with cluster analysis. RESULTS The annual atrophy rates for the corpus callosum (Adx) and cerebellum (Vdx) and symptom progression differed significantly by subtype of cerebellar ataxia (p = 0.026, 0.019, and 0.021, respectively). However, neither the annual atrophy rate of Adx nor Vdx was significantly correlated with the annual increase in the ICARS score. When the patients were categorized into three clusters based on the annual changes in Adx and Vdx, the annual increase in the ICARS score was significantly different among clusters (2.9 ± 1.7/year in Cluster 1, 4.8 ± 3.2/year in Cluster 2, and 8.7 ± 6.1/year in Cluster 3; p = 0.014). CONCLUSIONS The annual increase in the ICARS score can be stratified by cluster analysis based on the atrophy rates of the corpus callosum and cerebellum. Further studies are warranted to explore whether these simple MRI methods could be used for random allocation of a broad spectrum of patients with degenerative cerebellar ataxia in clinical trials.
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Affiliation(s)
- Rie Sasaki
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Futaba Maki
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Daisuke Hara
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Shigeaki Tanaka
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Yasuhiro Hasegawa
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
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Akar E, Kara S, Akdemir H, Kırış A. 3D structural complexity analysis of cerebellum in Chiari malformation type I. Med Biol Eng Comput 2017; 55:2169-2182. [PMID: 28589373 DOI: 10.1007/s11517-017-1661-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/21/2017] [Indexed: 11/25/2022]
Abstract
Chiari malformation type I (CM-I), described by a descent of the cerebellar tonsils, is assumed to be a neurological developmental disorder. The aim of the present study was to investigate morphological variance in cerebellar sub-structures, including gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF), using magnetic resonance (MR) images with three-dimensional (3D) fractal dimension (FD) analysis in patients with CM-I. MRI data of 16 patients and 15 control subjects were obtained, and structural complexity analyses were performed using a box-counting FD algorithm. Results showed that patients with CM-I had significantly reduced FD values for WM and CSF in comparison with controls, and statistically significant differences in cerebellar GM and CSF volumes between patients and controls were found. Moreover, a significant difference was not found between the WM volumes. This may suggest that there are changes in structural complexity in WM even when its volume is unaffected. We conclude that the findings of this preliminary study indicate the possibility of using FD analysis to understand the pathophysiology of CM-I in patients.
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Affiliation(s)
- Engin Akar
- Independent Researcher, Adnan Kahveci Mh. Konak Cd., Beyaz İnci Evleri B Blok No:19, 34528 Beylikdüzü, Istanbul, Turkey.
| | - Sadık Kara
- Independent Researcher, Istanbul, Turkey
| | - Hidayet Akdemir
- Department of Neurosurgery, Medicana International Hospital, Istanbul, Turkey
| | - Adem Kırış
- Department of Radiology, Mehmet Akif Ersoy Cardio-Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Sleep Apnea in Multiple System Atrophy of Cerebellar Type: A 3.0 T MRS/Volumetry Pilot Study. eNeurologicalSci 2016; 6:6-8. [PMID: 29260007 PMCID: PMC5721553 DOI: 10.1016/j.ensci.2016.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/09/2016] [Indexed: 12/19/2022] Open
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Hara D, Maki F, Tanaka S, Sasaki R, Hasegawa Y. MRI-based cerebellar volume measurements correlate with the International Cooperative Ataxia Rating Scale score in patients with spinocerebellar degeneration or multiple system atrophy. CEREBELLUM & ATAXIAS 2016; 3:14. [PMID: 27536377 PMCID: PMC4987966 DOI: 10.1186/s40673-016-0052-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 08/04/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Progression of clinical symptoms and cerebellar atrophy may vary among subtypes of spinocerebellar degeneration and multiple system atrophy. The aim of this cross-sectional study was to demonstrate the relationship between the International Cooperative Ataxia Rating Scale (ICARS) score and cerebellar volume derived from magnetic resonance imaging (MRI) in a broad spectrum of Japanese patients with cerebellar ataxia. METHODS A total of 86 patients with cerebellar ataxia (18 with cortical cerebellar atrophy, 34 with spinocerebellar ataxia, and 34 with multiple system atrophy) and 30 healthy subjects were studied. MRI-based cerebellar volume measurements were performed in all subjects using T1-weighted images acquired with a 1.5-T MRI scanner. The cerebellar volume/cranial anteroposterior (AP) diameter was used for statistical analysis. RESULTS Stepwise multiple regression analyses demonstrated that cerebellar volume/cranial AP diameter and midbrain AP/cranial AP diameter were significantly associated with the total score and domain I sub-score of ICARS. We found no interactions between these two anatomical factors in the ICARS total and domain I sub-scores. The main effects of these two predictors were statistically significant both in total and domain I sub-scores (p = 0.001 and 0.022, respectively). CONCLUSIONS Cerebellar volume and midbrain AP diameter normalized to the cranial AP diameter were significantly correlated with the ICARS total and domain I sub-scores. Further longitudinal studies are warranted to explore the role of these MRI biomarkers for predicting disease progression.
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Affiliation(s)
- Daisuke Hara
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Futaba Maki
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Shigeaki Tanaka
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Rie Sasaki
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
| | - Yasuhiro Hasegawa
- Department of Internal Medicine, Division of Neurology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Kanagawa 216-8511 Japan
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Baldarçara L, Currie S, Hadjivassiliou M, Hoggard N, Jack A, Jackowski AP, Mascalchi M, Parazzini C, Reetz K, Righini A, Schulz JB, Vella A, Webb SJ, Habas C. Consensus paper: radiological biomarkers of cerebellar diseases. THE CEREBELLUM 2015; 14:175-96. [PMID: 25382714 DOI: 10.1007/s12311-014-0610-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hereditary and sporadic cerebellar ataxias represent a vast and still growing group of diseases whose diagnosis and differentiation cannot only rely on clinical evaluation. Brain imaging including magnetic resonance (MR) and nuclear medicine techniques allows for characterization of structural and functional abnormalities underlying symptomatic ataxias. These methods thus constitute a potential source of radiological biomarkers, which could be used to identify these diseases and differentiate subgroups of them, and to assess their severity and their evolution. Such biomarkers mainly comprise qualitative and quantitative data obtained from MR including proton spectroscopy, diffusion imaging, tractography, voxel-based morphometry, functional imaging during task execution or in a resting state, and from SPETC and PET with several radiotracers. In the current article, we aim to illustrate briefly some applications of these neuroimaging tools to evaluation of cerebellar disorders such as inherited cerebellar ataxia, fetal developmental malformations, and immune-mediated cerebellar diseases and of neurodegenerative or early-developing diseases, such as dementia and autism in which cerebellar involvement is an emerging feature. Although these radiological biomarkers appear promising and helpful to better understand ataxia-related anatomical and physiological impairments, to date, very few of them have turned out to be specific for a given ataxia with atrophy of the cerebellar system being the main and the most usual alteration being observed. Consequently, much remains to be done to establish sensitivity, specificity, and reproducibility of available MR and nuclear medicine features as diagnostic, progression and surrogate biomarkers in clinical routine.
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18
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Alsemari A, Al-Hindi HN. Large-scale mitochondrial DNA deletion underlying familial multiple system atrophy of the cerebellar subtype. Clin Case Rep 2015; 4:111-7. [PMID: 26862402 PMCID: PMC4736521 DOI: 10.1002/ccr3.435] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/03/2015] [Accepted: 09/29/2015] [Indexed: 11/29/2022] Open
Abstract
A family with mitochondrial inheritance of multiple system atrophy of the cerebellar subtype. MRI brain shows significant cerebellar atrophy with mild pontine atrophy and the classical hot cross bun sign in Pons. The muscle biopsy was indicative of mitochondrial myopathy. Mitochondrial DNA analysis revealed a low‐level large mtDNA deletion, m.3264_1607del12806 bp.
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Affiliation(s)
- Abdulaziz Alsemari
- Department of Neurosciences King Faisal Specialist Hospital and Research Centre PO box 3354 Riyadh 11211 Saudi Arabia
| | - Hindi Nasser Al-Hindi
- Department of Pathology and Laboratory Medicine King Faisal Specialist Hospital and Research Centre PO box 3354 Riyadh 11211 Saudi Arabia
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Ciolli L, Krismer F, Nicoletti F, Wenning GK. An update on the cerebellar subtype of multiple system atrophy. CEREBELLUM & ATAXIAS 2014; 1:14. [PMID: 26331038 PMCID: PMC4552412 DOI: 10.1186/s40673-014-0014-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/24/2014] [Indexed: 01/05/2023]
Abstract
Multiple system atrophy is a rare and fatal neurodegenerative disorder characterized by progressive autonomic failure, ataxia and parkinsonism in any combination. The clinical manifestations reflect central autonomic and striatonigral degeneration as well as olivopontocerebellar atrophy. Glial cytoplasmic inclusions, composed of α-synuclein and other proteins are considered the cellular hallmark lesion. The cerebellar variant of MSA (MSA-C) denotes a distinctive motor subtype characterized by progressive adult onset sporadic gait ataxia, scanning dysarthria, limb ataxia and cerebellar oculomotor dysfunction. In addition, there is autonomic failure and variable degrees of parkinsonism. A range of other disorders may present with MSA-C like features and therefore the differential diagnosis of MSA-C is not always straightforward. Here we review key aspects of MSA-C including pathology, pathogenesis, diagnosis, clinical features and treatment, paying special attention to differential diagnosis in late onset sporadic cerebellar ataxias.
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Affiliation(s)
- Ludovico Ciolli
- Sapienza University, Via di Grottarossa, 1035-00189 Rome, Italy ; Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Florian Krismer
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ferdinando Nicoletti
- IRCSS NEUROMED, Pozzilli, Isernia Italy ; Department of Physiology and Pharmacology "Vittorio Erspamer", Sapienza University, School of Medicine and Psychology, Rome, Italy
| | - Gregor K Wenning
- Department of Neurology, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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Friedel M, van Eede MC, Pipitone J, Chakravarty MM, Lerch JP. Pydpiper: a flexible toolkit for constructing novel registration pipelines. Front Neuroinform 2014; 8:67. [PMID: 25126069 PMCID: PMC4115634 DOI: 10.3389/fninf.2014.00067] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/26/2014] [Indexed: 01/12/2023] Open
Abstract
Using neuroimaging technologies to elucidate the relationship between genotype and phenotype and brain and behavior will be a key contribution to biomedical research in the twenty-first century. Among the many methods for analyzing neuroimaging data, image registration deserves particular attention due to its wide range of applications. Finding strategies to register together many images and analyze the differences between them can be a challenge, particularly given that different experimental designs require different registration strategies. Moreover, writing software that can handle different types of image registration pipelines in a flexible, reusable and extensible way can be challenging. In response to this challenge, we have created Pydpiper, a neuroimaging registration toolkit written in Python. Pydpiper is an open-source, freely available software package that provides multiple modules for various image registration applications. Pydpiper offers five key innovations. Specifically: (1) a robust file handling class that allows access to outputs from all stages of registration at any point in the pipeline; (2) the ability of the framework to eliminate duplicate stages; (3) reusable, easy to subclass modules; (4) a development toolkit written for non-developers; (5) four complete applications that run complex image registration pipelines “out-of-the-box.” In this paper, we will discuss both the general Pydpiper framework and the various ways in which component modules can be pieced together to easily create new registration pipelines. This will include a discussion of the core principles motivating code development and a comparison of Pydpiper with other available toolkits. We also provide a comprehensive, line-by-line example to orient users with limited programming knowledge and highlight some of the most useful features of Pydpiper. In addition, we will present the four current applications of the code.
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Affiliation(s)
- Miriam Friedel
- Mouse Imaging Centre, Hospital for Sick Children Toronto, ON, Canada
| | | | - Jon Pipitone
- Kimel Family Translational Imaging-Genetics Research Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health Toronto, ON, Canada
| | - M Mallar Chakravarty
- Kimel Family Translational Imaging-Genetics Research Laboratory, Research Imaging Centre, Centre for Addiction and Mental Health Toronto, ON, Canada ; Department of Psychiatry, Institute of Biomaterials and Biomedical Engineering, University of Toronto Toronto, ON, Canada ; Rotman Research Institute Toronto, ON, Canada
| | - Jason P Lerch
- Mouse Imaging Centre, Hospital for Sick Children Toronto, ON, Canada ; Department of Medical Biophysics, University of Toronto Toronto, ON, Canada
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Lin DJ, Hermann KL, Schmahmann JD. Multiple system atrophy of the cerebellar type: clinical state of the art. Mov Disord 2014; 29:294-304. [PMID: 24615754 DOI: 10.1002/mds.25847] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/27/2013] [Accepted: 01/27/2014] [Indexed: 01/21/2023] Open
Abstract
Multiple system atrophy (MSA) is a late-onset, sporadic neurodegenerative disorder clinically characterized by autonomic failure and either poorly levodopa-responsive parkinsonism or cerebellar ataxia. It is neuropathologically defined by widespread and abundant central nervous system α-synuclein-positive glial cytoplasmic inclusions and striatonigral and/or olivopontocerebellar neurodegeneration. There are two clinical subtypes of MSA distinguished by the predominant motor features: the parkinsonian variant (MSA-P) and the cerebellar variant (MSA-C). Despite recent progress in understanding the pathobiology of MSA, investigations into the symptomatology and natural history of the cerebellar variant of the disease have been limited. MSA-C presents a unique challenge to both clinicians and researchers alike. A key question is how to distinguish early in the disease course between MSA-C and other causes of adult-onset cerebellar ataxia. This is a particularly difficult question, because the clinical framework for conceptualizing and studying sporadic adult-onset ataxias continues to undergo flux. To date, several investigations have attempted to identify clinical features, imaging, and other biomarkers that may be predictive of MSA-C. This review presents a clinically oriented overview of our current understanding of MSA-C with a focus on evidence for distinguishing MSA-C from other sporadic, adult-onset ataxias.
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Affiliation(s)
- David J Lin
- Ataxia Unit, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Magnetic resonance imaging biomarkers in patients with progressive ataxia: current status and future direction. THE CEREBELLUM 2013; 12:245-66. [PMID: 22828959 DOI: 10.1007/s12311-012-0405-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A diagnostic challenge commonly encountered in neurology is that of an adult patient presenting with ataxia. The differential is vast and clinical assessment alone may not be sufficient due to considerable overlap between different causes of ataxia. Magnetic resonance (MR)-based biomarkers such as voxel-based morphometry, MR spectroscopy, diffusion-weighted and diffusion-tensor imaging and functional MR imaging are gaining great attention for their potential as indicators of disease. A number of studies have reported correlation with clinical severity and underlying pathophysiology, and in some cases, MR imaging has been shown to allow differentiation of conditions causing ataxia. However, despite recent advances, their sensitivity and specificity vary. In addition, questions remain over their validity and reproducibility, especially when applied in routine clinical practice. This article extensively reviews the current literature regarding MR-based biomarkers for the patient with predominantly adult-onset ataxia. Imaging features characteristic of a particular ataxia are provided and features differentiating ataxia groups and subgroups are discussed. Finally, discussion will turn to the feasibility of applying these biomarkers in routine clinical practice.
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Marques JP, Gruetter R, van der Zwaag W. In vivo structural imaging of the cerebellum, the contribution of ultra-high fields. THE CEREBELLUM 2012; 11:384-91. [PMID: 20596807 DOI: 10.1007/s12311-010-0189-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This review covers some of the contributions to date from cerebellar imaging studies performed at ultra-high magnetic fields. A short overview of the general advantages and drawbacks of the use of such high field systems for imaging is given. One of the biggest advantages of imaging at high magnetic fields is the improved spatial resolution, achievable thanks to the increased available signal-to-noise ratio. This high spatial resolution better matches the dimensions of the cerebellar substructures, allowing a better definition of such structures in the images. The implications of the use of high field systems is discussed for several imaging sequences and image contrast mechanisms. This review covers studies which were performed in vivo in both rodents and humans, with a special focus on studies that were directed towards the observation of the different cerebellar layers.
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Affiliation(s)
- José P Marques
- Laboratory for Functional and Metabolic Imaging, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
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Chakravarty MM, Steadman P, van Eede MC, Calcott RD, Gu V, Shaw P, Raznahan A, Collins DL, Lerch JP. Performing label-fusion-based segmentation using multiple automatically generated templates. Hum Brain Mapp 2012; 34:2635-54. [PMID: 22611030 DOI: 10.1002/hbm.22092] [Citation(s) in RCA: 249] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 03/01/2012] [Accepted: 03/08/2012] [Indexed: 01/18/2023] Open
Abstract
Classically, model-based segmentation procedures match magnetic resonance imaging (MRI) volumes to an expertly labeled atlas using nonlinear registration. The accuracy of these techniques are limited due to atlas biases, misregistration, and resampling error. Multi-atlas-based approaches are used as a remedy and involve matching each subject to a number of manually labeled templates. This approach yields numerous independent segmentations that are fused using a voxel-by-voxel label-voting procedure. In this article, we demonstrate how the multi-atlas approach can be extended to work with input atlases that are unique and extremely time consuming to construct by generating a library of multiple automatically generated templates of different brains (MAGeT Brain). We demonstrate the efficacy of our method for the mouse and human using two different nonlinear registration algorithms (ANIMAL and ANTs). The input atlases consist a high-resolution mouse brain atlas and an atlas of the human basal ganglia and thalamus derived from serial histological data. MAGeT Brain segmentation improves the identification of the mouse anterior commissure (mean Dice Kappa values (κ = 0.801), but may be encountering a ceiling effect for hippocampal segmentations. Applying MAGeT Brain to human subcortical structures improves segmentation accuracy for all structures compared to regular model-based techniques (κ = 0.845, 0.752, and 0.861 for the striatum, globus pallidus, and thalamus, respectively). Experiments performed with three manually derived input templates suggest that MAGeT Brain can approach or exceed the accuracy of multi-atlas label-fusion segmentation (κ = 0.894, 0.815, and 0.895 for the striatum, globus pallidus, and thalamus, respectively).
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Affiliation(s)
- M Mallar Chakravarty
- Mouse Imaging Centre, The Hospital for Sick Children, Toronto, Canada; Kimel Family Translational Imaging Genetics Research Laboratory, The Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
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Wu YT, Shyu KK, Jao CW, Liao YL, Wang TY, Wu HM, Wang PS, Soong BW. Quantifying cerebellar atrophy in multiple system atrophy of the cerebellar type (MSA-C) using three-dimensional gyrification index analysis. Neuroimage 2012; 61:1-9. [DOI: 10.1016/j.neuroimage.2012.02.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022] Open
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Abstract
Sporadic adult-onset ataxia of unknown etiology (SAOA) denotes the non-hereditary degenerative adult-onset ataxia disorders that are distinct from multiple system atrophy (MSA). Rather than being a defined disease entity, SAOA has to be regarded as a group of disorders of unknown etiology that are defined by a common clinical syndrome and the exclusion of known disease causes. Epidemiological studies have revealed prevalence rates ranging from 2.2 to 8.4 per 100000, which are higher than those of hereditary ataxias. Clinically, SAOA is characterized by a slowly progressive cerebellar syndrome starting around the age of 50 years. About one-third of SAOA patients have either polyneuropathy or pyramidal tract involvement accompanying cerebellar ataxia. Cognitive impairment is not the rule, and, if present, is only mild. More than half of SAOA patients have signs of mild autonomic dysfunction that do not meet the criteria of severe autonomic failure required for a diagnosis of MSA. Neuropathological and imaging studies show an isolated cerebellar cortical degeneration with no or only mild brainstem involvement. There is no established therapy for SAOA.
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Lin Y, Chen Z, Zhong J. Signal-to-noise ratio enhancement of intermolecular double-quantum coherence MR spectroscopy in inhomogeneous fields with phased array coils on a 3 Tesla whole-body scanner. J Magn Reson Imaging 2011; 33:698-703. [PMID: 21563255 DOI: 10.1002/jmri.22434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To improve signal-to-noise ratio (SNR) of intermolecular double-quantum coherence (iDQC) MRS on a 3 Tesla (T) whole-body scanner. MATERIALS AND METHODS A 32-channel phased array coil was used to acquire iDQC signal of a MRS phantom in the presence of large field inhomogeneity. The obtained individual spectra from the array elements were combined together in the time domain using a multichannel nonparametric singular value decomposition algorithm. The results were compared quantitatively with those acquired with a circularly polarized (CP) head coil. RESULTS The achieved gain in SNR ranges from 1.63 to 2.10 relative to the CP coil, mainly depending on the relative position between the surface of the phased array coil and the voxel of acquisition. CONCLUSION SNR enhancement of iDQC MRS in inhomogeneous fields on a 3T whole-body scanner is feasible with phased array coils. This can facilitate iDQC applications of high-resolution in vivo spectroscopy in the presence of field inhomogeneity for potential disease diagnosis in humans.
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Affiliation(s)
- Yanqin Lin
- Department of Imaging Sciences and Rochester Center for Brain Imaging, University of Rochester, Rochester, New York, USA
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Tong M, Longato L, de la Monte SM. Early limited nitrosamine exposures exacerbate high fat diet-mediated type 2 diabetes and neurodegeneration. BMC Endocr Disord 2010; 10:4. [PMID: 20302640 PMCID: PMC3161394 DOI: 10.1186/1472-6823-10-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 03/19/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and several types of neurodegeneration, including Alzheimer's, are linked to insulin-resistance, and chronic high dietary fat intake causes T2DM with mild neurodegeneration. Intra-cerebral Streptozotocin, a nitrosamine-related compound, causes neurodegeneration, whereas peripheral treatment causes DM. HYPOTHESIS Limited early exposures to nitrosamines that are widely present in the environment, enhance the deleterious effects of high fat intake in promoting T2DM and neurodegeneration. METHODS Long Evans rat pups were treated with N-nitrosodiethylamine (NDEA) by i.p. injection, and upon weaning, they were fed with high fat (60%; HFD) or low fat (5%; LFD) chow for 8 weeks. Cerebella were harvested to assess gene expression, and insulin and insulin-like growth factor (IGF) deficiency and resistance in the context of neurodegeneration. RESULTS HFD +/- NDEA caused T2DM, neurodegeneration with impairments in brain insulin, insulin receptor, IGF-2 receptor, or insulin receptor substrate gene expression, and reduced expression of tau and choline acetyltransferase (ChAT), which are regulated by insulin and IGF-1. In addition, increased levels of 4-hydroxynonenal and nitrotyrosine were measured in cerebella of HFD +/- NDEA treated rats, and overall, NDEA+HFD treatment reduced brain levels of Tau, phospho-GSK-3beta (reflecting increased GSK-3beta activity), glial fibrillary acidic protein, and ChAT to greater degrees than either treatment alone. Finally, pro-ceramide genes, examined because ceramides cause insulin resistance, oxidative stress, and neurodegeneration, were significantly up-regulated by HFD and/or NDEA exposure, but the highest levels were generally present in brains of HFD+NDEA treated rats. CONCLUSIONS Early limited exposure to nitrosamines exacerbates the adverse effects of later chronic high dietary fat intake in promoting T2DM and neurodegeneration. The mechanism involves increased generation of ceramides and probably other toxic lipids in brain.
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Affiliation(s)
- Ming Tong
- Liver Research Center, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
- Warren Alpert Medical School of Brown University, Box G, 97 Waterman Street, Providence, RI 02912, USA
| | - Lisa Longato
- Liver Research Center, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
- Pathobiology Program, Brown University, Box G, 222 Richmond Street, Providence, RI 02903, USA
| | - Suzanne M de la Monte
- Department of Pathology (Neuropathology), Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
- Department of Neurology, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA
- Liver Research Center, Rhode Island Hospital, 55 Claverick Street, Providence, RI 02903, USA
- Pathobiology Program, Brown University, Box G, 222 Richmond Street, Providence, RI 02903, USA
- Warren Alpert Medical School of Brown University, Box G, 97 Waterman Street, Providence, RI 02912, USA
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Chou W, Salamon G, Orr NB, Salamon N. Neuroanatomic analysis of diffusion tensor imaging of white matter tracts with dejerine sections and neuroimaging. Neuroradiol J 2009; 22:499-517. [PMID: 24209394 DOI: 10.1177/197140090902200501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 10/17/2009] [Indexed: 11/17/2022] Open
Abstract
We present a neuroanatomical comparison with stereotaxic precision correlating modern diffusion tensor imaging (DTI), MRI data and classical neuroanatomical textbooks. The neuroatlas compiled by J. and A. Dejerine deserves emphasis for its role of a bridge between precise classical neuroanatomy techniques with modern neuroimaging methods. We present its utility in identifying major white matter tracts of the brain in concert with DTI in the horizontal-plane axis to elucidate axonal directionality. The axonal directionality of DTI is necessary for understanding white matter connectivity in the brain. Many DTI studies publish findings in selective regions of the brain, and our study is mainly devoted to comparing our images with data from Dejerine for the entire brain.
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Affiliation(s)
- W Chou
- Department of Biomedical Engineering, University of California; Los Angeles, California, USA -
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Wu YT, Shyu KK, Jao CW, Wang ZY, Soong BW, Wu HM, Wang PS. Fractal dimension analysis for quantifying cerebellar morphological change of multiple system atrophy of the cerebellar type (MSA-C). Neuroimage 2009; 49:539-51. [PMID: 19635573 DOI: 10.1016/j.neuroimage.2009.07.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 07/09/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022] Open
Abstract
Multiple system atrophy of the cerebellar type (MSA-C) is a degenerative neurological disease of the central nervous system. This study aims to demonstrate that the morphological changes of cerebellar structure, specifically, the cerebellum white matter (CBWM) and cerebellum gray matter (CBGM) from T1-weighted magnetic resonance (MR) images, can be quantified by three-dimensional (3D) fractal dimension (FD) analysis, which is a measure of complexity. Twenty-three MSA-C patients and twenty-one normal subjects participated in this study. The results of this study show that MSA-C patients presented significantly lower FD values compared to the control group, and that morphological change in the CBWM dominates the cerebellar degeneration. In addition, the FD analysis method is superior to conventional volumetric methods in quantifying the structural changes of WM and GM because it exhibits smaller variances and less gender effect. Since a decrease of cerebellar FD value indicates degeneration of the cerebellar structure, this study further suggests that the morphological changes of cerebellar structures (CBGM and CBWM) can be characterized by FD analysis.
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Affiliation(s)
- Yu-Te Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan, ROC
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Prakash N, Hageman N, Hua X, Toga AW, Perlman SL, Salamon N. Patterns of fractional anisotropy changes in white matter of cerebellar peduncles distinguish spinocerebellar ataxia-1 from multiple system atrophy and other ataxia syndromes. Neuroimage 2009; 47 Suppl 2:T72-81. [PMID: 19446636 DOI: 10.1016/j.neuroimage.2009.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2009] [Revised: 04/29/2009] [Accepted: 05/01/2009] [Indexed: 12/17/2022] Open
Abstract
AIM To determine prospectively if qualitative and quantitative diffusion tensor imaging (DTI) metrics of white matter integrity are better than conventional magnetic resonance imaging (MRI) metrics for discriminating cerebellar diseases. METHODS Conventional MRI images from 31 consecutive patients with ataxia and 12 controls were interpreted by a neuroradiologist given only a clinical indication of ataxia. An expert ataxologist, blinded to radiological findings, determined the clinical diagnosis, as well as ataxia severity and asymmetry for each patient. For qualitative analysis, a comparison of the cerebellar white matter in ataxic vs. control patients was made by visual inspection of directionally encoded color (DEC) images. For quantitative analysis, segmentation of the cerebellar white matter in the inferior, middle, and superior cerebellar peduncles (ICP, MCP, and SCP) was attempted using three methods: a region of interest method, a deterministic DTI tractography (DDT) method, and a probabilistic DTI tractography (PDT) method. A statistical comparison of the average fractional anisotropy (FA) in these tracts was made between subject groups, and correlated to clinical diagnosis, severity, and asymmetry. RESULTS Of the 31 consecutive patients with ataxia, the two largest subgroups had a clinical diagnosis of multiple system atrophy (cerebellar subtype; MSA-C), and spinocerebellar ataxia-1 (SCA1). Conventional MRI features, such as degree of pontocerebellar atrophy, correlated with ataxia severity, but were neither sensitive nor specific for the ataxia subtypes. PDT was the most accurate and least variable method of the three methods used for determining FA, especially in the ICP. Average FA in all ataxic patients was significantly decreased in the MCP, SCP and ICP and this decrease correlated to disease severity. Asymmetric ataxia correlated to proportionately larger contralateral MCP, ICP and SCP FA values. MCP, ICP, and SCP FA difference values formed distinct clusters that distinguished MSA-C from SCA-1, and other ataxia syndromes. CONCLUSIONS Qualitative and quantitative reductions in DTI metrics of white matter integrity in the cerebellar peduncles correlated better to clinical features of patients with sporadic and hereditary ataxias than conventional structural MRI measures of pontocerebellar atrophy.
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Affiliation(s)
- Neal Prakash
- Department of Internal Medicine, John A. Burns School of Medicine, University of Hawaii, PO Box 4636, Honolulu, HI 96812-4636, USA.
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Brooks DJ, Seppi K. Proposed neuroimaging criteria for the diagnosis of multiple system atrophy. Mov Disord 2009; 24:949-64. [DOI: 10.1002/mds.22413] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Sitburana O, Ondo WG. Brain magnetic resonance imaging (MRI) in parkinsonian disorders. Parkinsonism Relat Disord 2008; 15:165-74. [PMID: 19059803 DOI: 10.1016/j.parkreldis.2008.04.033] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 04/10/2008] [Accepted: 04/20/2008] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging (MRI) is increasingly integrated into neurological diagnostics. In addition to functional MRI, a large number of sequences (T1W, T2W, PD, T2W gradient echo, diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI)), investigate CNS abnormalities. Objective quantification techniques (T1W voxel-based morphometry) can also discern subtle anatomical differences. Parkinsonian conditions such as Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration and manganese-induced parkinsonism can clinically overlap, yet have very different prognoses and treatments. Relatively little radiographic interest has focused on movement disorders. Nevertheless in the past decade, a variety of findings, often subtle and routinely overlooked, have emerged to help the clinician differentiate these conditions. This review will summarize and discuss MRI findings in parkinsonian conditions. Most data concern either structural abnormalities or the imaging sequelae of abnormal iron deposition, common in some parkinsonian conditions.
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Affiliation(s)
- Oraporn Sitburana
- Neurology Center, Bumrungrad International Hospital, 33 Sukhumvit 3, Bangkok 10110, Thailand.
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Abele M, Minnerop M, Urbach H, Specht K, Klockgether T. Sporadic adult onset ataxia of unknown etiology. J Neurol 2007; 254:1384-9. [DOI: 10.1007/s00415-007-0556-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 02/05/2007] [Accepted: 02/26/2007] [Indexed: 10/22/2022]
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Boesch SM, Wolf C, Seppi K, Felber S, Wenning GK, Schocke M. Differentiation of SCA2 from MSA-C using proton magnetic resonance spectroscopic imaging. J Magn Reson Imaging 2007; 25:564-9. [PMID: 17326083 DOI: 10.1002/jmri.20846] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To assess and compare biochemical and volumetric features of the cerebellum in patients with spinocerebellar ataxia type 2 (SCA2) and patients with the cerebellar variant of multiple system atrophy (MSA-C). MATERIALS AND METHODS Nine genetically assigned SCA2 patients and six MSA-C patients who met the clinical criteria of MSA-C underwent a clinical and neuroradiological workup with respect to cerebellar features. The MR protocol consisted of a sagittal T1-weighted three-dimensional fast low-angle shot (3D FLASH) sequence and a transversal T2- and spin-density-weighted turbo spin-echo sequence. The proton magnetic resonance spectroscopic imaging ((1)H-MRSI) protocol consisted of two chemical shift imaging (CSI) sequences (echo time (TE) = 20 and 135 msec). RESULTS Both short- and long-TE MR spectroscopy (MRS) images showed significant decreases in values for N-acetylaspartate to creatine (NAA/Cr), and choline to creatine (Cho/Cr) ratios in MSA-C and SCA2 compared to normal controls, though there was no difference between the two patient groups. In contrast, distinct cerebellar lactate (Lac) peaks were detected in seven SCA2 patients, and small peaks were detected in two. However, we did not detect any definite Lac peak in MSA-C or control subjects. CONCLUSION MRSI revealed Lac pathology in SCA2 but not in MSA-C. Whether this indicates distinct pathogenetic mechanisms of cerebellar degeneration remains to be established.
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Affiliation(s)
- Sylvia M Boesch
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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Hauser TK, Luft A, Skalej M, Nägele T, Kircher TTJ, Leube DT, Schulz JB. Visualization and quantification of disease progression in multiple system atrophy. Mov Disord 2007; 21:1674-81. [PMID: 16830312 DOI: 10.1002/mds.21032] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To visualize and quantify disease progression in multiple system atrophy (MSA) from cerebellar type (MSA-C), we combined two magnetic resonance imaging (MRI) techniques, voxel-based morphometry (VBM) and 3D-based volumetry. Patients suffering from MSA-C (n = 14) were imaged twice with an interval of 2.0 +/- 0.2 years. We first applied VBM to map brain morphology changes between MSA patients and controls and to identify brain areas that showed a significant amount of atrophy. Using 3D-based volumetry, we confirmed that in MSA-C patients, the brainstem including medulla and pons, vermis and cerebellar hemispheres, caudate nucleus and putamen showed significant atrophy compared with controls. Next, we used 3D-based volumetry to analyze the atrophy rates. Atrophy rates in patients with MSA were significantly different from controls for putamen (-11.4% +/- 2.6%/year), vermis (-12.3% +/- 2.9%/year), and cerebellar hemispheres (-6.6% +/- 1.1%/year). The results show that 3D-based MRI volumetry is a tool that allows the disease progression of MSA to be followed over a time period of 2 years and suggest that it may serve as a surrogate marker in clinical trials to measure disease progression.
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Affiliation(s)
- Till-Karsten Hauser
- Department of General Neurology, Center of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Salamon N, Sicotte N, Alger J, Shattuck D, Perlman S, Sinha U, Schultze-Haakh H, Salamon G. Analysis of the brain-stem white-matter tracts with diffusion tensor imaging. Neuroradiology 2005; 47:895-902. [PMID: 16158279 DOI: 10.1007/s00234-005-1439-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Accepted: 07/20/2005] [Indexed: 10/25/2022]
Abstract
The authors have reviewed the diffusion tensor imaging (DTI) of the brain stem in 19 subjects, consisting of 15 normal volunteers and four multi-system atrophy patients. The study was performed with 1.5 T MRI scanners. DTI was correlated with an automated program allowing superposition of the structural anatomy. Axial, sagittal, and coronal images demonstrated major white-matter fibers within the brain stem, including cortico-spinal tracts, transverse pontine fibers, and medial lemniscus. Smaller fibers, such as medial longitudinal fascicles and central tegmental tracts are difficult to visualize. To identify the anatomical orientation of the brain stem, white-matter fibers will help us understand the different functional disease processes, and DTI will play an important role for the evaluation of the different white matter fibers in the brain stem.
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Affiliation(s)
- N Salamon
- Department of Radiology, University of California at Los Angeles, USA.
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Richter S, Dimitrova A, Maschke M, Gizewski E, Beck A, Aurich V, Timmann D. Degree of Cerebellar Ataxia Correlates with Three-Dimensional MRI-Based Cerebellar Volume in Pure Cerebellar Degeneration. Eur Neurol 2005; 54:23-7. [PMID: 16088175 DOI: 10.1159/000087241] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 04/13/2005] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to compare the severity of cerebellar ataxia as measured by the International Cooperative Ataxia Rating Scale (ICARS) by Trouillas et al. [ J Neurol Sci 1997;145:205-211] with the cerebellar volume in chronic cerebellar disease. Fifteen patients with pure cerebellar degeneration were investigated. Seven patients suffered from spinocerebellar ataxia type 6, 5 from idiopathic late-onset cerebellar ataxia, 2 from autosomal dominant cerebellar ataxia type III and 1 from episodic ataxia type 2. Volumetric analysis was based on individual three-dimensional MR images. Total ICARS score significantly inversely correlated with the cerebellar volume (r = -0.805, p < 0.0001), correlations between ICARS subscores and cerebellar volume were significant for upper and lower limb ataxia, ataxia of posture and gait, and dysarthria, but not for the oculomotor subscore. The results suggest that the degree of cerebellar atrophy in pure cerebellar degenerative disorders is accompanied by comparable functional impairment (i.e. degree of cerebellar ataxia).
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Affiliation(s)
- Stefanie Richter
- Department of Neurology, University of Duisburg-Essen, Essen, Germany.
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Abstract
The diagnosis of multiple system atrophy (MSA) in life remains entirely clinical. Consensus diagnostic criteria have been developed, but their use does not particularly render a diagnosis of MSA more accurate than are clinicians' diagnoses. Some patients may not fulfill the stipulated core diagnostic criteria, yet display many so-called red flags pointing toward MSA. The additional usefulness of these red flags and of a variety of investigations currently is being investigated, with a view to some of them being incorporated in future sets of diagnostic criteria.
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Affiliation(s)
- Niall P Quinn
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK
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