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Mistry N, Hobart J, Rog D, Muhlert N, Mathews J, Baker D, Giovannoni G. Reconciling lesions, relapses and smouldering associated worsening: A unifying model for multiple sclerosis pathogenesis. Mult Scler Relat Disord 2024; 88:105706. [PMID: 38880031 DOI: 10.1016/j.msard.2024.105706] [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: 04/02/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
The failure of relapses and white matter lesions to properly explain long-term disability and progression in multiple sclerosis is compounded by its artificial separation into relapsing remitting, secondary progressive, and primary progressive pigeonholes. The well-known epidemiological disconnection between relapses and long-term disability progression has been rediscovered as "progression independent of relapse activity", i.e. smouldering multiple sclerosis. This smouldering associated worsening proceeds despite early and prolonged use of disease modification therapies, even those that are highly effective at preventing relapses and new/enhancing white matter lesions on MRI. We recognise that smouldering associated worsening and relapse/lesion associated worsening coexist, to varying extents. The extent of cortical demyelination has been shown to correlate significantly with the severity of diffuse injury in normal appearing white matter (post mortem histopathologically (r = 0.55; P = 0.001), and in vivo with MRI (r = -0.6874; P = 0.0006)) and does so independently of white matter lesion burden. Axon loss in the normal appearing white matter explains disability in multiple sclerosis better than focal white matter lesions do. Smouldering associated worsening typically manifests as a length-dependent central axonopathy. We propose a unifying model for multiple sclerosis pathogenesis, wherein accumulation of cortical lesion burden predisposes associated normal appearing white matter to diffuse injury, whilst also intensifying damage within white matter lesions. Our novel two-hit hypothesis implicates cortical disease as a culprit for smouldering multiple sclerosis, abetted by active focal inflammation in the white matter (and vice versa). Substantiation of the two-hit hypothesis would advance the importance of specific therapeutic intervention for (and monitoring of) cortical/meningeal inflammation in people with multiple sclerosis.
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Affiliation(s)
- Niraj Mistry
- Department of Clinical Neurosciences, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Jeremy Hobart
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - David Rog
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Nils Muhlert
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Joela Mathews
- Department of Neurology, The Royal London Hospital, London, UK
| | - David Baker
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gavin Giovannoni
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Brett BL, Klein AP, Vazirnia P, Omidfar S, Guskiewicz KK, McCrea M, Meier T. White Matter Hyperintensities and Microstructural Alterations in Contact Sport Athletes from Adolescence to Early Midlife. J Neurotrauma 2024. [PMID: 38661548 DOI: 10.1089/neu.2023.0609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Studies have demonstrated associations between cumulative concussion and repetitive head impact exposure (RHI) via contact sports with white matter (WM) alterations later in life. The course of WM changes associated with exposure earlier in the lifespan are unclear. This study investigated alterations in white matter (WM hyperintensity [WMH] volume and microstructural changes) associated with concussion and RHI exposure from adolescence to early midlife, as well as the interaction between exposure and age-cohort (i.e., adolescent/young adult compared to early midlife athlete cohorts) on WM outcomes. Participating football players included an adolescent/young adulthood cohort (n=82; Mage=18.41.7) and an early midlife cohort (37 former collegiate players approximately 15-years removed from sport; Mage=37.71.4). Years of football participation and number of prior concussions were exposures of interest. White matter outcomes included log-transformed manually segmented total WMH volume and neurite orientation dispersion and density imaging metrics of microstructure/organization (isotropic volume fraction[Viso], intra-cellular volume fraction[Vic], and orientation dispersion[OD]). Regression models were fit to test effects of concussion history, years of football participation, and age-cohort by years of football participation with WM outcomes. Spearman's correlations assessed associations between significant WM metrics and measures of cognitive and psychological function. A significant age-cohort by years of participation effect was observed for whole brain white matter OD, B=-0.002, SE=0.001, p=0.001. The interaction was driven by a negative association between years of participation and OD within the younger cohort, B=-0.001, SE=0.0004, p=0.008, whereas a positive association between participation and OD in the early midlife cohort, B=0.001, SE=0.0003, p=0.039, was observed. Follow-up ROI analyses showed significant interaction effects for OD in the body of the corpus callosum, genu of the corpus callosum, cingulum, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, posterior thalamic radiation (ps<0.05). Greater concussion history was significantly associated with greater Viso in the early midlife cohort, B=0.001, SE= 0.0002, p=0.010. Years of participation and concussion history were not associated with WMH volume, ps>0.05. Performance on a measure of executive function was significantly associated with years of participation, =.34, p=.04, and a trend was observed for OD, =.28, p=.09 in the early midlife cohort only. The global characterization of white matter changes associated with years of football participation were broadly similar and stable from adolescence through early midlife (i.e., microstructural alterations, but not macroscopic lesions). An inverse association between years of participation and orientation dispersion across age-cohorts may represent a process of initial recovery/reorganization proximal to sport, followed by later reduction of white matter coherence.
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Affiliation(s)
- Benjamin L Brett
- Medical College of Wisconsin, 5506, Neurosurgery and Neurology, 8701 W Watertown Plank Rd, Milwaukee, Wisconsin, United States, 53226;
| | - Andrew P Klein
- Medical College of Wisconsin, 5506, Radiology, 9200 West Wisconsin Ave, Milwaukee, Wisconsin, United States, 53226;
| | - Parsia Vazirnia
- Medical College of Wisconsin, 5506, Milwaukee, Wisconsin, United States;
| | - Samantha Omidfar
- Medical College of Wisconsin, 5506, Milwaukee, Wisconsin, United States;
| | - Kevin K Guskiewicz
- University of North Carolina, Exercise and Sport Science, CB#8700, Chapel Hill, North Carolina, United States, 27599-8700;
| | - Michael McCrea
- Medical College of Wisconsin, Neurosurgery, Hub for Collaborative Medicine, 8701 Watertown Plank Road, Milwaukee, Wisconsin, United States, 53226;
| | - Timothy Meier
- Medical College of Wisconsin, Neurosurgery, 8701 Watertown Plank Road, Milwaukee, Wisconsin, United States, 53226;
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Kiss C, Wurth S, Heschl B, Khalil M, Gattringer T, Enzinger C, Ropele S. Low-frequency MR elastography reveals altered deep gray matter viscoelasticity in multiple sclerosis. Neuroimage Clin 2024; 42:103606. [PMID: 38669859 PMCID: PMC11068637 DOI: 10.1016/j.nicl.2024.103606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/23/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Brain viscoelasticity as assessed by magnetic resonance elastography (MRE) has been discussed as a promising surrogate of microstructural alterations due to neurodegenerative processes. Existing studies indicate that multiple sclerosis (MS) is associated with a global reduction in brain stiffness. However, no study to date systematically investigated the MS-related characteristics of brain viscoelasticity separately in normal-appearing white matter (NAWM), deep gray matter (DGM) and T2-hyperintense white matter (WM) lesions. METHODS 70 MS patients and 42 healthy volunteers underwent whole-cerebral MRE using a stimulated echo sequence (DENSE) with a low-frequency mechanical excitation at 20 Hertz. The magnitude |G∗| (Pa) and phase angle φ (rad) of the complex shear modulus G∗ were reconstructed by multifrequency dual elasto-visco (MDEV) inversion and related to structural imaging and clinical parameters. RESULTS We observed φ in the thalamus to be higher by 4.3 % in patients relative to healthy controls (1.11 ± 0.07 vs. 1.06 ± 0.07, p < 0.0001). Higher Expanded Disability Status Scale (EDSS) scores were negatively associated with φ in the basal ganglia (p = 0.01). We measured φ to be lower in MS lesions compared to surrounding NAWM (p = 0.001), which was most prominent for lesions in the temporal lobe (1.01 ± 0.22 vs. 1.06 ± 0.19, p = 0.003). Age was associated with lower values of |G∗| (p = 0.04) and φ (p = 0.004) in the thalamus of patients. No alteration in NAWM stiffness relative to WM in healthy controls was observed. CONCLUSION Low-frequency elastography in MS patients reveals age-independent alterations in the viscoelasticity of deep gray matter at early stages of disease.
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Affiliation(s)
- Christian Kiss
- Department of Neurology, Medical University of Graz, Austria.
| | - Sebastian Wurth
- Department of Neurology, Medical University of Graz, Austria.
| | - Bettina Heschl
- Department of Neurology, Medical University of Graz, Austria.
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Austria.
| | | | | | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Austria; Neuroimaging Research Unit, Department of Neurology, Medical University of Graz, Austria.
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Luchicchi A, Muñoz‐Gonzalez G, Halperin ST, Strijbis E, van Dijk LHM, Foutiadou C, Uriac F, Bouman PM, Schouten MAN, Plemel J, 't Hart BA, Geurts JJG, Schenk GJ. Micro-diffusely abnormal white matter: An early multiple sclerosis lesion phase with intensified myelin blistering. Ann Clin Transl Neurol 2024; 11:973-988. [PMID: 38425098 PMCID: PMC11021636 DOI: 10.1002/acn3.52015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) is a chronic central nervous system disease whose white matter lesion origin remains debated. Recently, we reported subtle changes in the MS normal appearing white matter (NAWM), presenting with an increase in myelin blisters and myelin protein citrullination, which may recapitulate some of the prodromal degenerative processes involved in MS pathogenesis. Here, to clarify the relevance of these changes for subsequent MS myelin degeneration we explored their prevalence in WM regions characterized by subtly reduced myelination (dubbed as micro-diffusely abnormal white matter, mDAWM). METHODS We used an in-depth (immuno)histochemistry approach in 27 MS donors with histological presence of mDAWM and 5 controls. An antibody panel against degenerative markers was combined and the presence of myelin/axonal aberrations was analyzed and compared with the NAWM from the same cases/slices/regions. RESULTS mDAWM-defined areas exhibit ill-defined borders, no signs of Wallerian degeneration, and they associate with visible veins. Remarkably, such areas present with augmented myelin blister frequency, enhanced prevalence of polar myelin phospholipids, citrullination, and degradation of myelin basic protein (MBP) when compared with the NAWM. Furthermore, enhanced reactivity of microglia/macrophages against citrullinated MBP was also observed in this tissue. INTERPRETATION We report a new histologically defined early phase in MS lesion formation, namely mDAWM, which lacks signs of Wallerian pathology. These results support the prelesional nature of the mDAWM. We conceptualize that evolution to pathologically evident lesions comprises the previously documented imbalance of axo-myelinic units (myelin blistering) leading to their degeneration and immune system activation by released myelin components.
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Affiliation(s)
- Antonio Luchicchi
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Gema Muñoz‐Gonzalez
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Saar T. Halperin
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Eva Strijbis
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
- Department of NeurologyAmsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Laura H. M. van Dijk
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Chrisa Foutiadou
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Florence Uriac
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Piet M. Bouman
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Maxime A. N. Schouten
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Jason Plemel
- Department of NeuroscienceUniversity of AlbertaEdmontonAlbertaCanada
| | - Bert A. 't Hart
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Jeroen J. G. Geurts
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Geert J. Schenk
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
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Gloor M, Andelova M, Gaetano L, Papadopoulou A, Burguet Villena F, Sprenger T, Radue EW, Kappos L, Bieri O, Garcia M. Longitudinal analysis of new multiple sclerosis lesions with magnetization transfer and diffusion tensor imaging. Eur Radiol 2024; 34:1680-1691. [PMID: 37658894 PMCID: PMC10873225 DOI: 10.1007/s00330-023-10173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/02/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE The potential of magnetization transfer imaging (MTI) and diffusion tensor imaging (DTI) for the detection and evolution of new multiple sclerosis (MS) lesions was analyzed. METHODS Nineteen patients with MS obtained conventional MRI, MTI, and DTI examinations bimonthly for 12 months and again after 24 months at 1.5 T MRI. MTI was acquired with balanced steady-state free precession (bSSFP) in 10 min (1.3 mm3 isotropic resolution) yielding both magnetization transfer ratio (MTR) and quantitative magnetization transfer (qMT) parameters (pool size ratio (F), exchange rate (kf), and relaxation times (T1/T2)). DTI provided fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS At the time of their appearance on MRI, the 21 newly detected MS lesions showed significantly reduced MTR/F/kf and prolonged T1/T2 parameters, as well as significantly reduced FA and increased AD/MD/RD. Significant differences were already observed for MTR 4 months and for qMT parameters 2 months prior to lesions' detection on MRI. DTI did not show any significant pre-lesional differences. Slightly reversed trends were observed for most lesions up to 8 months after their detection for qMT and less pronounced for MTR and three diffusion parameters, while appearing unchanged on MRI. CONCLUSIONS MTI provides more information than DTI in MS lesions and detects tissue changes 2 to 4 months prior to their appearance on MRI. After lesions' detection, qMT parameter changes promise to be more sensitive than MTR for the lesions' evolutional assessment. Overall, bSSFP-based MTI adumbrates to be more sensitive than MRI and DTI for the early detection and follow-up assessment of MS lesions. CLINICAL RELEVANCE STATEMENT When additionally acquired in routine MRI, fast bSSFP-based MTI can complement the MRI/DTI longitudinal lesion assessment by detecting MS lesions 2-4 months earlier than with MRI, which could implicate earlier clinical decisions and better follow-up/treatment assessment in MS patients. KEY POINTS • Magnetization transfer imaging provides more information than DTI in multiple sclerosis lesions and can detect tissue changes 2 to 4 months prior to their appearance on MRI. • After lesions' detection, quantitative magnetization transfer changes are more pronounced than magnetization transfer ratio changes and therefore promise to be more sensitive for the lesions' evolutional assessment. • Balanced steady-state free precession-based magnetization transfer imaging is more sensitive than MRI and DTI for the early detection and follow-up assessment of multiple sclerosis lesions.
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Affiliation(s)
- Monika Gloor
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Michaela Andelova
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Laura Gaetano
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Medical Image Analysis Center (MIAC) AG, Basel, Switzerland
- Novartis Institutes for BioMedical Research Basel, Basel, Switzerland
| | - Athina Papadopoulou
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Federico Burguet Villena
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Till Sprenger
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- University Hospital Zürich, Zurich, Switzerland
| | | | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, Faculty of Medicine, University Hospital Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Meritxell Garcia
- Division of Neuroradiology, Department of Radiology, University Hospital Basel, Basel, Switzerland.
- Department of Neuroradiology, University Hospital Zürich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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van den Bosch AMR, van der Poel M, Fransen NL, Vincenten MCJ, Bobeldijk AM, Jongejan A, Engelenburg HJ, Moerland PD, Smolders J, Huitinga I, Hamann J. Profiling of microglia nodules in multiple sclerosis reveals propensity for lesion formation. Nat Commun 2024; 15:1667. [PMID: 38396116 PMCID: PMC10891081 DOI: 10.1038/s41467-024-46068-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Microglia nodules (HLA-DR+ cell clusters) are associated with brain pathology. In this post-mortem study, we investigated whether they represent the first stage of multiple sclerosis (MS) lesion formation. We show that microglia nodules are associated with more severe MS pathology. Compared to microglia nodules in stroke, those in MS show enhanced expression of genes previously found upregulated in MS lesions. Furthermore, genes associated with lipid metabolism, presence of T and B cells, production of immunoglobulins and cytokines, activation of the complement cascade, and metabolic stress are upregulated in microglia nodules in MS. Compared to stroke, they more frequently phagocytose oxidized phospholipids and possess a more tubular mitochondrial network. Strikingly, in MS, some microglia nodules encapsulate partially demyelinated axons. Taken together, we propose that activation of microglia nodules in MS by cytokines and immunoglobulins, together with phagocytosis of oxidized phospholipids, may lead to a microglia phenotype prone to MS lesion formation.
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Affiliation(s)
- Aletta M R van den Bosch
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
| | - Marlijn van der Poel
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Nina L Fransen
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Maria C J Vincenten
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Anneleen M Bobeldijk
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Aldo Jongejan
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Hendrik J Engelenburg
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Perry D Moerland
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joost Smolders
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- MS Center ErasMS, Department of Neurology and Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Inge Huitinga
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands.
| | - Jörg Hamann
- Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
- Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Center, Amsterdam, The Netherlands.
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Buch S, Subramanian K, Chen T, Chen Y, Larvie M, Bernitsas E, Haacke EM. Characterization of white matter lesions in multiple sclerosis using proton density and T1-relaxation measures. Magn Reson Imaging 2024; 106:110-118. [PMID: 38145698 DOI: 10.1016/j.mri.2023.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/18/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE Although lesion dissemination in time is a defining characteristic of multiple sclerosis (MS), there is a limited understanding of lesion heterogeneity. Currently, conventional sequences such as fluid attenuated inversion recovery (FLAIR) and T1-weighted (T1W) data are used to assess MS lesions qualitatively. Estimating water content could provide a measure of local tissue rarefaction, or reduced tissue density, resulting from chronic inflammation. Our goal was to utilize the proton spin density (PD), derived from a rapid, multi-contrast STAGE (strategically acquired gradient echo) protocol to characterize white matter (WM) lesions seen on T2W, FLAIR and T1W data. MATERIALS AND METHODS Twenty (20) subjects with relapsing-remitting MS were scanned at 3 T using T1W, T2-weighted, FLAIR and strategically acquired gradient echo (STAGE) sequences. PD and T1 maps were derived from the STAGE data. Disease severity scores, including Extended Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC), were correlated with total, high PD and high T1 lesion volumes. A probability map of high PD regions and all lesions across all subjects was generated. Five perilesional normal appearing WM (NAWM) bands surrounding the lesions were generated to compare the median PD and T1 values in each band with the lesional values and the global WM. RESULTS T1W intensity was negatively correlated with PD as expected (R = -0.87, p < 0.01, R2 = 0.756) and the FLAIR signal was suppressed for high PD volumes within the lesions, roughly for PD ≥ 0.85. The threshold for high PD and T1 regions was set to 0.909 and 1953.6 ms, respectively. High PD regions showed a high probability of occurrence near the boundary of the lateral ventricles. EDSS score and nine-hole peg test (dominant and non-dominant hand) were significantly correlated with the total lesion volume and the volumes of high PD and T1 regions (p < 0.05). There was a significant difference in PD/T1 values between the high PD/T1 regions within the lesions and the remaining lesional tissue (p < 0.001). In addition, the PD values of the first NAWM perilesional band directly adjacent to the lesional boundary displayed a significant difference (p < 0.05) compared to the global WM. CONCLUSION Lesions with high PD and T1s had the highest probability of occurrence at the boundary of the lateral ventricles and likely represent chronic lesions with significant local tissue rarefaction. Moreover, the perilesional NAWM exhibited subtly increasing PD and T1 values from the NAWM up to the lesion boundary. Unlike on the T1 maps, the perilesional band adjacent to the lesion boundary possessed a significantly higher PD value than the global WM PD values. This shows that PD maps were sensitive to the subtle changes in NAWM surrounding the lesions.
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Affiliation(s)
- Sagar Buch
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | | | - Teresa Chen
- College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Yongsheng Chen
- Department of Neurology, Wayne State University, Detroit, MI, USA
| | - Mykol Larvie
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | | | - E Mark Haacke
- Department of Neurology, Wayne State University, Detroit, MI, USA; Department of Radiology, Wayne State University, Detroit, MI, USA.
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Tanasescu R, Mougin O, Chou IJ, Al-Radaideh A, Jerca OP, Lim SY, Gowland P, Constantinescu CS. Natalizumab Treatment for Relapsing Multiple Sclerosis Stabilises Normal-Appearing White Matter Microstructure: A One-Year Prospective Ultra-High-Field Quantitative Imaging Study. Brain Sci 2023; 13:1464. [PMID: 37891832 PMCID: PMC10605806 DOI: 10.3390/brainsci13101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/24/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Natalizumab dramatically reduces relapses and MRI inflammatory activity (new lesions and enhancing lesions) in multiple sclerosis (MS). Chemical exchange saturation transfer (CEST) MRI can explore brain tissue in vivo with high resolution and sensitivity. We investigated if natalizumab can prevent microstructural tissue damage progression measured with MRI at ultra-high field (7 Tesla) over the first year of treatment. (2) Methods: In this one-year prospective longitudinal study, patients with active relapsing-remitting MS were assessed clinically and scanned at ultra-high-field MRI at the time of their first natalizumab infusion, at 6 and 12 months, with quantitative imaging aimed to detect microstructural changes in the normal-appearing white matter (NAWM), including sequences sensitive to magnetisation transfer (MT) effects from amide proton transfer (MTRAPT) and the nuclear Overhauser effect (MTRNOE). (3) Results: 12 patients were recruited, and 10 patients completed the study. The difference in the T1 relaxation times at month 6 and month 12 of natalizumab treatment was not significant, suggesting the lack of accumulation of tissue damage, while improvements were seen in MTR (MTRAPT and MTRNOE measures) at month 12, suggesting a tissue repair effect. This paralleled the expected lack of clinical and radiological worsening of conventional MRI measures of disease activity (new lesions or gadolinium-enhancing lesions). (4) Conclusion: Natalizumab prevents microstructural brain damage and has effects suggesting an improved white matter microstructure measured at ultra-high field during the first year of treatment.
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Affiliation(s)
- Radu Tanasescu
- Academic Unit of Mental Health and Clinical Neurosciences, Section of Clinical Neurology, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Neurology, Nottingham Centre for MS and Neuroinflammation, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Olivier Mougin
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham NG7 2QL, UK; (O.M.)
| | - I-Jun Chou
- Academic Unit of Mental Health and Clinical Neurosciences, Section of Clinical Neurology, University of Nottingham, Nottingham NG7 2UH, UK
- Chang Gung Memorial Hospital, Linko Branch, Taoyuan 333, Taiwan
| | - Ali Al-Radaideh
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham NG7 2QL, UK; (O.M.)
- Department of Medical Imaging, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan
- Department of Medical Radiography, College of Health Sciences, University of Doha for Science and Technology, Doha 24449, Qatar
| | - Oltita P. Jerca
- Academic Unit of Mental Health and Clinical Neurosciences, Section of Clinical Neurology, University of Nottingham, Nottingham NG7 2UH, UK
- Medizinisches Zentrum Harz, 38820 Halberstadt, Germany
| | - Su-Yin Lim
- Academic Unit of Mental Health and Clinical Neurosciences, Section of Clinical Neurology, University of Nottingham, Nottingham NG7 2UH, UK
- School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics & Astronomy, University of Nottingham, Nottingham NG7 2QL, UK; (O.M.)
| | - Cris S. Constantinescu
- Academic Unit of Mental Health and Clinical Neurosciences, Section of Clinical Neurology, University of Nottingham, Nottingham NG7 2UH, UK
- Department of Neurology, Nottingham Centre for MS and Neuroinflammation, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
- Cooper Neurological Institute, Cooper Medical School of Rowan University, Camden, NJ 08013, USA
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9
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Oost W, Huitema AJ, Kats K, Giepmans BNG, Kooistra SM, Eggen BJL, Baron W. Pathological ultrastructural alterations of myelinated axons in normal appearing white matter in progressive multiple sclerosis. Acta Neuropathol Commun 2023; 11:100. [PMID: 37340488 DOI: 10.1186/s40478-023-01598-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023] Open
Abstract
Multiple sclerosis (MS) pathophysiology includes inflammation, demyelination and neurodegeneration, but the exact mechanisms of disease initiation and progression are unknown. A major feature of lesions is lack of myelin, which increases axonal energy demand and requires adaptation in number and size of mitochondria. Outside lesions, subtle and diffuse alterations are observed in normal appearing white matter (NAWM) and normal appearing grey matter (NAGM), including increased oxidative stress, reduced axon density and changes in myelin composition and morphology. On an ultrastructural level, only limited data is available on alterations in myelinated axons. We generated large scale 2D scanning transmission electron microscopy images ('nanotomy') of non-demyelinated brain tissue of control and progressive MS donors, accessible via an open-access online repository. We observed a reduced density of myelinated axons in NAWM, without a decrease in cross-sectional axon area. Small myelinated axons were less frequently and large myelinated axons were more frequently present in NAWM, while the g-ratio was similar. The correlation between axonal mitochondrial radius and g-ratio was lost in NAWM, but not in NAGM. Myelinated axons in control GM and NAGM had a similar g-ratio and radius distribution. We hypothesize that axonal loss in NAWM is likely compensated by swelling of the remaining myelinated axons and subsequent adjustment of myelin thickness to maintain their g-ratio. Failure of axonal mitochondria to adjust their size and fine-tuning of myelin thickness may render NAWM axons and their myelin more susceptible to injury.
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Affiliation(s)
- Wendy Oost
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Allard J Huitema
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kim Kats
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ben N G Giepmans
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Susanne M Kooistra
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bart J L Eggen
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wia Baron
- Department of Biomedical Sciences of Cells and Systems, Section Molecular Neurobiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- MS Center Noord Nederland, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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10
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Caba B, Cafaro A, Lombard A, Arnold DL, Elliott C, Liu D, Jiang X, Gafson A, Fisher E, Belachew SM, Paragios N. Single-timepoint low-dimensional characterization and classification of acute versus chronic multiple sclerosis lesions using machine learning. Neuroimage 2023; 265:119787. [PMID: 36473647 DOI: 10.1016/j.neuroimage.2022.119787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease characterized by the appearance of focal lesions across the central nervous system. The discrimination of acute from chronic MS lesions may yield novel biomarkers of inflammatory disease activity which may support patient management in the clinical setting and provide endpoints in clinical trials. On a single timepoint and in the absence of a prior reference scan, existing methods for acute lesion detection rely on the segmentation of hyperintense foci on post-gadolinium T1-weighted magnetic resonance imaging (MRI), which may underestimate recent acute lesion activity. In this paper, we aim to improve the sensitivity of acute MS lesion detection in the single-timepoint setting, by developing a novel machine learning approach for the automatic detection of acute MS lesions, using single-timepoint conventional non-contrast T1- and T2-weighted brain MRI. The MRI input data are supplemented via the use of a convolutional neural network generating "lesion-free" reconstructions from original "lesion-present" scans using image inpainting. A multi-objective statistical ranking module evaluates the relevance of textural radiomic features from the core and periphery of lesion sites, compared within "lesion-free" versus "lesion-present" image pairs. Then, an ensemble classifier is optimized through a recursive loop seeking consensus both in the feature space (via a greedy feature-pruning approach) and in the classifier space (via model selection repeated after each pruning operation). This leads to the identification of a compact textural signature characterizing lesion phenotype. On the patch-level task of acute versus chronic MS lesion classification, our method achieves a balanced accuracy in the range of 74.3-74.6% on fully external validation cohorts.
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Affiliation(s)
- Bastien Caba
- Biogen Digital Health, Biogen, Cambridge, MA, USA.
| | | | | | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada; NeuroRx Research, Montreal, QC, Canada
| | | | - Dawei Liu
- Biogen Digital Health, Biogen, Cambridge, MA, USA
| | | | - Arie Gafson
- Biogen Digital Health, Biogen, Cambridge, MA, USA
| | | | | | - Nikos Paragios
- CentraleSupélec, University of Paris-Saclay, Gif-sur-Yvette, France; TheraPanacea, Paris, France
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11
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Voskuhl RR, MacKenzie-Graham A. Chronic experimental autoimmune encephalomyelitis is an excellent model to study neuroaxonal degeneration in multiple sclerosis. Front Mol Neurosci 2022; 15:1024058. [PMID: 36340686 PMCID: PMC9629273 DOI: 10.3389/fnmol.2022.1024058] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/30/2022] [Indexed: 08/19/2023] Open
Abstract
Animal models of multiple sclerosis (MS), specifically experimental autoimmune encephalomyelitis (EAE), have been used extensively to develop anti-inflammatory treatments. However, the similarity between MS and one particular EAE model does not end at inflammation. MS and chronic EAE induced in C57BL/6 mice using myelin oligodendrocyte glycoprotein (MOG) peptide 35-55 share many neuropathologies. Beyond both having white matter lesions in spinal cord, both also have widespread neuropathology in the cerebral cortex, hippocampus, thalamus, striatum, cerebellum, and retina/optic nerve. In this review, we compare neuropathologies in each of these structures in MS with chronic EAE in C57BL/6 mice, and find evidence that this EAE model is well suited to study neuroaxonal degeneration in MS.
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Affiliation(s)
- Rhonda R. Voskuhl
- UCLA MS Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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12
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Tagge IJ, Leppert IR, Fetco D, Campbell JS, Rudko DA, Brown RA, Stikov N, Pike GB, Giacomini PS, Arnold DL, Narayanan S. Permanent tissue damage in multiple sclerosis lesions is associated with reduced pre-lesion myelin and axon volume fractions. Mult Scler 2022; 28:2027-2037. [PMID: 35903888 PMCID: PMC9574230 DOI: 10.1177/13524585221110585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of advanced magnetic resonance imaging (MRI) techniques in MS research has led to new insights in lesion evolution and disease outcomes. It has not yet been determined if, or how, pre-lesional abnormalities in normal-appearing white matter (NAWM) relate to the long-term evolution of new lesions. OBJECTIVE To investigate the relationship between abnormalities in MRI measures of axonal and myelin volume fractions (AVF and MVF) in NAWM preceding development of black-hole (BH) and non-BH lesions in people with MS. METHODS We obtained magnetization transfer and diffusion MRI at 6-month intervals in patients with MS to estimate MVF and AVF during lesion evolution. Lesions were classified as either BH or non-BH on the final imaging visit using T1 maps. RESULTS Longitudinal data from 97 new T2 lesions from 9 participants were analyzed; 25 lesions in 8 participants were classified as BH 6-12 months after initial appearance. Pre-lesion MVF, AVF, and MVF/AVF were significantly lower, and T1 was significantly higher, in the lesions that later became BHs (p < 0.001) compared to those that did not. No significant pre-lesion abnormalities were found in non-BH lesions (p > 0.05). CONCLUSION The present work demonstrated that pre-lesion abnormalities are associated with worse long-term lesion-level outcome.
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Affiliation(s)
- Ian J Tagge
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Ilana R Leppert
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Dumitru Fetco
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Jennifer Sw Campbell
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - David A Rudko
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Robert A Brown
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Nikola Stikov
- Electrical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - G Bruce Pike
- Departments of Radiology and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Paul S Giacomini
- Neurology and Neurosurgery, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Douglas L Arnold
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
| | - Sridar Narayanan
- McConnell Brain Imaging Center, Montreal Neurological Institute & Hospital, Montreal, QC, Canada
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13
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Zhu Q, Zheng Q, Luo D, Peng Y, Yan Z, Wang X, Chen X, Li Y. The Application of Diffusion Kurtosis Imaging on the Heterogeneous White Matter in Relapsing-Remitting Multiple Sclerosis. Front Neurosci 2022; 16:849425. [PMID: 35360163 PMCID: PMC8960252 DOI: 10.3389/fnins.2022.849425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 12/21/2022] Open
Abstract
Objectives To evaluate the microstructural damage in the heterogeneity of different white matter areas in relapsing-remitting multiple sclerosis (RRMS) patients by using diffusion kurtosis imaging (DKI) and its correlation with clinical and cognitive status. Materials and Methods Kurtosis fractional anisotropy (KFA), fractional anisotropy (FA), mean kurtosis (MK), and mean diffusivity (MD) in T1-hypointense lesions (T1Ls), pure T2-hyperintense lesions (pure-T2Ls), normal-appearing white matter (NAWM), and white matter in healthy controls (WM in HCs) were measured in 48 RRMS patients and 26 sex- and age-matched HCs. All the participants were assessed with the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Symbol Digit Modalities Test (SDMT) scores as the cognitive status. The Kurtzke Expanded Disability Status Scale (EDSS) scores were used to evaluate the clinical status in RRMS patients. Results The lowest KFA, FA, and MK values and the highest MD values were found in T1Ls, followed by pure-T2Ls, NAWM, and WM in HCs. The T1Ls and pure-T2Ls were significantly different in FA (p = 0.002) and MK (p = 0.013), while the NAWM and WM in HCs were significantly different in KFA, FA, and MK (p < 0.001; p < 0.001; p = 0.001). The KFA, FA, MK, and MD values in NAWM (r = 0.360, p = 0.014; r = 0.415, p = 0.004; r = 0.369, p = 0.012; r = −0.531, p < 0.001) were correlated with the MMSE scores and the FA, MK, and MD values in NAWM (r = 0.423, p = 0.003; r = 0.427, p = 0.003; r = −0.359, p = 0.014) were correlated with the SDMT scores. Conclusion Applying DKI to the imaging-based white matter classification has the potential to reflect the white matter damage and is correlated with cognitive impairment.
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