Differentiation of experimental white matter lesions using multiparametric magnetic resonance measurements

Neuroimaging of demyelination and remyelination models

Small-animal magnetic resonance imaging is becoming an increasingly utilized noninvasive tool in the study of animal models of MS including the most commonly used autoimmune, viral, and toxic models. Because most MS models are induced in rodents with brains and spinal cords of a smaller magnitude than humans, small-animal MRI must accomplish much higher resolution acquisition in order to generate useful data. In this review, we discuss key aspects and important differences between high field strength experimental and human MRI. We describe the role of conventional imaging sequences including T1, T2, and proton density-weighted imaging, and we discuss the studies aimed at analyzing blood-brain barrier (BBB) permeability and acute inflammation utilizing gadolinium-enhanced MRI. Advanced MRI methods, including diffusion-weighted and magnetization transfer imaging in monitoring demyelination, axonal damage, and remyelination, and studies utilizing in vivo T1 and T2 relaxometry, provide insight into the pathology of demyelinating diseases at previously unprecedented details. The technical challenges of small voxel in vivo MR spectroscopy and the biologically relevant information obtained by analysis of MR spectra in demyelinating models is also discussed. Novel cell-specific and molecular imaging techniques are becoming more readily available in the study of experimental MS models. As a growing number of tissue restorative and remyelinating strategies emerge in the coming years, noninvasive monitoring of remyelination will be an important challenge in small-animal imaging. High field strength small-animal experimental MRI will continue to evolve and interact with the development of new human MR imaging and experimental NMR techniques.

Value of magnetic resonance imaging in assessing efficacy in clinical trials of multiple sclerosis therapies

Magnetic resonance imaging (MRI) has become an important technique for monitoring the effectiveness of putative treatments for multiple sclerosis (MS) because of its high sensitivity, objectivity, and noninvasive nature. Its importance as a surrogate measure of disease, however, is an issue that is more difficult to validate than might seem to be the case. In this review, we describe the role of MRI in the assessment of putative therapies for MS. New magnetic resonance techniques and methods of image analyses aimed at better demonstrating the nature and extent of disease are discussed, and the role of MRI in published MS therapeutic trials is examined. MRI is a frequently used secondary outcome measure for putative treatment strategies for MS. Although it is sensitive to changes in the inflammatory component of the MS disease process, poor correlation has been noted between MRI findings and long-term patient outcome. There is a widespread expectation that new magnetic resonance techniques--such as fluid-attenuated inversion recovery, magnetization transfer imaging, and magnetic resonance spectroscopy--will ultimately be useful for characterization of pathologic changes within the MS lesion and more generally of the MS disease process. Whether magnetic resonance changes seen in experimental therapies predict the long-term clinical course of the disease remains to be determined.

In vivo noninvasive determination of abnormal water diffusion in the rat brain studied in an animal model for multiple sclerosis by diffusion-weighted NMR imaging

In vivo NMR images of the rat brain were obtained using a NMR microscope (7 T) from SMIS (England). Four animals were imaged every 3-4 days during a pathological cycle (starting after induction and up to 37 days) of experimental allergic encephalomyelitis (EAE), an animal model for multiple sclerosis. The EAE rats were weighted and clinically scored daily. We aimed at measuring the apparent diffusion coefficient (ADC) or the mean diffusivity (D) with a high accuracy, and within a reasonable experimental time frame, because of the clinical situation of the animals. Therefore, we fitted the ADC value from five diffusion-weighted images--with an experimental time of 17 min/image--and chose to apply diffusion-sensitizing gradients in a direction intersecting all fiber directions of the external capsule. With this, we also obtained high b-values. For the control rats, we obtained a statistical mean value of ADC = (388 +/- 16) 10(-12) m2/s for gray matter and a statistical mean value of (D) of (750 +/- 30) 10(-12) m2/s for white matter, measured in the external capsule. For the EAE rats, no alterations in ADC values of gray matter with increasing clinical scores were observed. Concerning white matter, as determined in the external capsule, there were no significant differences in (D) values between controls and EAE rats before clinical signs occurred. However, when clinical signs were observed, we could demonstrate a significant positive correlation between the clinical score and the (D) values in the external capsule. As the clinical signs became more severe, we measured a rise in water diffusion (increase in (D)) in the external capsule, which was accompanied by the occurrence of interstitial edema as revealed by a complementary histological study.

White matter abnormalities in phenylketonuria: results of magnetic resonance measurements

In adolescents and adults with PKU, blood phenylalanine levels above 10 mg/dl are generally associated with white matter changes in MRI. The grade of these changes is correlated to most recent blood phenylalanine levels. Based on studies using T2 relaxometry the MRI changes seem to be the consequence of a reversible dysmyelination. The clinical relevance of these white matter changes remains unclear as the extent of MRI alterations did not correlate with IQ, neurological and electrophysiological deficits of the patients. The intracerebral phenylalanine concentration as measured by protonspectroscopy amounts to about 50% of blood phenylalanine concentrations. Preliminary data indicate that brain phenylalanine levels remain constant if blood concentrations exceed 20 mg/dl. This might be of clinical relevance for the treatment of adolescent and adult PKU patients.

Compartmental analysis of brain edema using magnetic resonance imaging

The potential exists for increasing the sensitivity of magnetic resonance imaging (MRI) to white matter (WM) pathologies by identifying compartments of tissue water. We have found the physical equivalents of myelin-associated biological water compartments in normal and pathologic states by using multiexponential analysis of T2 relaxation. In addition, we have applied this multi-parametric technique for the definition of various types of white matter edemas. We were able to identify some changes in physical compartments visible by MRI with simultaneous changes in biological compartments. We conclude that MRI is a very sensitive method to quantify abnormal accumulation of intracerebral water; however, it is a somewhat limited probe for identifying the biologic compartmentation of edema among the various biological compartments of the brain.

White matter abnormalities in patients with treated hyperphenylalaninaemia: magnetic resonance relaxometry and proton spectroscopy findings

In order to further clarify the pathogenesis and clinical significance of MRI white matter abnormalities in treated hyperphenylalaninaemia (HPA), ten patients (seven type I HPA, two type II and one type III) underwent T2 relaxometry (n = 8) and/or 1H spectroscopy (n = 7) in addition to conventional MR spin-echo imaging at 1.5 T. Two patients with severe MRI abnormalities had repeat examinations during and after a 6- to 8-month period of strict diet control. The clinical evaluation included a detailed neurological examination. In nine out of ten patients visual evoked potentials (VEP) were obtained parallel to the MR examination. MR imaging demonstrated typical symmetrical areas of prolonged T2 relaxation time predominantly in the posterior periventricular white matter in all but one of type I and II patients. There was no consistent relationship between MRI findings and time of diagnosis/initiation of therapy, IQ or visual evoked potential changes. MRI abnormalities tended to be more severe in patients with poor dietary control and high current plasma phenylalanine levels, whereas a normal MRI was found only in patients with plasma phenylalanine levels continuously below 0.36 mmol/l. There was marked regression of MRI abnormalities already after 3 months of strict diet control. T2 relaxometry showed a bi-exponential behaviour of T2 in the affected white matter, with a slow component of about 200-450 ms, indicating an increase in free (extracellular) water. 1H spectroscopy revealed no signs of severe neuronal damage. We conclude, that the observed white matter changes in treated HPA probably represent reversible structural myelin changes rather than permanent demyelination.