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Luchetti L, Prados F, Cortese R, Gentile G, Calabrese M, Mortilla M, De Stefano N, Battaglini M. Evaluation of cervical spinal cord atrophy using a modified SIENA approach. Neuroimage 2024; 298:120775. [PMID: 39106936 DOI: 10.1016/j.neuroimage.2024.120775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 07/12/2024] [Accepted: 08/02/2024] [Indexed: 08/09/2024] Open
Abstract
Spinal cord (SC) atrophy obtained from structural magnetic resonance imaging has gained relevance as an indicator of neurodegeneration in various neurological disorders. The common method to assess SC atrophy is by comparing numerical differences of the cross-sectional spinal cord area (CSA) between time points. However, this indirect approach leads to considerable variability in the obtained results. Studies showed that this limitation can be overcome by using a registration-based technique. The present study introduces the Structural Image Evaluation using Normalization of Atrophy on the Spinal Cord (SIENA-SC), which is an adapted version of the original SIENA method, designed to directly calculate the percentage of SC volume change over time from clinical brain MRI acquired with an extended field of view to cover the superior part of the cervical SC. In this work, we compared SIENA-SC with the Generalized Boundary Shift Integral (GBSI) and the CSA change. On a scan-rescan dataset, SIENA-SC was shown to have the lowest measurement error than the other two methods. When comparing a group of 190 Healthy Controls with a group of 65 Multiple Sclerosis patients, SIENA-SC provided significantly higher yearly rates of atrophy in patients than in controls and a lower sample size when measured for treatment effect sizes of 50%, 30% and 10%. Our findings indicate that SIENA-SC is a robust, reproducible, and sensitive approach for assessing longitudinal changes in spinal cord volume, providing neuroscientists with an accessible and automated tool able to reduce the need for manual intervention and minimize variability in measurements.
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Affiliation(s)
- Ludovico Luchetti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; Siena Imaging S.r.l., Siena, Italy
| | - Ferran Prados
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Center for Medical Imaging Computing, Medical Physics and Biomedical Engineering Department, University College London, London, United Kingdom; e-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Massimilano Calabrese
- Department of Neuroscience, Biomedicine and Movements, The Multiple Sclerosis Center of the University Hospital of Verona, Verona, Italy
| | - Marzia Mortilla
- Anna Meyer Children's University Hospital-IRCCS, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; Siena Imaging S.r.l., Siena, Italy.
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Millward JM, Ramos Delgado P, Smorodchenko A, Boehmert L, Periquito J, Reimann HM, Prinz C, Els A, Scheel M, Bellmann-Strobl J, Waiczies H, Wuerfel J, Infante-Duarte C, Chien C, Kuchling J, Pohlmann A, Zipp F, Paul F, Niendorf T, Waiczies S. Transient enlargement of brain ventricles during relapsing-remitting multiple sclerosis and experimental autoimmune encephalomyelitis. JCI Insight 2020; 5:140040. [PMID: 33148886 PMCID: PMC7710287 DOI: 10.1172/jci.insight.140040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022] Open
Abstract
The brain ventricles are part of the fluid compartments bridging the CNS with the periphery. Using MRI, we previously observed a pronounced increase in ventricle volume (VV) in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis (MS). Here, we examined VV changes in EAE and MS patients in longitudinal studies with frequent serial MRI scans. EAE mice underwent serial MRI for up to 2 months, with gadolinium contrast as a proxy of inflammation, confirmed by histopathology. We performed a time-series analysis of clinical and MRI data from a prior clinical trial in which RRMS patients underwent monthly MRI scans over 1 year. VV increased dramatically during preonset EAE, resolving upon clinical remission. VV changes coincided with blood-brain barrier disruption and inflammation. VV was normal at the termination of the experiment, when mice were still symptomatic. The majority of relapsing-remitting MS (RRMS) patients showed dynamic VV fluctuations. Patients with contracting VV had lower disease severity and a shorter duration. These changes demonstrate that VV does not necessarily expand irreversibly in MS but, over short time scales, can expand and contract. Frequent monitoring of VV in patients will be essential to disentangle the disease-related processes driving short-term VV oscillations from persistent expansion resulting from atrophy. Brain ventricle volumes expand and contract during experimental autoimmune encephalomyelitis and relapsing-remitting multiple sclerosis, suggesting that short-term inflammatory processes are interlaced with gradual brain atrophy.
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Affiliation(s)
- Jason M Millward
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paula Ramos Delgado
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Alina Smorodchenko
- Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Laura Boehmert
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Joao Periquito
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Henning M Reimann
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Christian Prinz
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Antje Els
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, a joint venture of the Max Delbrück Center for Molecular Medicine and the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Jens Wuerfel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Medical Image Analysis Center (MIAC AG) and Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Carmen Infante-Duarte
- Institute for Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Chien
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joseph Kuchling
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Pohlmann
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Frauke Zipp
- Department of Neurology, University Medical Center of the Johannes Gutenberg, University of Mainz, Mainz, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, a joint venture of the Max Delbrück Center for Molecular Medicine and the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thoralf Niendorf
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.,Experimental and Clinical Research Center, a joint venture of the Max Delbrück Center for Molecular Medicine and the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sonia Waiczies
- Experimental Ultrahigh Field Magnetic Resonance, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
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Rocca MA, Preziosa P, Filippi M. What role should spinal cord MRI take in the future of multiple sclerosis surveillance? Expert Rev Neurother 2020; 20:783-797. [PMID: 32133874 DOI: 10.1080/14737175.2020.1739524] [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] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In multiple sclerosis (MS), inflammatory, demyelinating, and neurodegenerative phenomena affect the spinal cord, with detrimental effects on patients' clinical disability. Although spinal cord imaging may be challenging, improvements in MRI technologies have contributed to better evaluate spinal cord involvement in MS. AREAS COVERED This review summarizes the current state-of-art of the application of conventional and advanced MRI techniques to evaluate spinal cord damage in MS. Typical features of spinal cord lesions, their role in the diagnostic work-up of suspected MS, their predictive role for subsequent disease course and clinical worsening, and their utility to define treatment response are discussed. The role of spinal cord atrophy and of other advanced MRI techniques to better evaluate the associations between spinal cord abnormalities and the accumulation of clinical disability are also evaluated. Finally, how spinal cord assessment could evolve in the future to improve monitoring of disease progression and treatment effects is examined. EXPERT OPINION Spinal cord MRI provides relevant additional information to brain MRI in understanding MS pathophysiology, in allowing an earlier and more accurate diagnosis of MS, and in identifying MS patients at higher risk to develop more severe disability. A future role in monitoring the effects of treatments is also foreseen.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Vita-Salute San Raffaele University , Milan, Italy
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Moccia M, Ruggieri S, Ianniello A, Toosy A, Pozzilli C, Ciccarelli O. Advances in spinal cord imaging in multiple sclerosis. Ther Adv Neurol Disord 2019; 12:1756286419840593. [PMID: 31040881 PMCID: PMC6477770 DOI: 10.1177/1756286419840593] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/03/2019] [Indexed: 11/18/2022] Open
Abstract
The spinal cord is frequently affected in multiple sclerosis (MS), causing motor, sensory and autonomic dysfunction. A number of pathological abnormalities, including demyelination and neuroaxonal loss, occur in the MS spinal cord and are studied in vivo with magnetic resonance imaging (MRI). The aim of this review is to summarise and discuss recent advances in spinal cord MRI. Advances in conventional spinal cord MRI include improved identification of MS lesions, recommended spinal cord MRI protocols, enhanced recognition of MRI lesion characteristics that allow MS to be distinguished from other myelopathies, evidence for the role of spinal cord lesions in predicting prognosis and monitoring disease course, and novel post-processing methods to obtain lesion probability maps. The rate of spinal cord atrophy is greater than that of brain atrophy (-1.78% versus -0.5% per year), and reflects neuroaxonal loss in an eloquent site of the central nervous system, suggesting that it can become an important outcome measure in clinical trials, especially in progressive MS. Recent developments allow the calculation of spinal cord atrophy from brain volumetric scans and evaluation of its progression over time with registration-based techniques. Fully automated analysis methods, including segmentation of grey matter and intramedullary lesions, will facilitate the use of spinal cord atrophy in trial designs and observational studies. Advances in quantitative imaging techniques to evaluate neuroaxonal integrity, myelin content, metabolic changes, and functional connectivity, have provided new insights into the mechanisms of damage in MS. Future directions of research and the possible impact of 7T scanners on spinal cord imaging will be discussed.
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Affiliation(s)
- Marcello Moccia
- Queen Square MS Centre, NMR Research Unit, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Multiple Sclerosis Clinical Care and Research Centre, Department of Neurosciences, Federico II University of Naples, via Sergio Pansini, 5, Edificio 17 - piano terra, Napoli, 80131 Naples, Italy
| | - Serena Ruggieri
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Antonio Ianniello
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Ahmed Toosy
- Queen Square MS Centre, NMR Research Unit, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Carlo Pozzilli
- Department of Human Neuroscience, Sapienza University of Rome, Italy
| | - Olga Ciccarelli
- Queen Square MS Centre, NMR Research Unit, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
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Laule C, Moore GW. Myelin water imaging to detect demyelination and remyelination and its validation in pathology. Brain Pathol 2018; 28:750-764. [PMID: 30375119 PMCID: PMC8028667 DOI: 10.1111/bpa.12645] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 12/11/2022] Open
Abstract
Damage to myelin is a key feature of multiple sclerosis (MS) pathology. Magnetic resonance imaging (MRI) has revolutionized our ability to detect and monitor MS pathology in vivo. Proton density, T1 and T2 can provide qualitative contrast weightings that yield superb in vivo visualization of central nervous system tissue and have proved invaluable as diagnostic and patient management tools in MS. However, standard clinical MR methods are not specific to the types of tissue damage they visualize, and they cannot detect subtle abnormalities in tissue that appears otherwise normal on conventional MRIs. Myelin water imaging is an MR method that provides in vivo measurement of myelin. Histological validation work in both human brain and spinal cord tissue demonstrates a strong correlation between myelin water and staining for myelin, validating myelin water as a marker for myelin. Myelin water varies throughout the brain and spinal cord in healthy controls, and shows good intra- and inter-site reproducibility. MS plaques show variably decreased myelin water fraction, with older lesions demonstrating the greatest myelin loss. Longitudinal study of myelin water can provide insights into the dynamics of demyelination and remyelination in plaques. Normal appearing brain and spinal cord tissues show reduced myelin water, an abnormality which becomes progressively more evident over a timescale of years. Diffusely abnormal white matter, which is evident in 20%-25% of MS patients, also shows reduced myelin water both in vivo and postmortem, and appears to originate from a primary lipid abnormality with relative preservation of myelin proteins. Active research is ongoing in the quest to refine our ability to image myelin and its perturbations in MS and other disorders of the myelin sheath.
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Affiliation(s)
- Cornelia Laule
- RadiologyUniversity of British ColumbiaVancouverBCCanada
- Pathology & Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
- Physics & AstronomyUniversity of British ColumbiaVancouverBCCanada
- International Collaboration on Repair Discoveries (ICORD)University of British ColumbiaVancouverBCCanada
| | - G.R. Wayne Moore
- Pathology & Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
- International Collaboration on Repair Discoveries (ICORD)University of British ColumbiaVancouverBCCanada
- Medicine (Neurology)University of British ColumbiaVancouverBCCanada
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Suthiphosuwan S, Kim D, Bharatha A, Oh J. Imaging Markers for Monitoring Disease Activity in Multiple Sclerosis. Curr Treat Options Neurol 2017; 19:18. [DOI: 10.1007/s11940-017-0453-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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