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Ananthavarathan P, Sahi N, Chard DT. An update on the role of magnetic resonance imaging in predicting and monitoring multiple sclerosis progression. Expert Rev Neurother 2024; 24:201-216. [PMID: 38235594 DOI: 10.1080/14737175.2024.2304116] [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: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION While magnetic resonance imaging (MRI) is established in diagnosing and monitoring disease activity in multiple sclerosis (MS), its utility in predicting and monitoring disease progression is less clear. AREAS COVERED The authors consider changing concepts in the phenotypic classification of MS, including progression independent of relapses; pathological processes underpinning progression; advances in MRI measures to assess them; how well MRI features explain and predict clinical outcomes, including models that assess disease effects on neural networks, and the potential role for machine learning. EXPERT OPINION Relapsing-remitting and progressive MS have evolved from being viewed as mutually exclusive to having considerable overlap. Progression is likely the consequence of several pathological elements, each important in building more holistic prognostic models beyond conventional phenotypes. MRI is well placed to assess pathogenic processes underpinning progression, but we need to bridge the gap between MRI measures and clinical outcomes. Mapping pathological effects on specific neural networks may help and machine learning methods may be able to optimize predictive markers while identifying new, or previously overlooked, clinically relevant features. The ever-increasing ability to measure features on MRI raises the dilemma of what to measure and when, and the challenge of translating research methods into clinically useable tools.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Nitin Sahi
- Department of Neuroinflammation, University College London Queen Square Multiple Sclerosis Centre, London, UK
| | - Declan T Chard
- Clinical Research Associate & Consultant Neurologist, Institute of Neurology - Queen Square Multiple Sclerosis Centre, London, UK
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De Lury AD, Bisulca JA, Lee JS, Altaf MD, Coyle PK, Duong TQ. Magnetic resonance imaging detection of deep gray matter iron deposition in multiple sclerosis: A systematic review. J Neurol Sci 2023; 453:120816. [PMID: 37827008 DOI: 10.1016/j.jns.2023.120816] [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: 07/16/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/14/2023]
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disease involving immune-mediated damage. Iron deposition in deep gray matter (DGM) structures like the thalamus and basal ganglia have been suggested to play a role in MS pathogenesis. Magnetic Resonance Imaging (MRI) imaging methods like T2 and T2* imaging, susceptibility-weighted imaging, and quantitative susceptibility mapping can track iron deposition storage in the brain primarily from ferritin and hemosiderin (paramagnetic iron storage proteins) with varying levels of tissue contrast and sensitivity. In this systematic review, we evaluated the role of DGM iron deposition as detected by MRI techniques in relation to MS-related neuroinflammation and its potential as a novel therapeutic target. We searched through PubMed, Embase, and Web of Science databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, against predetermined inclusion and exclusion criteria. We included 89 articles (n = 6630 patients), and then grouped them into different categories: i) methodological techniques to measure DGM iron, ii) cross-sectional and group comparison of DGM iron content, iii) longitudinal comparisons of DGM iron, iv) associations between DGM iron and other imaging and neurobiological markers, v) associations with disability, and vi) associations with cognitive impairment. The review revealed that iron deposition in DGM is independent yet concurrent with demyelination, and that these iron deposits contribute to MS-related cognitive impairment and disability. Variability in iron distributions appears to rely on a positive feedback loop between inflammation, and release of iron by oligodendrocytes. DGM iron seems to be a promising prognostic biomarker for MS pathophysiology.
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Affiliation(s)
- Amy D De Lury
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Joseph A Bisulca
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Jimmy S Lee
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Muhammad D Altaf
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
| | - Patricia K Coyle
- Department of Neurology, Stony Brook University Medical Center, Stony Brook, NY, USA.
| | - Tim Q Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 East 210(th) Street, Bronx, NY, USA.
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Costa I, Barbosa DJ, Benfeito S, Silva V, Chavarria D, Borges F, Remião F, Silva R. Molecular mechanisms of ferroptosis and their involvement in brain diseases. Pharmacol Ther 2023; 244:108373. [PMID: 36894028 DOI: 10.1016/j.pharmthera.2023.108373] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Ferroptosis is a type of regulated cell death characterized by intracellular accumulation of iron and reactive oxygen species, inhibition of system Xc-, glutathione depletion, nicotinamide adenine dinucleotide phosphate oxidation and lipid peroxidation. Since its discovery and characterization in 2012, many efforts have been made to reveal the underlying mechanisms, modulating compounds, and its involvement in disease pathways. Ferroptosis inducers include erastin, sorafenib, sulfasalazine and glutamate, which, by inhibiting system Xc-, prevent the import of cysteine into the cells. RSL3, statins, Ml162 and Ml210 induce ferroptosis by inhibiting glutathione peroxidase 4 (GPX4), which is responsible for preventing the formation of lipid peroxides, and FIN56 and withaferin trigger GPX4 degradation. On the other side, ferroptosis inhibitors include ferrostatin-1, liproxstatin-1, α-tocopherol, zileuton, FSP1, CoQ10 and BH4, which interrupt the lipid peroxidation cascade. Additionally, deferoxamine, deferiprone and N-acetylcysteine, by targeting other cellular pathways, have also been classified as ferroptosis inhibitors. Increased evidence has established the involvement of ferroptosis in distinct brain diseases, including Alzheimer's, Parkinson's and Huntington's diseases, amyotrophic lateral sclerosis, multiple sclerosis, and Friedreich's ataxia. Thus, a deep understanding of how ferroptosis contributes to these diseases, and how it can be modulated, can open a new window of opportunities for novel therapeutic strategies and targets. Other studies have shown a sensitivity of cancer cells with mutated RAS to ferroptosis induction and that chemotherapeutic agents and ferroptosis inducers synergize in tumor treatment. Thus, it is tempting to consider that ferroptosis may arise as a target mechanistic pathway for the treatment of brain tumors. Therefore, this work provides an up-to-date review on the molecular and cellular mechanisms of ferroptosis and their involvement in brain diseases. In addition, information on the main ferroptosis inducers and inhibitors and their molecular targets is also provided.
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Affiliation(s)
- Inês Costa
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; UCIBIO - Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Daniel José Barbosa
- TOXRUN - Toxicology Research Unit, Department of Sciences, University Institute of Health Sciences, CESPU, CRL, 4585-116 Gandra, Portugal; Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, 4200-135 Porto, Portugal
| | - Sofia Benfeito
- CIQUP-IMS - Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, R. Campo Alegre s/n, 4169-007 Porto, Portugal.
| | - Vera Silva
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; UCIBIO - Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; CIQUP-IMS - Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, R. Campo Alegre s/n, 4169-007 Porto, Portugal
| | - Daniel Chavarria
- CIQUP-IMS - Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, R. Campo Alegre s/n, 4169-007 Porto, Portugal
| | - Fernanda Borges
- CIQUP-IMS - Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, R. Campo Alegre s/n, 4169-007 Porto, Portugal
| | - Fernando Remião
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; UCIBIO - Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Renata Silva
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal; UCIBIO - Applied Molecular Biosciences Unit, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal.
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Ferroptosis inhibition by deferiprone, attenuates myelin damage and promotes neuroprotection in demyelinated optic nerve. Sci Rep 2022; 12:19630. [PMID: 36385152 PMCID: PMC9668997 DOI: 10.1038/s41598-022-24152-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease, which leads to focal demyelination in the brain and spinal cord. Studies showed that iron released during the course of myelin breakdown exacerbates tissue damage, which is in agreement with the features of iron-dependent cell death, ferroptosis. Here, we aimed to investigate the possible contribution of ferroptosis in the demyelinated optic nerve, and to explore the effectiveness of ferroptosis inhibitor, deferiprone (DFP), on the extent of demyelination, inflammation and axonal damage. For this purpose, focal demyelination was induced by injection of lysolecithin (LPC), into the optic nerve of male C57BL/6J mice. Afterward, optic nerves were harvested at different time points from as early as 6 h up to 7 days post-LPC injection. Next, to evaluate the effectiveness of DFP two groups of animals received daily intraperitoneal injection of DFP for 3 or 7 continuous days. Vehicle groups received saline. Iron deposition was observed at different time points post-LPC injection from 6 h to 7 days post injection. Examining ferroptosis markers showed a significant reduction in glutathione content along with increased level of malondialdehyde and upregulated ferroptosis marker genes at early time points after injection. Besides, DFP treatment during the inflammatory phase of the model resulted in decreased microgliosis and inflammation. Reduced demyelination, microgliosis and astrogliosis was shown in mice that received DFP for 7 days. Moreover, DFP protected against axonal damage and retinal ganglion cells loss. Our results suggest the possible contribution of ferroptosis pathway in the process of demyelination. The therapeutic strategies targeting iron deposition, e.g. DFP treatment might thus represent a promising therapeutic target for patients with MS.
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Meng Q, Liu M, Chen Z. Voxel-Based Intraclass Correlation Coefficient to Evaluate the Inter-Scanner Reproducibility of Quantitative Susceptibility Mapping over the Deep Gray Matter Structure at 3.0T MR. Curr Med Imaging 2022; 18:924-930. [PMID: 35170418 DOI: 10.2174/1573405618666220216120729] [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: 08/20/2021] [Revised: 12/04/2021] [Accepted: 12/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Quantitative susceptibility mapping (QSM) technique can be used to quantitatively evaluate the cerebral iron deposition of the deep gray matter structure (DGM) in clinical practice. However, it could be significantly important to assess the reproducibility of the susceptibility values at different magnetic resonance (MR) scanners before the QSM technique can be widely used in clinical applications. OBJECTIVE To assess the reproducibility of susceptibility value of the deep gray matter structure (DGM) at two different MR systems with the same magnetic strength. METHODS Raw data of 21 normal subjects (M/F = 7/14, median age 29 (21, 63) years) were acquired from a 3D multi-echo enhanced gradient recalled echo sequence at two different 3.0T MR systems, and STI software was used to reconstruct the magnetic susceptibility images. Brain structural images were used to be coregistered with magnitude images to generate normalized parameters and normalized susceptibility images. Voxel-based intraclass correlation coefficient (VB-ICC) was used to evaluate the reproducibility of susceptibility value of DGM at different 3.0T MR systems. RESULTS DGM with ICC > 0.75 located in the bilateral posterior putamen and globus pallidus, bilateral red nuclei and left dental nucleus. DGM with 0.6 < ICC < 0.75 mainly located in the bilateral anterior putamen and globus pallidus, the margin of the bilateral red nuclei, right dental nucleus and the margin of the left dental nucleus. DGM with 0.4 < ICC < 0.6 located in anterior parts of the bilateral putamen, bilateral globus pallidus and substantia nigra, the margin of the bilateral dental nuclei and the inferior part of right dental nucleus. CONCLUSION DGM presented regional dependent reproducibility of susceptibility value at two different 3.0T MR system based on VB-ICC analysis.
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Affiliation(s)
- Qinglin Meng
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
| | - Mengqi Liu
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Zhiye Chen
- Department of Radiology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572013, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou China
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Cho J, Nguyen TD, Huang W, Sweeney EM, Luo X, Kovanlikaya I, Zhang S, Gillen KM, Spincemaille P, Gupta A, Gauthier SA, Wang Y. Brain oxygen extraction fraction mapping in patients with multiple sclerosis. J Cereb Blood Flow Metab 2022; 42:338-348. [PMID: 34558996 PMCID: PMC9122515 DOI: 10.1177/0271678x211048031] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We aimed to demonstrate the feasibility of whole brain oxygen extraction fraction (OEF) mapping for measuring lesion specific and regional OEF abnormalities in multiple sclerosis (MS) patients. In 22 MS patients and 11 healthy controls (HC), OEF and neural tissue susceptibility (χn) maps were computed from MRI multi-echo gradient echo data. In MS patients, 80 chronic active lesions with hyperintense rim on quantitative susceptibility mapping were identified, and the mean OEF and χn within the rim and core were compared using linear mixed-effect model analysis. The rim showed higher OEF and χn than the core: relative to their adjacent normal appearing white matter, OEF contrast = -6.6 ± 7.0% vs. -9.8 ± 7.8% (p < 0.001) and χn contrast = 33.9 ± 20.3 ppb vs. 25.7 ± 20.5 ppb (p = 0.017). Between MS and HC, OEF and χn were compared using a linear regression model in subject-based regions of interest. In the whole brain, compared to HC, MS had lower OEF, 30.4 ± 3.3% vs. 21.4 ± 4.4% (p < 0.001), and higher χn, -23.7 ± 7.0 ppb vs. -11.3 ± 7.7 ppb (p = 0.018). Our feasibility study suggests that OEF may serve as a useful quantitative marker of tissue oxygen utilization in MS.
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Affiliation(s)
- Junghun Cho
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Weiyuan Huang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth M Sweeney
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Xianfu Luo
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Shun Zhang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Kelly M Gillen
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Susan A Gauthier
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.,Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA.,Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
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Cheli VT, Santiago González DA, Wan Q, Denaroso G, Wan R, Rosenblum SL, Paez PM. H-ferritin expression in astrocytes is necessary for proper oligodendrocyte development and myelination. Glia 2021; 69:2981-2998. [PMID: 34460113 PMCID: PMC10584656 DOI: 10.1002/glia.24083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/13/2021] [Accepted: 08/21/2021] [Indexed: 12/23/2022]
Abstract
How iron is delivered to the CNS for myelination is poorly understood. Astrocytes are the most abundant glial cells in the brain and are the only cells in close contact with blood vessels. Therefore, they are strategically located to obtain nutrients, such as iron, from circulating blood. To determine the importance of astrocyte iron uptake and storage in myelination and remyelination, we conditionally knocked-out the expression of the divalent metal transporter 1 (DMT1), the transferrin receptor 1 (Tfr1), and the ferritin heavy subunit (Fth) in Glast-1-positive astrocytes. DMT1 or Tfr1 ablation in astrocytes throughout early brain development did not significantly affects oligodendrocyte maturation or iron homeostasis. However, blocking Fth production in astrocytes during the first postnatal week drastically delayed oligodendrocyte development and myelin synthesis. Fth knockout animals presented an important decrease in the number of myelinating oligodendrocytes and a substantial reduction in the percentage of myelinated axons. This postnatal hypomyelination was accompanied by a decline in oligodendrocyte iron uptake and with an increase in brain oxidative stress. We also tested the relevance of astrocytic Fth expression in the cuprizone model of myelin damage and repair. Fth deletion in Glast1-positive astrocytes significantly reduced myelin production and the density of mature myelinating oligodendrocytes throughout the complete remyelination process. These results indicate that Fth iron storage in astrocytes is vital for early oligodendrocyte development as well as for the remyelination of the CNS.
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Affiliation(s)
- Veronica T Cheli
- Institute for Myelin and Glia Exploration, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, New York, USA
| | - Diara A Santiago González
- Institute for Myelin and Glia Exploration, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, New York, USA
| | - Qiuchen Wan
- Institute for Myelin and Glia Exploration, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, New York, USA
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Ghareghani M, Ghanbari A, Eid A, Shaito A, Mohamed W, Mondello S, Zibara K. Hormones in experimental autoimmune encephalomyelitis (EAE) animal models. Transl Neurosci 2021; 12:164-189. [PMID: 34046214 PMCID: PMC8134801 DOI: 10.1515/tnsci-2020-0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/14/2021] [Indexed: 12/30/2022] Open
Abstract
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS) in which activated immune cells attack the CNS and cause inflammation and demyelination. While the etiology of MS is still largely unknown, the interaction between hormones and the immune system plays a role in disease progression, but the mechanisms by which this occurs are incompletely understood. Several in vitro and in vivo experimental, but also clinical studies, have addressed the possible role of the endocrine system in susceptibility and severity of autoimmune diseases. Although there are several demyelinating models, experimental autoimmune encephalomyelitis (EAE) is the oldest and most commonly used model for MS in laboratory animals which enables researchers to translate their findings from EAE into human. Evidences imply that there is great heterogeneity in the susceptibility to the induction, the method of induction, and the response to various immunological or pharmacological interventions, which led to conflicting results on the role of specific hormones in the EAE model. In this review, we address the role of endocrine system in EAE model to provide a comprehensive view and a better understanding of the interactions between the endocrine and the immune systems in various models of EAE, to open up a ground for further detailed studies in this field by considering and comparing the results and models used in previous studies.
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Affiliation(s)
- Majid Ghareghani
- Neuroscience Laboratory, CHU de Québec Research Center and Department of Molecular Medicine, Faculty of Medicine, Laval University, Québec City, QC, Canada
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Amir Ghanbari
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Ali Eid
- Biomedical and Pharmaceutical Research Unit and Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Abdullah Shaito
- Department of Biological and Chemical Sciences, Faculty of Arts and Sciences, Lebanese International University, Beirut, Lebanon
| | - Wael Mohamed
- Clinical Pharmacology Department, Menoufia Medical School, Menoufia University, Shibin Al Kawm, Egypt
- Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Kazem Zibara
- PRASE, Lebanese University, Beirut, Lebanon
- Biology Department, Faculty of Sciences – I, Lebanese University, Beirut, Lebanon
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Cheli VT, Correale J, Paez PM, Pasquini JM. Iron Metabolism in Oligodendrocytes and Astrocytes, Implications for Myelination and Remyelination. ASN Neuro 2020; 12:1759091420962681. [PMID: 32993319 PMCID: PMC7545512 DOI: 10.1177/1759091420962681] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Iron is a key nutrient for normal central nervous system (CNS) development and function; thus, iron deficiency as well as iron excess may result in harmful effects in the CNS. Oligodendrocytes and astrocytes are crucial players in brain iron equilibrium. However, the mechanisms of iron uptake, storage, and efflux in oligodendrocytes and astrocytes during CNS development or under pathological situations such as demyelination are not completely understood. In the CNS, iron is directly required for myelin production as a cofactor for enzymes involved in ATP, cholesterol and lipid synthesis, and oligodendrocytes are the cells with the highest iron levels in the brain which is linked to their elevated metabolic needs associated with the process of myelination. Unlike oligodendrocytes, astrocytes do not have a high metabolic requirement for iron. However, these cells are in close contact with blood vessel and have a strong iron transport capacity. In several pathological situations, changes in iron homoeostasis result in altered cellular iron distribution and accumulation and oxidative stress. In inflammatory demyelinating diseases such as multiple sclerosis, reactive astrocytes accumulate iron and upregulate iron efflux and influx molecules, which suggest that they are outfitted to take up and safely recycle iron. In this review, we will discuss the participation of oligodendrocytes and astrocytes in CNS iron homeostasis. Understanding the molecular mechanisms of iron uptake, storage, and efflux in oligodendrocytes and astrocytes is necessary for planning effective strategies for iron management during CNS development as well as for the treatment of demyelinating diseases.
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Affiliation(s)
- Veronica T Cheli
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, Hunter James Kelly Research Institute, The State University of New York, University at Buffalo, Buffalo, New York, United States
| | | | - Pablo M Paez
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences, Hunter James Kelly Research Institute, The State University of New York, University at Buffalo, Buffalo, New York, United States
| | - Juana M Pasquini
- CONICET, Instituto de Química y Fisicoquímica Biológicas, Universidad de Buenos Aires, Buenos Aires, Argentina
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Al-Radaideh A, Athamneh I, Alabadi H, Hbahbih M. Deep gray matter changes in relapsing-remitting multiple sclerosis detected by multi-parametric, high-resolution magnetic resonance imaging (MRI). Eur Radiol 2020; 31:706-715. [PMID: 32851443 DOI: 10.1007/s00330-020-07199-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/16/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate a variety of magnetic resonance imaging (MRI) quantitative metrics, which reflect different aspects of microstructural damage in deep gray matter (dGM) regions and white matter T2 lesions in patients with relapsing-remitting multiple sclerosis (RRMS), and to determine the level of pathological interconnection between these two entities as well as their association with clinical disability. METHODS We recruited thirty RRMS patients along with thirty age-matched healthy controls (HCs). Both groups were scanned at 3 T MRI using 3D high-resolution T1-, T2-, and T2*-weighted, magnetization transfer (MT)-prepared gradient echo for MT ratio (MTR) mapping, and eight repeats of T1-weighted images acquired at different inversion times to create T1 maps. dGM structures were segmented from T1-weighted images using FreeSurfer, WM-T2 lesions were extracted from T2-weighted images, and iron maps were calculated from the phase part of the T2*-weighted sequence. Extracted dGM MRI indices were compared between both groups. In the RRMS group, dGM MRI indices were correlated with those of WM-T2 lesions, expanded disability status scale, and disease duration. RESULTS dGM volumetric metrics of RRMS patients were significantly (p < 0.01) smaller than those of HCs and showed a significant moderate association with lesions' load (p < 0.05) and lesions' iron concentration (p < 0.01). dGM MTRs of RRMS patients were significantly (p < 0.01) smaller than those of HCs and showed a significant (p < 0.01) moderate correlation with lesion T1 times. While T1 changes in some dGM regions of RRMS patients associated weakly with those of T2 lesions, dGM iron concentration did not show any association with any of lesions' metrics. Furthermore, lesions' MTR changes did not show any association with any dGM metrics. Most dGM metrics did not show any correlation with disease severity. Contrarily, most lesions' metrics showed weak association with disease severity. CONCLUSIONS dGM changes occur in a non-uniform pattern and, almost, do not link directly to MS disease severity. Contrarily, most WM-T2 lesions' metrics tend to correlate with MS disease severity better than those of dGM. KEY POINTS • Deep gray matter (dGM) structures are very much involved in the MS disease process and quite substantial neurodegeneration is undergone during the relapsing-remitting phase of the MS disease. • Deep gray matter (dGM) quantitative changes occur in a non-uniform and non-linked pattern and, except for CN's iron deposition, do not directly associate with the MS disease severity. • Most white matter T2 lesions' metrics tend to correlate with MS disease severity better than those of dGM structures.
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Affiliation(s)
- Ali Al-Radaideh
- Department of Medical Imaging, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan.
| | - Imad Athamneh
- Department of Radiology, King Hussein Medical Center, Jordanian Royal Medical Services, Amman, Jordan
| | - Hadeel Alabadi
- Department of Radiology, King Hussein Medical Center, Jordanian Royal Medical Services, Amman, Jordan
| | - Majed Hbahbih
- Department of Internal Medicine, Neurology, King Hussein Medical Centre, Jordanian Royal Medical Services, Amman, Jordan
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Hnilicová P, Štrbák O, Kolisek M, Kurča E, Zeleňák K, Sivák Š, Kantorová E. Current Methods of Magnetic Resonance for Noninvasive Assessment of Molecular Aspects of Pathoetiology in Multiple Sclerosis. Int J Mol Sci 2020; 21:E6117. [PMID: 32854318 PMCID: PMC7504207 DOI: 10.3390/ijms21176117] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease with expanding axonal and neuronal degeneration in the central nervous system leading to motoric dysfunctions, psychical disability, and cognitive impairment during MS progression. The exact cascade of pathological processes (inflammation, demyelination, excitotoxicity, diffuse neuro-axonal degeneration, oxidative and metabolic stress, etc.) causing MS onset is still not fully understood, although several accompanying biomarkers are particularly suitable for the detection of early subclinical changes. Magnetic resonance (MR) methods are generally considered to be the most sensitive diagnostic tools. Their advantages include their noninvasive nature and their ability to image tissue in vivo. In particular, MR spectroscopy (proton 1H and phosphorus 31P MRS) is a powerful analytical tool for the detection and analysis of biomedically relevant metabolites, amino acids, and bioelements, and thus for providing information about neuro-axonal degradation, demyelination, reactive gliosis, mitochondrial and neurotransmitter failure, cellular energetic and membrane alternation, and the imbalance of magnesium homeostasis in specific tissues. Furthermore, the MR relaxometry-based detection of accumulated biogenic iron in the brain tissue is useful in disease evaluation. The early description and understanding of the developing pathological process might be critical for establishing clinically effective MS-modifying therapies.
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Affiliation(s)
- Petra Hnilicová
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Oliver Štrbák
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Martin Kolisek
- Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (O.Š.); (M.K.)
| | - Egon Kurča
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia;
| | - Štefan Sivák
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
| | - Ema Kantorová
- Clinic of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia; (E.K.); (Š.S.); (E.K.)
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Valcarcel AM, Muschelli J, Pham DL, Martin ML, Yushkevich P, Brandstadter R, Patterson KR, Schindler MK, Calabresi PA, Bakshi R, Shinohara RT. TAPAS: A Thresholding Approach for Probability Map Automatic Segmentation in Multiple Sclerosis. Neuroimage Clin 2020; 27:102256. [PMID: 32428847 PMCID: PMC7236059 DOI: 10.1016/j.nicl.2020.102256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/15/2022]
Abstract
Total brain white matter lesion (WML) volume is the most widely established magnetic resonance imaging (MRI) outcome measure in studies of multiple sclerosis (MS). To estimate WML volume, there are a number of automatic segmentation methods available, yet manual delineation remains the gold standard approach. Automatic approaches often yield a probability map to which a threshold is applied to create lesion segmentation masks. Unfortunately, few approaches systematically determine the threshold employed; many methods use a manually selected threshold, thus introducing human error and bias into the automated procedure. In this study, we propose and validate an automatic thresholding algorithm, Thresholding Approach for Probability Map Automatic Segmentation in Multiple Sclerosis (TAPAS), to obtain subject-specific threshold estimates for probability map automatic segmentation of T2-weighted (T2) hyperintense WMLs. Using multimodal MRI, the proposed method applies an automatic segmentation algorithm to obtain probability maps. We obtain the true subject-specific threshold that maximizes the Sørensen-Dice similarity coefficient (DSC). Then the subject-specific thresholds are modeled on a naive estimate of volume using a generalized additive model. Applying this model, we predict a subject-specific threshold in data not used for training. We ran a Monte Carlo-resampled split-sample cross-validation (100 validation sets) using two data sets: the first obtained from the Johns Hopkins Hospital (JHH) on a Philips 3 Tesla (3T) scanner (n = 94) and a second collected at the Brigham and Women's Hospital (BWH) using a Siemens 3T scanner (n = 40). By means of the proposed automated technique, in the JHH data we found an average reduction in subject-level absolute error of 0.1 mL per one mL increase in manual volume. Using Bland-Altman analysis, we found that volumetric bias associated with group-level thresholding was mitigated when applying TAPAS. The BWH data showed similar absolute error estimates using group-level thresholding or TAPAS likely since Bland-Altman analyses indicated no systematic biases associated with group or TAPAS volume estimates. The current study presents the first validated fully automated method for subject-specific threshold prediction to segment brain lesions.
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Affiliation(s)
- Alessandra M Valcarcel
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - John Muschelli
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Dzung L Pham
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20892, United States
| | - Melissa Lynne Martin
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Paul Yushkevich
- Penn Image Computing and Science Laboratory (PICSL), Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Rachel Brandstadter
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Kristina R Patterson
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Matthew K Schindler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Peter A Calabresi
- Department of Neurology, School of Medicine Johns Hopkins University, Baltimore, MD 21287, United States
| | - Rohit Bakshi
- Department of Neurology, Brigham Women's Hospital, Harvard Medical School, Boston, MA 02115, United States; Department of Radiology, Brigham Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States; Center for Biomedical Image Computing and Analytics (CBICA), Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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Cortical hypointensity in T2-weighted gradient-echo sequences in patients with progressive multifocal leukoencephalopathy. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Singhal T, O'Connor K, Dubey S, Pan H, Chu R, Hurwitz S, Cicero S, Tauhid S, Silbersweig D, Stern E, Kijewski M, DiCarli M, Weiner HL, Bakshi R. Gray matter microglial activation in relapsing vs progressive MS: A [F-18]PBR06-PET study. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e587. [PMID: 31355321 PMCID: PMC6624145 DOI: 10.1212/nxi.0000000000000587] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/15/2019] [Indexed: 11/15/2022]
Abstract
Objective To determine the value of [F-18]PBR06-PET for assessment of microglial activation in the cerebral gray matter in patients with MS. Methods Twelve patients with MS (7 relapsing-remitting and 5 secondary progressive [SP]) and 5 healthy controls (HCs) had standardized uptake value (SUV) PET maps coregistered to 3T MRI and segmented into cortical and subcortical gray matter regions. SUV ratios (SUVRs) were global brain normalized. Voxel-by-voxel analysis was performed using statistical parametric mapping (SPM). Normalized brain parenchymal volumes (BPVs) were determined from MRI using SIENAX. Results Cortical SUVRs were higher in the hippocampus, amygdala, midcingulate, posterior cingulate, and rolandic operculum and lower in the medial-superior frontal gyrus and cuneus in the MS vs HC group (all p < 0.05). Subcortical gray matter SUVR was higher in SPMS vs RRMS (+10.8%, p = 0.002) and HC (+11.3%, p = 0.055) groups. In the MS group, subcortical gray matter SUVR correlated with the Expanded Disability Status Scale (EDSS) score (r = 0.75, p = 0.005) and timed 25-foot walk (T25FW) (r = 0.70, p = 0.01). Thalamic SUVRs increased with increasing EDSS scores (r = 0.83, p = 0.0008) and T25FW (r = 0.65, p = 0.02) and with decreasing BPV (r = -0.63, p = 0.03). Putaminal SUVRs increased with increasing EDSS scores (0.71, p = 0.009) and with decreasing BPV (r = -0.67, p = 0.01). On SPM analysis, peak correlations of thalamic voxels with BPV were seen in the pulvinar and with the EDSS score and T25FW in the dorsomedial thalamic nuclei. Conclusions This study suggests that [F-18]PBR06-PET detects widespread abnormal microglial activation in the cerebral gray matter in MS. Increased translocator protein binding in subcortical gray matter regions is associated with brain atrophy and may link to progressive MS.
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Affiliation(s)
- Tarun Singhal
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Kelsey O'Connor
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shipra Dubey
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hong Pan
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Renxin Chu
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shelley Hurwitz
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Steven Cicero
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shahamat Tauhid
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David Silbersweig
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Stern
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marie Kijewski
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marcelo DiCarli
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Howard L Weiner
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rohit Bakshi
- Partners MS Center (T.S., K.O.C., R.C., S.C., S.T., H.L.W., R.B.), Laboratory for Neuroimaging Research, Ann Romney Center for Neurological Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (S.D., M.K., M.D.), Department of Radiology, Brigham and Women's Hospital, Harvard Medical School; Functional Neuroimaging Laboratory (H.P., D.S., E.S.), Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School; Department of Medicine (S.H.) and Department of Radiology (E.S., R.B.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Karussis D, Petrou P. Immune reconstitution therapy (IRT) in multiple sclerosis: the rationale. Immunol Res 2019; 66:642-648. [PMID: 30443887 DOI: 10.1007/s12026-018-9032-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunotherapy of multiple sclerosis (MS) and other neuroimmune diseases is rapidly evolving. For the past 25 years, there has been an accelerating inclusion of new immunomodulating drugs. Based on their molecular construction and their basic mechanism of action, immunotherapeutic agents belong to the following categories: (1) cytotoxic drugs, (2) synthetic immunomodulators, (3) monoclonal antibodies, (4) vaccines (T cell vaccines, antigen vaccines), (5) oral tolerizing agents, (6) modalities that act as indirect immunosuppressants (plasmapheresis, intravenous immunoglobulins [IVIG]), and (7) cellular therapies. MS immunotherapies may also be classified in a different way, into treatments that are given continuously (chronic treatments) and medications that are applied intermittently (IRTs). The principle behind the latter is depletion of the immune system that allows it to rebuild itself. Upon its reconstitution/resetting, the immune system regains the ability to respond to infections and survey the periphery for cancer. An IRT by definition is given at short intermittent courses and not continuously. IRT modalities were shown to induce long-term remission of MS that, in some cases, is close to the definition of a "cure." There are cohorts of patients having been treated with the IRTs, alemtuzumab, and HSCT, who experience-under these modalities-no evidence of disease activity (NEDA) for over 10 years. Most importantly, IRTs cause radical changes in the lymphocyte repertoire after the reconstitution phase that may explain the long-term beneficial effects of IRT and the possibility of re-induction of self-tolerance to self/myelin antigens. In comparison, a chronic treatment cannot result in cure of the autoimmune reactivity, because it only blocks the immune system, as long as it is given; it cannot therefore radically affect the immunopathogenesis of the disease. The risks of adverse events related to immune suppression (such as opportunistic infections and secondary malignancies) with IRTs are lower and front-loaded, whereas the common side effects of chronic immunomodulation are higher and accumulate with time. In conclusion, IRT provides a novel concept for MS therapy with substantial advantages over chronic immunosuppression. IRT therapies have shown a significantly higher level of efficacy in MS. The "Holy grail" of the treatment of autoimmunity, which is to re-induce the disrupted self-tolerance, seems to be achievable-at least in part-with this approach. Moreover, the benefits of IRT, administered in short pulses, include significantly higher adherence to treatment and lower risks for accumulative side effects that are typically associated with chronic immunosuppression.
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Affiliation(s)
- Dimitrios Karussis
- MS Center and Unit of Neuroimmunology, Department of Neurology, Hadassah Medical Center, Jerusalem, Israel.
| | - Panayiota Petrou
- MS Center and Unit of Neuroimmunology, Department of Neurology, Hadassah Medical Center, Jerusalem, Israel
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López Sala P, Alberdi Aldasoro N, Zelaya Huerta MV, Bacaicoa Saralegui MC, Cabada Giadás T. Cortical hypointensity in T2-weighted gradient-echo sequences in patients with progressive multifocal leukoencephalopathy. RADIOLOGIA 2019; 62:59-66. [PMID: 31375267 DOI: 10.1016/j.rx.2019.06.003] [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: 12/10/2018] [Revised: 05/06/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy is a demyelinating disease of the central nervous system caused by the reactivation of the JC virus. This opportunistic encephalopathy mainly affects immunodepressed patients with stage III HIV infection, although in recent years it has also been found in association with treatment with immunosuppressors such as natalizumab. MRI plays an important role in both the early diagnosis and follow-up of this disease. Recently, it has been reported that hypointensities in U-fibers and cortex adjacent to white-matter lesions characteristic of the disease can be identified on T2-weighted gradient-echo and susceptibility-weighted sequences in patients with progressive multifocal leukoencephalopathy. OBJECTIVE We aimed to analyze the presence and usefulness of cortical hypointensity on T2-weighted gradient-echo sequences in relation to the diagnosis of progressive multifocal leukoencephalopathy and to review the literature on the topic. MATERIAL AND METHODS We analyze three cases of progressive multifocal leukoencephalopathy seen at our center in three patients with immunosuppression of different origins: one with stage III HIV infection, one with multiple sclerosis being treated with natalizumab, and one with rheumatoid arthritis being treated with rituximab. RESULTS In all three cases MRI showed the cortical hypointensity adjacent to the white-matter lesion in the T2-weighted gradient-echo sequence. In the patient with multiple sclerosis, this sign appeared earlier than the abnormal signal in the white matter. The patient being treated with rituximab was diagnosed postmortem and the pathology findings correlated with the MRI findings. CONCLUSION The finding of cortical hypointensity on T2-weighted gradient-echo MRI sequences seems to support the diagnosis of progressive multifocal leukoencephalopathy, regardless of the type of immunosuppression, so this finding should routinely assessed in patients suspected of having this disease.
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Affiliation(s)
- P López Sala
- Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
| | - N Alberdi Aldasoro
- Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M V Zelaya Huerta
- Servicio de Anatomía Patológica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - M C Bacaicoa Saralegui
- Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - T Cabada Giadás
- Servicio de Radiodiagnóstico, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Five year iron changes in relapsing-remitting multiple sclerosis deep gray matter compared to healthy controls. Mult Scler Relat Disord 2019; 33:107-115. [DOI: 10.1016/j.msard.2019.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 12/11/2022]
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Hernández‐Torres E, Wiggermann V, Machan L, Sadovnick AD, Li DK, Traboulsee A, Hametner S, Rauscher A. Increased mean R2* in the deep gray matter of multiple sclerosis patients: Have we been measuring atrophy? J Magn Reson Imaging 2018; 50:201-208. [DOI: 10.1002/jmri.26561] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/13/2018] [Accepted: 10/16/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Enedino Hernández‐Torres
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
| | - Vanessa Wiggermann
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
- Department of Physics and AstronomyUniversity of British Columbia Vancouver Canada
| | - Lindsay Machan
- Department of RadiologyUniversity of British Columbia Vancouver Canada
| | - A. Dessa Sadovnick
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
- Centre for Brain HealthUniversity of British Columbia Vancouver Canada
- Department of Medical GeneticsUniversity of British Columbia Vancouver Canada
| | - David K.B. Li
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology)University of British Columbia Vancouver Canada
- Centre for Brain HealthUniversity of British Columbia Vancouver Canada
| | - Simon Hametner
- Department of Neuroimmunology, Center for Brain ResearchMedical University of Vienna Vienna Austria
- Institute of NeuropathologyUniversity Medical Center Göttingen Germany
| | - Alexander Rauscher
- UBC MRI Research CentreUniversity of British Columbia Vancouver Canada
- Department of PediatricsUniversity of British Columbia Vancouver Canada
- Department of Physics and AstronomyUniversity of British Columbia Vancouver Canada
- Department of RadiologyUniversity of British Columbia Vancouver Canada
- BC Children's Hospital Research InstituteUniversity of British Columbia Vancouver Canada
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Whole brain and deep gray matter atrophy detection over 5 years with 3T MRI in multiple sclerosis using a variety of automated segmentation pipelines. PLoS One 2018; 13:e0206939. [PMID: 30408094 PMCID: PMC6224096 DOI: 10.1371/journal.pone.0206939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 10/21/2018] [Indexed: 11/23/2022] Open
Abstract
Background Cerebral atrophy is common in multiple sclerosis (MS) and selectively involves gray matter (GM). Several fully automated methods are available to measure whole brain and regional deep GM (DGM) atrophy from MRI. Objective To assess the sensitivity of fully automated MRI segmentation pipelines in detecting brain atrophy in patients with relapsing-remitting (RR) MS and normal controls (NC) over five years. Methods Consistent 3D T1-weighted sequences were performed on a 3T GE unit in 16 mildly disabled patients with RRMS and 16 age-matched NC at baseline and five years. All patients received disease-modifying immunotherapy on-study. Images were applied to two pipelines to assess whole brain atrophy [brain parenchymal fraction (BPF) from SPM12; percentage brain volume change (PBVC) from SIENA] and two other pipelines (FSL-FIRST; FreeSurfer) to assess DGM atrophy (thalamus, caudate, globus pallidus, putamen). MRI change was compared by two sample t-tests. Expanded Disability Status Scale (EDSS) and timed 25-foot walk (T25FW) change was compared by repeated measures proportional odds models. Results Using FreeSurfer, the MS group had a ~10-fold acceleration in on-study volume loss than NC in the caudate (mean decrease 0.51 vs. 0.05 ml, p = 0.022). In contrast, caudate atrophy was not detected by FSL-FIRST (mean decrease 0.21 vs. 0.12 ml, p = 0.53). None of the other pipelines showed any difference in volume loss between groups, for whole brain or regional DGM atrophy (all p>0.38). The MS group showed on-study stability on EDSS (p = 0.47) but slight worsening of T25FW (p = 0.054). Conclusions In this real-world cohort of mildly disabled treated patients with RRMS, we identified ongoing atrophy of the caudate nucleus over five years, despite the lack of any significant whole brain atrophy, compared to healthy controls. The detectability of caudate atrophy was dependent on the MRI segmentation pipeline employed. These findings underscore the increased sensitivity gained when assessing DGM atrophy in monitoring MS.
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20
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Belova AN, Solovieva VS, Boyko AN. [Anemia and dysregulation of iron metabolism in multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:10-17. [PMID: 30160662 DOI: 10.17116/jnevro201811808210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anemia is one of the common diseases comorbid with multiple sclerosis (MS). This article reviews the prevalence and types of anemia in MS patients. It has been shown that anemia is often accompanied by a decrease in serum iron level. The authors present the data on iron metabolism in patients with MS and MRI findings concerning deposits of iron in the gray matter of the brain. The causal relationship between abnormalities in iron metabolism and MS remains unclear; this study allows to approach the understanding of the MS pathogenesis and to increase the efficacy of therapy for this disease.
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Affiliation(s)
- A N Belova
- Privolzskyi Federal Medical Research Center, Nizhny Novgorod, Russia
| | - V S Solovieva
- City Clinical Hospital #3, Regional Center fo Multiple Sclerosis, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia; Center for Demyelination Diseases 'Neuroclinic', Moscow, Russia
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21
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Increased glutamate and deep brain atrophy can predict the severity of multiple sclerosis. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 163:45-53. [PMID: 30150790 DOI: 10.5507/bp.2018.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE In multiple sclerosis (MS), deep grey matter (DGM) atrophy has been recognised as a crucial component of the disease that presents early and it has been associated with disability. Although the precise mechanism underlying grey matter atrophy is unknown, several hypotheses have been postulated. Our previous research pointed to correlations of hypothalamic metabolic alterations with clinical outcomes of MS, therefore we decided to further test the relationship of these alterations with DGM atrophy. METHODS We used 1H-Magnetic Resonance spectroscopy (1H-MRS) of the hypothalamus to test its metabolites in 26 patients with RRMS and 22 healthy age-matched controls. DGM atrophy was evaluated by simple planimetry of third ventricular width on the hypothalamic level (3VW) in T1 weighted MRI pictures. Metabolite ratios of N-acetyl aspartate (NAA), choline (Cho), glutamate and glutamine (Glx), myo-inositol (mIns) and creatine (Cr) were correlated with Multiple Sclerosis Severity Scale (MSSS) and 3VW. RESULTS Metabolite concentrations were compared between patients and controls using multiple regression models allowing for age, 3VW and metabolites. It revealed that the only relevant predictors of MSSS were 3VW and Glx/NAA. At a significance level of P<0.05, a unit increase of 3VW was associated with a 0.35 increase of MSSS, for a typical value of Glx/NAA; P value 0.0039. A unit increase of Glx/NAA was associated with a 0.93 increase of MSSS, for a typical value of atrophy; P value 0.090. There were significant linear correlations between Glx/Cr and MSSS, Glx/NAA and MSSS, and between mIns/NAA and 3VW. CONCLUSIONS The results suggest that both NAA and Glx are associated with neurodegeneration of hypothalamic DGM and severe disease course. Glx related 1H-MRS parameters seem to be superior to other metabolites in determining disease burden, independently of otherwise powerful 3VW planimetry. Significantly increased mIns/NAA in MS patients compared to controls point to gliosis, which parallels the atrophy of hypothalamic DGM.
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22
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Abstract
Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis, longitudinal monitoring, evaluation of therapeutic response, and scientific investigations in multiple sclerosis (MS). The clinical usage of MRI has increased in parallel with technical innovations in the technique itself; the widespread adoption of clinically routine MRI at 1.5T has allowed sensitive qualitative and quantitative assessments of macroscopic central nervous system (CNS) inflammatory demyelinating lesions and tissue atrophy. However, conventional MRI lesion measures lack specificity for the underlying MS pathology and only weakly correlate with clinical status. Higher field strength units and newer, advanced MRI techniques offer increased sensitivity and specificity in the detection of disease activity and disease severity. This review summarizes the current status and future prospects regarding the role of MRI in the characterization of MS-related brain and spinal cord involvement.
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Affiliation(s)
- Christopher C Hemond
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Partners Multiple Sclerosis Center, Ann Romney Center for Neurologic Diseases, Departments of Neurology and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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23
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Abstract
PURPOSE 2D turbo-spin-echo (TSE) is widely used in the clinic for neuroimaging. However, the long refocusing radiofrequency pulse train leads to high specific absorption rate (SAR) and alters the contrast compared to conventional spin-echo. The purpose of this work is to develop a robust 2D spiral TSE technique for fast T2 -weighted imaging with low SAR and improved contrast. METHODS A spiral-in/out readout is incorporated into 2D TSE to fully take advantage of the acquisition efficiency of spiral sampling while avoiding potential off-resonance-related artifacts compared to a typical spiral-out readout. A double encoding strategy and a signal demodulation method are proposed to mitigate the artifacts because of the T2 -decay-induced signal variation. An adapted prescan phase correction as well as a concomitant phase compensation technique are implemented to minimize the phase errors. RESULTS Phantom data demonstrate the efficacy of the proposed double encoding/signal demodulation, as well as the prescan phase correction and concomitant phase compensation. Volunteer data show that the proposed 2D spiral TSE achieves fast scan speed with high SNR, low SAR, and improved contrast compared to conventional Cartesian TSE. CONCLUSION A robust 2D spiral TSE technique is feasible and provides a potential alternative to conventional 2D Cartesian TSE for T2 -weighted neuroimaging.
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Affiliation(s)
- Zhiqiang Li
- Imaging Research, Barrow Neurological Institute, Phoenix, Arizona
| | - John P Karis
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona
| | - James G Pipe
- Imaging Research, Barrow Neurological Institute, Phoenix, Arizona
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Gillen KM, Mubarak M, Nguyen TD, Pitt D. Significance and In Vivo Detection of Iron-Laden Microglia in White Matter Multiple Sclerosis Lesions. Front Immunol 2018. [PMID: 29515576 PMCID: PMC5826076 DOI: 10.3389/fimmu.2018.00255] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Microglia are resident immune cells that fulfill protective and homeostatic functions in the central nervous system (CNS) but may also promote neurotoxicity in the aged brain and in chronic disease. In multiple sclerosis (MS), an autoimmune demyelinating disease of the CNS, microglia and macrophages contribute to the development of white matter lesions through myelin phagocytosis, and possibly to disease progression through diffuse activation throughout myelinated white matter. In this review, we discuss an additional compartment of myeloid cell activation in MS, i.e., the rim and normal adjacent white matter of chronic active lesions. In chronic active lesions, microglia and macrophages may contain high amounts of iron, express markers of proinflammatory polarization, are activated for an extended period of time (years), and drive chronic tissue damage. Iron-positive myeloid cells can be visualized and quantified with quantitative susceptibility mapping (QSM), a magnetic resonance imaging technique. Thus, QSM has potential as an in vivo biomarker for chronic inflammatory activity in established white matter MS lesions. Reducing chronic inflammation associated with iron accumulation using existing or novel MS therapies may impact disease severity and progression.
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Affiliation(s)
- Kelly M Gillen
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Mayyan Mubarak
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - David Pitt
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
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25
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Yarnykh VL, Krutenkova EP, Aitmagambetova G, Repovic P, Mayadev A, Qian P, Jung Henson LK, Gangadharan B, Bowen JD. Iron-Insensitive Quantitative Assessment of Subcortical Gray Matter Demyelination in Multiple Sclerosis Using the Macromolecular Proton Fraction. AJNR Am J Neuroradiol 2018; 39:618-625. [PMID: 29439122 DOI: 10.3174/ajnr.a5542] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Fast macromolecular proton fraction mapping is a recent quantitative MR imaging method for myelin assessment. The objectives of this study were to evaluate the macromolecular proton fraction as a measure of demyelination in subcortical GM structures in multiple sclerosis and assess a potential relationship between demyelination and excess iron deposition using the macromolecular proton fraction and T2* mapping. MATERIALS AND METHODS Macromolecular proton fraction and T2* maps were obtained from 12 healthy controls, 18 patients with relapsing-remitting MS, and 12 patients with secondary-progressive MS using 3T MR imaging. Parameter values in the caudate nucleus, globus pallidus, putamen, substantia nigra, and thalamus were compared between groups and correlated to clinical data. RESULTS The macromolecular proton fraction in all subcortical structures and T2* in the globus pallidus, putamen, and caudate nucleus demonstrated a significant monotonic decrease from controls to patients with relapsing-remitting MS and from those with relapsing-remitting MS to patients with secondary-progressive MS. The macromolecular proton fraction in all subcortical structures significantly correlated with the Expanded Disability Status Scale and MS Functional Composite scores with absolute Pearson correlation coefficient (r) values in a range of 0.4-0.6. Significant correlations (r = -0.4 to -0.6) were also identified between the macromolecular proton fraction and the 9-Hole Peg Test, indicating a potential relationship with nigrostriatal pathway damage. Among T2* values, weak significant correlations with clinical variables were found only in the putamen. The macromolecular proton fraction did not correlate with T2* in any of the studied anatomic structures. CONCLUSIONS The macromolecular proton fraction provides an iron-insensitive measure of demyelination. Myelin loss in subcortical GM structures in MS is unrelated to excess iron deposition. Subcortical GM demyelination is more closely associated with the disease phenotype and disability than iron overload.
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Affiliation(s)
- V L Yarnykh
- From the Department of Radiology (V.L.Y.), University of Washington, Seattle, Washington .,Research Institute of Biology and Biophysics (E.P.K., G.A., V.L.Y.), Tomsk State University, Tomsk, Russian Federation
| | - E P Krutenkova
- Research Institute of Biology and Biophysics (E.P.K., G.A., V.L.Y.), Tomsk State University, Tomsk, Russian Federation
| | - G Aitmagambetova
- Research Institute of Biology and Biophysics (E.P.K., G.A., V.L.Y.), Tomsk State University, Tomsk, Russian Federation
| | - P Repovic
- Multiple Sclerosis Center (P.R., A.M., P.Q., L.K.J.H., B.G., J.D.B.), Swedish Neuroscience Institute, Seattle, Washington
| | - A Mayadev
- Multiple Sclerosis Center (P.R., A.M., P.Q., L.K.J.H., B.G., J.D.B.), Swedish Neuroscience Institute, Seattle, Washington
| | - P Qian
- Multiple Sclerosis Center (P.R., A.M., P.Q., L.K.J.H., B.G., J.D.B.), Swedish Neuroscience Institute, Seattle, Washington
| | - L K Jung Henson
- Multiple Sclerosis Center (P.R., A.M., P.Q., L.K.J.H., B.G., J.D.B.), Swedish Neuroscience Institute, Seattle, Washington.,Piedmont Henry Hospital (L.K.J.H.), Stockbridge, Georgia
| | - B Gangadharan
- Multiple Sclerosis Center (P.R., A.M., P.Q., L.K.J.H., B.G., J.D.B.), Swedish Neuroscience Institute, Seattle, Washington
| | - J D Bowen
- Multiple Sclerosis Center (P.R., A.M., P.Q., L.K.J.H., B.G., J.D.B.), Swedish Neuroscience Institute, Seattle, Washington
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26
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Chu R, Hurwitz S, Tauhid S, Bakshi R. Automated segmentation of cerebral deep gray matter from MRI scans: effect of field strength on sensitivity and reliability. BMC Neurol 2017; 17:172. [PMID: 28874119 PMCID: PMC5584325 DOI: 10.1186/s12883-017-0949-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 08/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background The cerebral subcortical deep gray matter nuclei (DGM) are a common, early, and clinically-relevant site of atrophy in multiple sclerosis (MS). Robust and reliable DGM segmentation could prove useful to evaluate putative neuroprotective MS therapies. The objective of the study was to compare the sensitivity and reliability of DGM volumes obtained from 1.5T vs. 3T MRI. Methods Fourteen patients with MS [age (mean, range) 50.2 (32.0–60.8) years, disease duration 18.4 (8.2–35.5) years, Expanded Disability Status Scale score 3.1 (0–6), median 3.0] and 15 normal controls (NC) underwent brain 3D T1-weighted paired scan-rescans at 1.5T and 3T. DGM (caudate, thalamus, globus pallidus, and putamen) segmentation was obtained by the fully automated FSL-FIRST pipeline. Both raw and normalized volumes were derived. Results DGM volumes were generally higher at 3T vs. 1.5T in both groups. For raw volumes, 3T showed slightly better sensitivity (thalamus: p = 0.02; caudate: p = 0.10; putamen: p = 0.02; globus pallidus: p = 0.0004; total DGM: p = 0.01) than 1.5T (thalamus: p = 0.05; caudate: p = 0.09; putamen: p = 0.03; globus pallidus: p = 0.0006; total DGM: p = 0.02) for detecting DGM atrophy in MS vs. NC. For normalized volumes, 3T but not 1.5T detected atrophy in the globus pallidus in the MS group. Across all subjects, scan-rescan reliability was generally very high for both platforms, showing slightly higher reliability for some DGM volumes at 3T. Raw volumes showed higher reliability than normalized volumes. Raw DGM volume showed higher reliability than the individual structures. Conclusions These results suggest somewhat higher sensitivity and reliability of DGM volumes obtained from 3T vs. 1.5T MRI. Further studies should assess the role of this 3T pipeline in tracking potential MS neurotherapeutic effects.
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Affiliation(s)
- Renxin Chu
- Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Mailbox 9002L, Boston, MA, 02115, USA.,Departments of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shelley Hurwitz
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Mailbox 9002L, Boston, MA, 02115, USA.,Departments of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rohit Bakshi
- Laboratory for Neuroimaging Research, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Rd, Mailbox 9002L, Boston, MA, 02115, USA. .,Departments of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Partners MS Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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27
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Rocca MA, Comi G, Filippi M. The Role of T1-Weighted Derived Measures of Neurodegeneration for Assessing Disability Progression in Multiple Sclerosis. Front Neurol 2017; 8:433. [PMID: 28928705 PMCID: PMC5591328 DOI: 10.3389/fneur.2017.00433] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 12/26/2022] Open
Abstract
Introduction Multiple sclerosis (MS) is characterised by the accumulation of permanent neurological disability secondary to irreversible tissue loss (neurodegeneration) in the brain and spinal cord. MRI measures derived from T1-weighted image analysis (i.e., black holes and atrophy) are correlated with pathological measures of irreversible tissue loss. Quantifying the degree of neurodegeneration in vivo using MRI may offer a surrogate marker with which to predict disability progression and the effect of treatment. This review evaluates the literature examining the association between MRI measures of neurodegeneration derived from T1-weighted images and disability in MS patients. Methods A systematic PubMed search was conducted in January 2017 to identify MRI studies in MS patients investigating the relationship between “black holes” and/or atrophy in the brain and spinal cord, and disability. Results were limited to human studies published in English in the previous 10 years. Results A large number of studies have evaluated the association between the previous MRI measures and disability. These vary considerably in terms of study design, duration of follow-up, size, and phenotype of the patient population. Most, although not all, have shown that there is a significant correlation between disability and black holes in the brain, as well as atrophy of the whole brain and grey matter. The results for brain white matter atrophy are less consistently positive, whereas studies evaluating spinal cord atrophy consistently showed a significant correlation with disability. Newer ways of measuring atrophy, thanks to the development of segmentation and voxel-wise methods, have allowed us to assess the involvement of strategic regions of the CNS (e.g., thalamus) and to map the regional distribution of damage. This has resulted in better correlations between MRI measures and disability and in the identification of the critical role played by some CNS structures for MS clinical manifestations. Conclusion The evaluation of MRI measures of atrophy as predictive markers of disability in MS is a highly active area of research. At present, measurement of atrophy remains within the realm of clinical studies, but its utility in clinical practice has been recognized and barriers to its implementation are starting to be addressed.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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28
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Abdelhak A, Weber MS, Tumani H. Primary Progressive Multiple Sclerosis: Putting Together the Puzzle. Front Neurol 2017; 8:234. [PMID: 28620346 PMCID: PMC5449443 DOI: 10.3389/fneur.2017.00234] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/12/2017] [Indexed: 12/23/2022] Open
Abstract
The focus of multiple sclerosis research has recently turned to the relatively rare and clearly more challenging condition of primary progressive multiple sclerosis (PPMS). Many risk factors such as genetic susceptibility, age, and Epstein–Barr virus (EBV) infection may interdepend on various levels, causing a complex pathophysiological cascade. Variable pathological mechanisms drive disease progression, including inflammation-associated axonal loss, continuous activation of central nervous system resident cells, such as astrocytes and microglia as well as mitochondrial dysfunction and iron accumulation. Histological studies revealed diffuse infiltration of the gray and white matter as well as of the meninges with inflammatory cells such as B-, T-, natural killer, and plasma cells. While numerous anti-inflammatory agents effective in relapsing remitting multiple sclerosis basically failed in treatment of PPMS, the B-cell-depleting monoclonal antibody ocrelizumab recently broke the dogma that PPMS cannot be treated by an anti-inflammatory approach by demonstrating efficacy in a phase 3 PPMS trial. Other treatments aiming at enhancing remyelination (MD1003) as well as EBV-directed treatment strategies may be promising agents on the horizon. In this article, we aim to summarize new advances in the understanding of risk factors, pathophysiology, and treatment of PPMS. Moreover, we introduce a novel concept to understand the nature of the disease and possible treatment strategies in the near future.
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Affiliation(s)
| | - Martin S Weber
- Department of Neuropathology, University Medical Center, Georg August University, Göttingen, Germany.,Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University, Ulm, Germany.,Specialty Clinic of Neurology Dietenbronn, Schwendi, Germany
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29
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Uddin MN, McPhee KC, Blevins G, Wilman AH. Recovery of accurate T 2 from historical 1.5 tesla proton density and T 2 -weighted images: Application to 7-year T 2 changes in multiple sclerosis brain. Magn Reson Imaging 2017; 37:21-26. [DOI: 10.1016/j.mri.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 01/12/2023]
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Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) characterized by loss of motor and sensory function that results from immune-mediated inflammation, demyelination, and subsequent axonal damage. Clinically, most MS patients experience recurrent episodes (relapses) of neurological impairment, but in most cases (60–80%) the course of the disease eventually becomes chronic and progressive, leading to cumulative motor, sensory, and visual disability, and cognitive deficits. The course of the disease is largely unpredictable and its clinical presentation is variable, but its predilection for certain parts of the CNS, which includes the optic nerves, the brain stem, cerebellum, and cervical spinal cord, provides a characteristic constellation of signs and symptoms. Several variants of MS have been nowadays defined with variable immunopathogenesis, course and prognosis. Many new treatments targeting the immune system have shown efficacy in preventing the relapses of MS and have been introduced to its management during the last decade.
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31
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Lewin A, Hamilton S, Witkover A, Langford P, Nicholas R, Chataway J, Bangham CR. Free serum haemoglobin is associated with brain atrophy in secondary progressive multiple sclerosis. Wellcome Open Res 2016; 1:10. [PMID: 27996064 PMCID: PMC5159626 DOI: 10.12688/wellcomeopenres.9967.2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background A major cause of disability in secondary progressive multiple sclerosis (SPMS) is progressive brain atrophy, whose pathogenesis is not fully understood. The objective of this study was to identify protein biomarkers of brain atrophy in SPMS. Methods We used surface-enhanced laser desorption-ionization time-of-flight mass spectrometry to carry out an unbiased search for serum proteins whose concentration correlated with the rate of brain atrophy, measured by serial MRI scans over a 2-year period in a well-characterized cohort of 140 patients with SPMS. Protein species were identified by liquid chromatography-electrospray ionization tandem mass spectrometry. Results There was a significant (p<0.004) correlation between the rate of brain atrophy and a rise in the concentration of proteins at 15.1 kDa and 15.9 kDa in the serum. Tandem mass spectrometry identified these proteins as alpha-haemoglobin and beta-haemoglobin, respectively. The abnormal concentration of free serum haemoglobin was confirmed by ELISA (p<0.001). The serum lactate dehydrogenase activity was also highly significantly raised (p<10-12) in patients with secondary progressive multiple sclerosis. Conclusions An underlying low-grade chronic intravascular haemolysis is a potential source of the iron whose deposition along blood vessels in multiple sclerosis plaques contributes to the neurodegeneration and consequent brain atrophy seen in progressive disease. Chelators of free serum iron will be ineffective in preventing this neurodegeneration, because the iron (Fe2+) is chelated by haemoglobin.
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Affiliation(s)
- Alex Lewin
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK,Present address: Department of Mathematics, Brunel University, London, UK,
| | - Shea Hamilton
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK,
| | - Aviva Witkover
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Paul Langford
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Richard Nicholas
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Jeremy Chataway
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust and Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK
| | - Charles R.M. Bangham
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK,
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32
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Lewin A, Hamilton S, Witkover A, Langford P, Nicholas R, Chataway J, Bangham CRM. Free serum haemoglobin is associated with brain atrophy in secondary progressive multiple sclerosis. Wellcome Open Res 2016. [PMID: 27996064 DOI: 10.12688/wellcomeopenres.9967.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background A major cause of disability in secondary progressive multiple sclerosis (SPMS) is progressive brain atrophy, whose pathogenesis is not fully understood. The objective of this study was to identify protein biomarkers of brain atrophy in SPMS. Methods We used surface-enhanced laser desorption-ionization time-of-flight mass spectrometry to carry out an unbiased search for serum proteins whose concentration correlated with the rate of brain atrophy, measured by serial MRI scans over a 2-year period in a well-characterized cohort of 140 patients with SPMS. Protein species were identified by liquid chromatography-electrospray ionization tandem mass spectrometry. Results There was a significant (p<0.004) correlation between the rate of brain atrophy and a rise in the concentration of proteins at 15.1 kDa and 15.9 kDa in the serum. Tandem mass spectrometry identified these proteins as alpha-haemoglobin and beta-haemoglobin, respectively. The abnormal concentration of free serum haemoglobin was confirmed by ELISA (p<0.001). The serum lactate dehydrogenase activity was also highly significantly raised (p<10-12) in patients with secondary progressive multiple sclerosis. Conclusions An underlying low-grade chronic intravascular haemolysis is a potential source of the iron whose deposition along blood vessels in multiple sclerosis plaques contributes to the neurodegeneration and consequent brain atrophy seen in progressive disease. Chelators of free serum iron will be ineffective in preventing this neurodegeneration, because the iron (Fe2+) is chelated by haemoglobin.
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Affiliation(s)
- Alex Lewin
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK.,Present address: Department of Mathematics, Brunel University, London, UK
| | - Shea Hamilton
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Aviva Witkover
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Paul Langford
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
| | - Richard Nicholas
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - Jeremy Chataway
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust and Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK
| | - Charles R M Bangham
- Division of Infectious Diseases, Department of Medicine, Imperial College London, London, UK
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Wall MB, Birch D, Yong MY. Opportunities and considerations for visualising neuroimaging data on very large displays. F1000Res 2016; 5:2157. [PMID: 27703670 PMCID: PMC5031127 DOI: 10.12688/f1000research.9522.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/20/2022] Open
Abstract
Neuroimaging experiments can generate impressive volumes of data and many images of the results. This is particularly true of multi-modal imaging studies that use more than one imaging technique, or when imaging is combined with other assessments. A challenge for these studies is appropriate visualisation of results in order to drive insights and guide accurate interpretations. Next-generation visualisation technology therefore has much to offer the neuroimaging community. One example is the Imperial College London Data Observatory; a high-resolution (132 megapixel) arrangement of 64 monitors, arranged in a 313 degree arc, with a 6 metre diameter, powered by 32 rendering nodes. This system has the potential for high-resolution, large-scale display of disparate data types in a space designed to promote collaborative discussion by multiple researchers and/or clinicians. Opportunities for the use of the Data Observatory are discussed, with particular reference to applications in Multiple Sclerosis (MS) research and clinical practice. Technical issues and current work designed to optimise the use of the Data Observatory for neuroimaging are also discussed, as well as possible future research that could be enabled by the use of the system in combination with eye-tracking technology.
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Affiliation(s)
- Matthew B Wall
- Imanova Centre for Imaging Sciences, London, W12 0NN, UK; Division of Brain Sciences, Imperial College London, London, SW7 2AZ, UK; Clinical Psychopharmacology Unit, University College London, London, WC1E 7HB, UK
| | - David Birch
- Data Science Institute, Imperial College London, London, SW7 2AZ, UK
| | - May Y Yong
- Data Science Institute, Imperial College London, London, SW7 2AZ, UK
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Suttner LH, Mejia A, Dewey B, Sati P, Reich DS, Shinohara RT. Statistical estimation of white matter microstructure from conventional MRI. Neuroimage Clin 2016; 12:615-623. [PMID: 27722085 PMCID: PMC5048084 DOI: 10.1016/j.nicl.2016.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 08/29/2016] [Accepted: 09/10/2016] [Indexed: 12/11/2022]
Abstract
Diffusion tensor imaging (DTI) has become the predominant modality for studying white matter integrity in multiple sclerosis (MS) and other neurological disorders. Unfortunately, the use of DTI-based biomarkers in large multi-center studies is hindered by systematic biases that confound the study of disease-related changes. Furthermore, the site-to-site variability in multi-center studies is significantly higher for DTI than that for conventional MRI-based markers. In our study, we apply the Quantitative MR Estimation Employing Normalization (QuEEN) model to estimate the four DTI measures: MD, FA, RD, and AD. QuEEN uses a voxel-wise generalized additive regression model to relate the normalized intensities of one or more conventional MRI modalities to a quantitative modality, such as DTI. We assess the accuracy of the models by comparing the prediction error of estimated DTI images to the scan-rescan error in subjects with two sets of scans. Across the four DTI measures, the performance of the models is not consistent: Both MD and RD estimations appear to be quite accurate, while AD estimation is less accurate than MD and RD; the accuracy of FA estimation is poor. Thus, in some cases when assessing white matter integrity, it may be sufficient to acquire conventional MRI sequences alone.
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Affiliation(s)
- Leah H Suttner
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Amanda Mejia
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, United States
| | - Blake Dewey
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disease and Stroke, National Institute of Health, Bethesda, MD 20892, United States
| | - Pascal Sati
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disease and Stroke, National Institute of Health, Bethesda, MD 20892, United States
| | - Daniel S Reich
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, United States
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disease and Stroke, National Institute of Health, Bethesda, MD 20892, United States
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, United States
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Uddin MN, Lebel RM, Seres P, Blevins G, Wilman AH. Spin echo transverse relaxation and atrophy in multiple sclerosis deep gray matter: A two-year longitudinal study. Mult Scler 2016; 22:1133-43. [DOI: 10.1177/1352458515614091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/03/2015] [Indexed: 02/04/2023]
Abstract
Background: Deep gray matter (DGM) is affected in relapsing–remitting multiple sclerosis (RRMS) and may be studied using short-term longitudinal MRI. Objective: To investigate two-year changes in spin-echo transverse relaxation rate (R2) and atrophy in DGM, and its relationship with disease severity in RRMS patients. Methods: Twenty six RRMS patients and 26 matched controls were imaged at 4.7 T. Multiecho spin-echo R2 maps and atrophy measurements were obtained in DGM at baseline and two-year follow-up. Differences between MRI measures and correlations to disease severity were examined. Results: After two years, mean R2 values in the globus pallidus and pulvinar increased by ~4% ( p<0.001) in patients and <1.7% in controls. Two-year changes in R2 showed significant correlation to disease severity in the globus pallidus, pulvinar, substantia nigra, and thalamus. Multiple regression of the two-year R2 difference using these four DGM structures as variables, yielded high correlation with disease severity ( r=0.83, p<0.001). Two-year changes in volume and R2 showed significant correlation only for the globus pallidus in multiple sclerosis (MS) ( p<0.05). Conclusions: Two-year difference R2 measurements in DGM correlate to disease severity in MS. R2 mapping and atrophy measurements over two years can be used to identify changes in DGM in MS.
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Affiliation(s)
- Md Nasir Uddin
- Department of Biomedical Engineering, University of Alberta, Canada
| | - R Marc Lebel
- Department of Biomedical Engineering, University of Alberta, Canada
| | - Peter Seres
- Department of Biomedical Engineering, University of Alberta, Canada
| | - Gregg Blevins
- Division of Neurology, Department of Medicine, University of Alberta, Canada
| | - Alan H Wilman
- Department of Biomedical Engineering, University of Alberta, Canada
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Ciampi E, Pareto D, Sastre-Garriga J, Vidal-Jordana A, Tur C, Río J, Tintoré M, Auger C, Rovira A, Montalban X. Grey matter atrophy is associated with disability increase in natalizumab-treated patients. Mult Scler 2016; 23:556-566. [DOI: 10.1177/1352458516656808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Brain volume loss (BVL) is a key outcome in multiple sclerosis (MS) trials. Natalizumab is highly effective on inflammation with moderate impact on atrophy. Objective: To explore BVL in patients receiving natalizumab with an emphasis on grey matter (GM). Methods: We performed a retrospective post hoc analysis of BVL in 38 patients receiving natalizumab for 3 years using longitudinal voxel-based morphometry (VBM) and FreeSurfer. Results: Significant BVL was observed during first year: brain parenchymal fraction (BPF): −1.12% ( p < 0.001); white matter fraction (WMF): −0.9% ( p = 0.001); grey matter fraction (GMF): −1.28% ( p = 0.002). GM loss was found using VBM in bilateral cerebellum, cingulum, left > right fronto-parietal cortex, right > left hippocampus and left caudate. FreeSurfer showed significant volume losses in subcortical GM, brainstem and cerebellum, and cortical thinning in the left insula. In the second year, only WMF decrease (−0.6%; p = 0.015) was observed with no VBM changes, although FreeSurfer detected significant volume loss in thalamus, hippocampus and cerebellum. Baseline gadolinium enhancement influenced WMF and BPF changes during the first year, but not GMF. Patients with confirmed Expanded Disability Status Scale (EDSS) worsening at 3 years had lower baseline GMF and left thalamus volume and greater BVL over follow-up. Conclusion: BVL develops mainly during the first year of natalizumab therapy. GM changes are independent of baseline inflammation and correlate with disability.
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Affiliation(s)
- Ethel Ciampi
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Servei de Radiologia, Unitat de Ressonància Magnètica, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Tur
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Servei de Radiologia, Unitat de Ressonància Magnètica, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Rovira
- Servei de Radiologia, Unitat de Ressonància Magnètica, Institut de Diagnòstic per la Imatge (IDI), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Servei de Neurologia/Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Bergsland N, Tavazzi E, Laganà MM, Baglio F, Cecconi P, Viotti S, Zivadinov R, Baselli G, Rovaris M. White Matter Tract Injury is Associated with Deep Gray Matter Iron Deposition in Multiple Sclerosis. J Neuroimaging 2016; 27:107-113. [DOI: 10.1111/jon.12364] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/21/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Niels Bergsland
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences; State University of New York at Buffalo; Buffalo NY
- Department of Electronics, Information and Bioengineering; Politecnico di Milano; Milan Italy
| | - Eleonora Tavazzi
- Unit of Motor Neurorehabilitation, Multiple Sclerosis Center, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | | | - Francesca Baglio
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | - Pietro Cecconi
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | - Stefano Viotti
- MR Research Laboratory, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
| | - Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Department of Neurology, School of Medicine and Biomedical Sciences; State University of New York at Buffalo; Buffalo NY
- MRI Clinical Translational Research Center, School of Medicine and Biomedical Sciences; University at Buffalo, State University of New York; Buffalo NY
| | - Giuseppe Baselli
- Department of Electronics, Information and Bioengineering; Politecnico di Milano; Milan Italy
| | - Marco Rovaris
- Unit of Motor Neurorehabilitation, Multiple Sclerosis Center, IRCCS; Don Gnocchi Foundation ONLUS; Milan Italy
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Fortin JP, Sweeney EM, Muschelli J, Crainiceanu CM, Shinohara RT. Removing inter-subject technical variability in magnetic resonance imaging studies. Neuroimage 2016; 132:198-212. [PMID: 26923370 PMCID: PMC5540379 DOI: 10.1016/j.neuroimage.2016.02.036] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/30/2016] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
Magnetic resonance imaging (MRI) intensities are acquired in arbitrary units, making scans non-comparable across sites and between subjects. Intensity normalization is a first step for the improvement of comparability of the images across subjects. However, we show that unwanted inter-scan variability associated with imaging site, scanner effect, and other technical artifacts is still present after standard intensity normalization in large multi-site neuroimaging studies. We propose RAVEL (Removal of Artificial Voxel Effect by Linear regression), a tool to remove residual technical variability after intensity normalization. As proposed by SVA and RUV [Leek and Storey, 2007, 2008, Gagnon-Bartsch and Speed, 2012], two batch effect correction tools largely used in genomics, we decompose the voxel intensities of images registered to a template into a biological component and an unwanted variation component. The unwanted variation component is estimated from a control region obtained from the cerebrospinal fluid (CSF), where intensities are known to be unassociated with disease status and other clinical covariates. We perform a singular value decomposition (SVD) of the control voxels to estimate factors of unwanted variation. We then estimate the unwanted factors using linear regression for every voxel of the brain and take the residuals as the RAVEL-corrected intensities. We assess the performance of RAVEL using T1-weighted (T1-w) images from more than 900 subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI), as well as healthy controls from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. We compare RAVEL to two intensity-normalization-only methods: histogram matching and White Stripe. We show that RAVEL performs best at improving the replicability of the brain regions that are empirically found to be most associated with AD, and that these regions are significantly more present in structures impacted by AD (hippocampus, amygdala, parahippocampal gyrus, enthorinal area, and fornix stria terminals). In addition, we show that the RAVEL-corrected intensities have the best performance in distinguishing between MCI subjects and healthy subjects using the mean hippocampal intensity (AUC=67%), a marked improvement compared to results from intensity normalization alone (AUC=63% and 59% for histogram matching and White Stripe, respectively). RAVEL is promising for many other imaging modalities.
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Affiliation(s)
- Jean-Philippe Fortin
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth M Sweeney
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Muschelli
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ciprian M Crainiceanu
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Tolerability and Safety of Combined Glatiramer Acetate and N-Acetylcysteine in Relapsing-Remitting Multiple Sclerosis. Clin Neuropharmacol 2016; 38:127-31. [PMID: 26166235 DOI: 10.1097/wnf.0000000000000090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an autoimmune disorder of the central nervous system where inflammation and neurodegeneration play key roles. Mounting evidence implicates oxidative stress in the development of irreversible neuronal and glial injury in this condition. N-acetylcysteine (NAC) is a sulfhydryl amino acid derivative with antioxidant and antiapoptotic properties. Administration of NAC to mice attenuated the induction of or improved experimental autoimmune encephalomyelitis (an MS model). METHODS We performed an open-label study to explore the tolerability and safety of the combination of glatiramer acetate (GA) and NAC in patients with relapsing-remitting multiple sclerosis at the outpatient MS clinics of the Jewish General Hospital and Hôpital Charles Lemoyne, Montreal, Canada. Seven patients with relapsing-remitting multiple sclerosis with at least one T1 gadolinium-enhancing lesion on screening magnetic resonance imaging were recruited. Treatment consisted of a 10-week run-in period followed by 36-week treatment with a combination of GA 20 mg subcutaneously once daily plus NAC 2.5 g orally twice daily. Outcome measures included safety and tolerability, redox biochemistry, and magnetic resonance imaging effect. RESULTS Treatment with the combination of GA and NAC was safe and well tolerated. CONCLUSIONS In light of the favorable safety profile, an efficacy-demonstrating study may be considered.
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Gracien RM, Reitz SC, Hof SM, Fleischer V, Zimmermann H, Droby A, Steinmetz H, Zipp F, Deichmann R, Klein JC. Assessment of cortical damage in early multiple sclerosis with quantitative T2 relaxometry. NMR IN BIOMEDICINE 2016; 29:444-450. [PMID: 26820580 DOI: 10.1002/nbm.3486] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/24/2015] [Accepted: 12/16/2015] [Indexed: 06/05/2023]
Abstract
T2 relaxation time is a quantitative MRI in vivo surrogate of cerebral tissue damage in multiple sclerosis (MS) patients. Cortical T2 prolongation is a known feature in later disease stages, but has not been demonstrated in the cortical normal appearing gray matter (NAGM) in early MS. This study centers on the quantitative evaluation of the tissue parameter T2 in cortical NAGM in a collective of early MS and clinically isolated syndrome (CIS) patients, hypothesizing that T2 prolongation is already present at early disease stages and variable over space, in line with global and focal inflammatory processes in MS. Additionally, magnetization transfer ratio (MTR) mapping was performed for further characterization of the expected cortical T2 alteration. Quantitative T2 and MTR maps were acquired from 12 patients with CIS and early MS, and 12 matched healthy controls. The lesion-free part of the cortical volume was identified, and the mean T2 and MTR values and their standard deviations within the cortical volume were determined. For evaluation of spatial specificity, cortical lobar subregions were tested separately for differences of mean T2 and T2 standard deviation. We detected significantly prolonged T2 in cortical NAGM in patients. T2 prolongation was found across the whole cerebral cortex and in all individual lobar subregions. Significantly higher standard deviations across the respective region of interest were found for the whole cerebral cortex and all subregions, suggesting the occurrence of spatially inhomogeneous cortical damage in all regions studied. A trend was observed for MTR reduction and increased MTR variability across the whole cortex in the MS group, suggesting demyelination. In conclusion, our results suggest that cortical damage in early MS is evidenced by spatially inhomogeneous T2 prolongation which goes beyond demyelination. Iron deposition, which is known to decrease T2, seems less prominent.
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Affiliation(s)
- René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Sarah C Reitz
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Stephanie-Michelle Hof
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Hilga Zimmermann
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Amgad Droby
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | | | - Frauke Zipp
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Johannes C Klein
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
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Schmalbrock P, Prakash RS, Schirda B, Janssen A, Yang GK, Russell M, Knopp MV, Boster A, Nicholas JA, Racke M, Pitt D. Basal Ganglia Iron in Patients with Multiple Sclerosis Measured with 7T Quantitative Susceptibility Mapping Correlates with Inhibitory Control. AJNR Am J Neuroradiol 2016; 37:439-46. [PMID: 26611996 DOI: 10.3174/ajnr.a4599] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 07/31/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE T2 hypointensity in the basal ganglia of patients with MS has been associated with clinical progression and cognitive decline. Our objectives were the following: 1) to compare signal in T2WI, R2 (ie, 1/T2), and R2* (ie, 1/T2*) relaxation rates and quantitative susceptibility mapping; and 2) to investigate the associations among MR imaging, clinical scores, and cognitive measures of inhibitory control linked to basal ganglia functioning. MATERIALS AND METHODS Twenty-nine patients with MS underwent a battery of neuropsychological tests including the Flanker and Stroop tasks. 7T MR imaging included 3D gradient-echo and single-echo multishot spin-echo EPI. Quantitative susceptibility mapping images were calculated by using a Wiener filter deconvolution algorithm. T2WI signal was normalized to CSF. R2 and R2* were calculated by log-linear regression. Average MR imaging metrics for the globus pallidus, putamen, and caudate were computed from manually traced ROIs including the largest central part of each structure. RESULTS Marked spatial variation was consistently visualized on quantitative susceptibility mapping and T2/T2*WI within each basal ganglia structure. MR imaging metrics correlated with each other for each basal ganglia structure individually. Notably, caudate and putamen quantitative susceptibility mapping metrics were similar, but the putamen R2 was larger than the caudate R2. This finding suggests that tissue features contribute differently to R2 and quantitative susceptibility mapping. Caudate and anterior putamen quantitative susceptibility mapping correlated with the Flanker but not Stroop measures; R2 did not correlate with inhibitory control measures. Putamen quantitative susceptibility mapping and caudate and putamen R2 correlated with the Expanded Disability Status Scale. CONCLUSIONS Our study showed that quantitative susceptibility mapping and R2 may be complementary indicators for basal ganglia tissue changes in MS. Our findings are consistent with the hypothesis that decreased performance of basal ganglia-reliant tasks involving inhibitory control is associated with increased quantitative susceptibility mapping.
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Affiliation(s)
- P Schmalbrock
- From the Departments of Radiology (P.S., G.K.Y., M. Russell, M.V.K.)
| | | | | | | | - G K Yang
- From the Departments of Radiology (P.S., G.K.Y., M. Russell, M.V.K.)
| | - M Russell
- From the Departments of Radiology (P.S., G.K.Y., M. Russell, M.V.K.)
| | - M V Knopp
- From the Departments of Radiology (P.S., G.K.Y., M. Russell, M.V.K.)
| | - A Boster
- Neurology (A.B., J.A.N., M. Racke), The Ohio State University, Columbus, Ohio
| | - J A Nicholas
- Neurology (A.B., J.A.N., M. Racke), The Ohio State University, Columbus, Ohio
| | - M Racke
- Neurology (A.B., J.A.N., M. Racke), The Ohio State University, Columbus, Ohio
| | - D Pitt
- Department of Neurology (D.P.), Yale School of Medicine, New Haven, Connecticut
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Stüber C, Pitt D, Wang Y. Iron in Multiple Sclerosis and Its Noninvasive Imaging with Quantitative Susceptibility Mapping. Int J Mol Sci 2016; 17:ijms17010100. [PMID: 26784172 PMCID: PMC4730342 DOI: 10.3390/ijms17010100] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 01/05/2016] [Accepted: 01/07/2016] [Indexed: 01/06/2023] Open
Abstract
Iron is considered to play a key role in the development and progression of Multiple Sclerosis (MS). In particular, iron that accumulates in myeloid cells after the blood-brain barrier (BBB) seals may contribute to chronic inflammation, oxidative stress and eventually neurodegeneration. Magnetic resonance imaging (MRI) is a well-established tool for the non-invasive study of MS. In recent years, an advanced MRI method, quantitative susceptibility mapping (QSM), has made it possible to study brain iron through in vivo imaging. Moreover, immunohistochemical investigations have helped defining the lesional and cellular distribution of iron in MS brain tissue. Imaging studies in MS patients and of brain tissue combined with histological studies have provided important insights into the role of iron in inflammation and neurodegeneration in MS.
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Affiliation(s)
- Carsten Stüber
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - David Pitt
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA.
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43
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Stüber C, Pitt D, Wang Y. Iron in Multiple Sclerosis and Its Noninvasive Imaging with Quantitative Susceptibility Mapping. Int J Mol Sci 2016. [PMID: 26784172 DOI: 10.3390/ijmsl17010100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Iron is considered to play a key role in the development and progression of Multiple Sclerosis (MS). In particular, iron that accumulates in myeloid cells after the blood-brain barrier (BBB) seals may contribute to chronic inflammation, oxidative stress and eventually neurodegeneration. Magnetic resonance imaging (MRI) is a well-established tool for the non-invasive study of MS. In recent years, an advanced MRI method, quantitative susceptibility mapping (QSM), has made it possible to study brain iron through in vivo imaging. Moreover, immunohistochemical investigations have helped defining the lesional and cellular distribution of iron in MS brain tissue. Imaging studies in MS patients and of brain tissue combined with histological studies have provided important insights into the role of iron in inflammation and neurodegeneration in MS.
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Affiliation(s)
- Carsten Stüber
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - David Pitt
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT 06511, USA.
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY 10044, USA.
- Department of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA.
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Abstract
Due to its sensitivity to the different multiple sclerosis (MS)-related abnormalities, magnetic resonance imaging (MRI) has become an established tool to diagnose MS and to monitor its evolution. MRI has been included in the diagnostic workup of patients with clinically isolated syndromes suggestive of MS, and ad hoc criteria have been proposed and are regularly updated. In patients with definite MS, the ability of conventional MRI techniques to explain patients' clinical status and progression of disability is still suboptimal. Several advanced MRI-based technologies have been applied to estimate overall MS burden in the different phases of the disease. Their use has allowed the heterogeneity of MS pathology in focal lesions, normal-appearing white matter and gray matter to be graded in vivo. Recently, additional features of MS pathology, including macrophage infiltration and abnormal iron deposition, have become quantifiable. All of this, combined with functional imaging techniques, is improving our understanding of the mechanisms associated with MS evolution. In the near future, the use of ultrahigh-field systems is likely to provide additional insight into disease pathophysiology. However, the utility of advanced MRI techniques in clinical trial monitoring and in assessing individual patients' response to treatment still needs to be assessed.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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45
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Mejia AF, Sweeney EM, Dewey B, Nair G, Sati P, Shea C, Reich DS, Shinohara RT. Statistical estimation of T1 relaxation times using conventional magnetic resonance imaging. Neuroimage 2015; 133:176-188. [PMID: 26732403 DOI: 10.1016/j.neuroimage.2015.12.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 12/11/2022] Open
Abstract
Quantitative T1 maps estimate T1 relaxation times and can be used to assess diffuse tissue abnormalities within normal-appearing tissue. T1 maps are popular for studying the progression and treatment of multiple sclerosis (MS). However, their inclusion in standard imaging protocols remains limited due to the additional scanning time and expert calibration required and susceptibility to bias and noise. Here, we propose a new method of estimating T1 maps using four conventional MR images, which are intensity-normalized using cerebellar gray matter as a reference tissue and related to T1 using a smooth regression model. Using cross-validation, we generate statistical T1 maps for 61 subjects with MS. The statistical maps are less noisy than the acquired maps and show similar reproducibility. Tests of group differences in normal-appearing white matter across MS subtypes give similar results using both methods.
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Affiliation(s)
- Amanda F Mejia
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Elizabeth M Sweeney
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, USA; Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Blake Dewey
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Govind Nair
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Pascal Sati
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Colin Shea
- Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Daniel S Reich
- Department of Biostatistics, The Johns Hopkins University, Baltimore, MD 21205, USA; Translational Neuroradiology Unit, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Russell T Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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46
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Abstract
Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system characterised by immune-mediated demyelination, and is a leading cause of neurological disability worldwide. It has a wide spectrum of clinical presentations which overlap with other neurological conditions many times. Further, the radiological array of findings in MS can also be confused for multiple other conditions, leading to the need to look for the more typical findings, and interpret these in close conjunction with the clinical picture including temporal evolution. This review aims to revisit the MRI findings in MS, including recent innovations in imaging, and to help distinguish MS from its mimics.
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Affiliation(s)
- Aparna Katdare
- Department of Neuroradiology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Meher Ursekar
- Department of Neuroradiology, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
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47
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Early and Degressive Putamen Atrophy in Multiple Sclerosis. Int J Mol Sci 2015; 16:23195-209. [PMID: 26404239 PMCID: PMC4632693 DOI: 10.3390/ijms161023195] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/07/2015] [Accepted: 09/08/2015] [Indexed: 01/12/2023] Open
Abstract
Putamen atrophy and its long-term progress during disease course were recently shown in patients with multiple sclerosis (MS). Here we investigated retrospectively the time point of atrophy onset in patients with relapsing-remitting MS (RRMS). 68 patients with RRMS and 26 healthy controls (HC) were admitted to 3T MRI in a cross-sectional study. We quantitatively analyzed the putamen volume of individual patients in relation to disease duration by correcting for age and intracranial volume (ICV). Patient’s relative putamen volume (RPV), expressed in percent of ICV, was significantly reduced compared to HC. Based on the correlation between RPV and age, we computed the age-corrected RPV deviation (ΔRPV) from HC. Patients showed significantly negative ΔRPV. Interestingly, the age-corrected ΔRPV depended logarithmically on disease duration: Directly after first symptom manifestation, patients already showed a reduced RPV followed by a further degressive volumetric decline. This means that atrophy progression was stronger in the first than in later years of disease. Putamen atrophy starts directly after initial symptom manifestation or even years before, and progresses in a degressive manner. Due to its important role in neurological functions, early detection of putamen atrophy seems necessary. High-resolution structural MRI allows monitoring of disease course.
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48
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Sieminski M, Losy J, Partinen M. Restless legs syndrome in multiple sclerosis. Sleep Med Rev 2015; 22:15-22. [DOI: 10.1016/j.smrv.2014.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/02/2014] [Accepted: 10/03/2014] [Indexed: 11/27/2022]
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49
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Zarruk JG, Berard JL, Passos dos Santos R, Kroner A, Lee J, Arosio P, David S. Expression of iron homeostasis proteins in the spinal cord in experimental autoimmune encephalomyelitis and their implications for iron accumulation. Neurobiol Dis 2015; 81:93-107. [PMID: 25724358 DOI: 10.1016/j.nbd.2015.02.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/16/2015] [Accepted: 02/03/2015] [Indexed: 02/06/2023] Open
Abstract
Iron accumulation occurs in the CNS in multiple sclerosis (MS) and in experimental autoimmune encephalomyelitis (EAE). However, the mechanisms underlying such iron accumulation are not fully understood. We studied the expression and cellular localization of molecules involved in cellular iron influx, storage, and efflux. This was assessed in two mouse models of EAE: relapsing-remitting (RR-EAE) and chronic (CH-EAE). The expression of molecules involved in iron homeostasis was assessed at the onset, peak, remission/progressive and late stages of the disease. We provide several lines of evidence for iron accumulation in the EAE spinal cord which increases with disease progression and duration, is worse in CH-EAE, and is localized in macrophages and microglia. We also provide evidence that there is a disruption of the iron efflux mechanism in macrophages/microglia that underlie the iron accumulation seen in these cells. Macrophages/microglia also lack expression of the ferroxidases (ceruloplasmin and hephaestin) which have antioxidant effects. In contrast, astrocytes which do not accumulate iron, show robust expression of several iron influx and efflux proteins and the ferroxidase ceruloplasmin which detoxifies ferrous iron. Astrocytes therefore are capable of efficiently recycling iron from sites of EAE lesions likely into the circulation. We also provide evidence of marked dysregulation of mitochondrial function and energy metabolism genes, as well as of NADPH oxidase genes in the EAE spinal cord. This data provides the basis for the selective iron accumulation in macrophage/microglia and further evidence of severe mitochondrial dysfunction in EAE. It may provide insights into processes underling iron accumulation in MS and other neurodegenerative diseases in which iron accumulation occurs.
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Affiliation(s)
- Juan G Zarruk
- Centre for Research in Neuroscience, The Research Institute of the McGill University Health Center, 1650 Cedar Ave., Montreal H3G 1A4, Quebec, Canada
| | - Jennifer L Berard
- Centre for Research in Neuroscience, The Research Institute of the McGill University Health Center, 1650 Cedar Ave., Montreal H3G 1A4, Quebec, Canada
| | - Rosmarini Passos dos Santos
- Centre for Research in Neuroscience, The Research Institute of the McGill University Health Center, 1650 Cedar Ave., Montreal H3G 1A4, Quebec, Canada
| | - Antje Kroner
- Centre for Research in Neuroscience, The Research Institute of the McGill University Health Center, 1650 Cedar Ave., Montreal H3G 1A4, Quebec, Canada
| | - Jaekwon Lee
- Dept of Biochemistry and Redox Biology Center, University of Nebraska-Lincoln, N210 Beadle Center, Lincoln, NE 68588-0664 USA
| | - Paolo Arosio
- Molecular Biology Laboratory, Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Samuel David
- Centre for Research in Neuroscience, The Research Institute of the McGill University Health Center, 1650 Cedar Ave., Montreal H3G 1A4, Quebec, Canada.
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50
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Harrison DM, Oh J, Roy S, Wood ET, Whetstone A, Seigo MA, Jones CK, Pham D, van Zijl P, Reich DS, Calabresi PA. Thalamic lesions in multiple sclerosis by 7T MRI: Clinical implications and relationship to cortical pathology. Mult Scler 2015; 21:1139-50. [PMID: 25583851 DOI: 10.1177/1352458514558134] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/10/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Pathology in both cortex and deep gray matter contribute to disability in multiple sclerosis (MS). We used the increased signal-to-noise ratio of 7-tesla (7T) MRI to visualize small lesions within the thalamus and to relate this to clinical information and cortical lesions. METHODS We obtained 7T MRI scans on 34 MS cases and 15 healthy volunteers. Thalamic lesion number and volume were related to demographic data, clinical disability measures, and lesions in cortical gray matter. RESULTS Thalamic lesions were found in 24/34 of MS cases. Two lesion subtypes were noted: discrete, ovoid lesions, and more diffuse lesional areas lining the periventricular surface. The number of thalamic lesions was greater in progressive MS compared to relapsing-remitting (mean ±SD, 10.7 ±0.7 vs. 3.0 ±0.7, respectively, p < 0.001). Thalamic lesion burden (count and volume) correlated with EDSS score and measures of cortical lesion burden, but not with white matter lesion burden or white matter volume. CONCLUSIONS Using 7T MRI allows identification of thalamic lesions in MS, which are associated with disability, progressive disease, and cortical lesions. Thalamic lesion analysis may be a simpler, more rapid estimate of overall gray matter lesion burden in MS.
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Affiliation(s)
- Daniel M Harrison
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Jiwon Oh
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Snehashis Roy
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Uniformed Services University of the Health Sciences, USA
| | - Emily T Wood
- Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), USA/Department of Neuroscience, Johns Hopkins School of Medicine, USA
| | - Anna Whetstone
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Michaela A Seigo
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
| | - Craig K Jones
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, USA/Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
| | - Dzung Pham
- Center for Neuroscience and Regenerative Medicine, Henry Jackson Foundation, Uniformed Services University of the Health Sciences, USA
| | - Peter van Zijl
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, USA/Department of Neuroscience, Johns Hopkins School of Medicine, USA/Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA/Translational Neuroradiology Unit, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), USA/Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins School of Medicine, USA
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