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Chylińska M, Karaszewski B, Komendziński J, Wyszomirski A, Hałas M, Szurowska E, Sabisz A. The association between white matter tract structural connectivity and information processing speed in relapsing-remitting multiple sclerosis. Neurol Sci 2023; 44:3221-3232. [PMID: 37103603 PMCID: PMC10415523 DOI: 10.1007/s10072-023-06817-6] [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: 10/18/2022] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Information processing speed (IPS) deterioration is common in relapsing-remitting multiple sclerosis (RRMS) patients [1] and might severely affect quality of life and occupational activity. However, understanding of its neural substrate is not fully elucidated. We aimed to investigate the associations between MRI-derived metrics of neuroanatomical structures, including the tracts, and IPS. METHODS Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Color Trails Test (CTT) were used to evaluate IPS in 73 RRMS consecutive patients, all undergoing only interferon beta (IFN-β) therapy during the study. At the same time, 1.5T MRI including diffusion tensor imaging (DTI) data was acquired for each recruited subject. We analyzed volumetric and diffusion MRI measures (FreeSurfer 6.0) including normalized brain volume (NBV), cortical thickness (thk), white matter hypointensities (WMH), volume (vol), diffusion parameters: mean (MD), radial (RD), axial (AD) diffusivities, and fractional anisotropy (FA) of 18 major white-matter (WM) tracts. Multiple linear regression model with interaction resulted in distinguishing the neural substrate of IPS deficit in the IPS impaired subgroup of patients. RESULTS The most significant tract abnormalities contributing to IPS deficit were right inferior longitudinal fasciculus (R ILF) FA, forceps major (FMAJ) FA, forceps minor (FMIN) FA, R uncinate fasciculus (UNC) AD, R corticospinal tract (CST) FA, and left superior longitudinal fasciculus FA (L SLFT). Among volumetric MRI metrics, IPS deficit was associated with L and R thalamic vol. and cortical thickness of insular regions. CONCLUSION In this study, we showed that disconnection of the selected WM tracts, in addition to cortical and deep gray matter (GM) atrophy, might underlie IPS deficit in RRMS patients but more extensive studies are needed for precise associations.
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Affiliation(s)
- Magdalena Chylińska
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland.
| | - Bartosz Karaszewski
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland.
| | - Jakub Komendziński
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
| | - Adam Wyszomirski
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
| | - Marek Hałas
- Department of Adult Neurology, Faculty of Medicine, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
| | - Edyta Szurowska
- Second Department of Radiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Agnieszka Sabisz
- Second Department of Radiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Amiri M, Gerami R, Shekarchi B, Azimi A, Asadi B, Bagheri H. Changes in diffusion tensor imaging indices in basal ganglia and thalamus of patients with Relapsing-Remitting Multiple Sclerosis and relation with clinical conditions: A case-control study. Eur J Radiol Open 2022; 10:100465. [PMID: 36578906 PMCID: PMC9791126 DOI: 10.1016/j.ejro.2022.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Background Multiple sclerosis (MS) is recognized as the most prevalent autoimmune abnormality of the CNS. T1WI, T2WI, and FLAIR are limited in the quantification of tissue damage and detection of tissue alterations in white and grey matter in MS. This study aimed to the evaluation of changes in DTI indices in these patients at the thalamus and basal ganglia. Methods 30 relapsing-remitting MS (RRMS) cases and 30 normal individuals were included. Conventional MRI (T2, FLAIR) was acquired to confirm NAGM in MS patients. A T1 MPRAGE protocol was used to normalize DTI images. FSL, SPM, and Explore DTI software were employed to reach Mean Diffusivities (MD), Axial Diffusivities (AD), Fractional anisotropy (FA), and Radial Diffusivity (RD) at the thalamus and the basal ganglia. Results The FA and RD of the thalamus were decreased in healthy controls compared to MS cases (0.319 vs. 0.296 and 0.0009 vs. 0.0006, respectively) (P < 0.05). The AD value in the thalamus and the FA value in the caudate nucleus were significantly lower in MS cases than in controls (0.0009 vs. 0.0011 and 0.16 vs. 0.18, respectively) (P < 0.05). MD values in the thalamus or basal ganglia were not significantly different between groups. Conclusions DTI measures including FA, RD, and AD have a good diagnostic performance in detecting microstructural changes in the normal-appearing thalamus in cases with RRMS while they had no significant relationship with clinical signs in terms of EDSS. Availability of data and material Not applicable.
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Affiliation(s)
- Mohammad Amiri
- Faculty of Medicine, Aja University of Medical Science, Tehran, Iran
| | - Reza Gerami
- Department of Radiology, Faculty of Medicine, Aja University of Medical Science, Tehran, Iran,Corresponding author.
| | - Babak Shekarchi
- Department of Radiology, Faculty of Medicine, Aja University of Medical Science, Tehran, Iran
| | - Amirreza Azimi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahador Asadi
- Department of Radiology, Faculty of Medicine, Aja University of Medical Science, Tehran, Iran
| | - Hamed Bagheri
- Radiation Sciences Research Center, Aja University of Medical Science, Tehran, Iran
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Bao J, Tu H, Li Y, Sun J, Hu Z, Zhang F, Li J. Diffusion Tensor Imaging Revealed Microstructural Changes in Normal-Appearing White Matter Regions in Relapsing–Remitting Multiple Sclerosis. Front Neurosci 2022; 16:837452. [PMID: 35310094 PMCID: PMC8924457 DOI: 10.3389/fnins.2022.837452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAxons and myelin sheaths are the physical foundation for white matter (WM) to perform normal functions. Our previous study found the metabolite abnormalities in frontal, parietal, and occipital normal-appearing white matter (NAWM) regions in relapsing–remitting multiple sclerosis (RRMS) patients by applying a 2D 1H magnetic resonance spectroscopic imaging method. Since the metabolite changes may associate with the microstructure changes, we used the diffusion tensor imaging (DTI) method to assess the integrity of NAWM in this study.MethodDiffusion tensor imaging scan was performed on 17 clinically definite RRMS patients and 21 age-matched healthy controls on a 3.0-T scanner. DTI metrics including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted from 19 predefined regions of interest (ROIs), which were generated by removing a mask of manually drawn probabilistic lesion map from the Johns Hopkins University white-matter atlas. The mean values of FA, MD, AD, and RD were compared between different groups in the same ROIs.ResultsA probabilistic lesion map was successfully generated, and the lesion regions were eliminated from the WM atlas. We found that the RRMS patients had significantly lower FA in the entire corpus callosum (CC), bilateral of anterior corona radiata, and right posterior thalamic radiation (PTR). At the same time, RRMS patients showed significantly higher MD in the bilateral anterior corona radiata and superior corona radiata. Moreover, all AD values increased, and the bilateral external capsule, PTR, and left tapetum NAWM show statistical significance. What is more, all NAWM tracts showed increasing RD values in RRMS patients, and the bilateral superior corona radiata, the anterior corona radiata, right PTR, and the genu CC reach statistical significance.ConclusionOur study revealed widespread microstructure changes in NAWM in RRMS patients through a ready-made WM atlas and probabilistic lesion map. These findings support the hypothesis of demyelination, accumulation of inflammatory cells, and axonal injury in NAWM for RRMS. The DTI-based metrics could be considered as potential non-invasive biomarkers of disease severity.
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Affiliation(s)
- Jianfeng Bao
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Hui Tu
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Yijia Li
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Jubao Sun
- MRI Center, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
| | - Zhigang Hu
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
| | - Fengshou Zhang
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- *Correspondence: Fengshou Zhang,
| | - Jinghua Li
- College of Medical Technology and Engineering, Henan University of Science and Technology, Luoyang, China
- Jinghua Li,
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Bauer C, Dyrby TB, Sellebjerg F, Madsen KS, Svolgaard O, Blinkenberg M, Siebner HR, Andersen KW. Motor fatigue is associated with asymmetric connectivity properties of the corticospinal tract in multiple sclerosis. Neuroimage Clin 2020; 28:102393. [PMID: 32916467 PMCID: PMC7490847 DOI: 10.1016/j.nicl.2020.102393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
Multiple Sclerosis (MS) is characterized by demyelination and neurodegeneration of the central nervous system and causes excessive fatigue in more than 80% of the patients. The pathophysiologic mechanisms causing fatigue are still largely unknown. In 46 right-handed patients with relapsing-remitting MS and 25 right-handed controls, we performed diffusion MRI and applied streamline based probabilistic tractography to derive unilateral anatomical connectivity maps for the white matter of the right and left hemispheres. The maps provide an indication how often a streamline has passed through a given voxel. Since tractography based anatomical connectivity mapping (ACM) is sensitive to disease-induced changes in anatomical connectivity, we used ACM to test whether motor fatigue is associated with altered ipsi-hemispherical anatomical connectivity in the major motor output pathway, the corticospinal tract (CST). Patients had higher mean ACM values in the CST than healthy controls. This indicated that a higher number of streamlines, starting from voxels in the same hemisphere, travelled through the CST and may reflect an accumulated disease-induced disintegration of CST. The motor subscale of the Fatigue Scale for Motor and Cognitive functions (FSMCMOTOR) was used to define sub-groups with (n = 29, FSMCMOTOR score ≥ 27) and without motor fatigue (n = 17, FSMSMOTOR score ≤ 26). Patients without fatigue only showed higher ACM values in right CST, while mean ACM values were unaltered in left CST. The higher the mean ACM values in the left relative to the right CST, the more patients reported motor fatigue. Left-right asymmetry in anatomical connectivity outside the CST did not scale with individual motor fatigue. Our results link lateralized changes of tractography-based microstructural properties in the CST with motor fatigue in relapsing-remitting MS.
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Affiliation(s)
- Christian Bauer
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Radiography, Department of Technology, University College Copenhagen, Copenhagen, Denmark
| | - Tim B Dyrby
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Finn Sellebjerg
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Skak Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Radiography, Department of Technology, University College Copenhagen, Copenhagen, Denmark
| | - Olivia Svolgaard
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Kasper Winther Andersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Denmark
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Alruwaili AR, Pannek K, Henderson RD, Gray M, Kurniawan ND, McCombe PA. Serial MRI studies over 12 months using manual and atlas-based region of interest in patients with amyotrophic lateral sclerosis. BMC Med Imaging 2020; 20:90. [PMID: 32746800 PMCID: PMC7397614 DOI: 10.1186/s12880-020-00489-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by loss of upper and lower motor neurons. There is a need for an imaging biomarker to track disease progression. Previously, magnetic resonance imaging (MRI) has shown loss of grey and white matter in the brain of patients with ALS compared to controls. We performed serial diffusion tractography imaging (DTI) study of patients with ALS looking for changes over time. METHODS On all subjects (n = 15), we performed three MRI studies at 6 month intervals. DTI changes were assessed with tract-based spatial statistics (TBSS) and region of interest (ROI) studies. Cortic-spinal tract (CST) was selected for our ROI at the upper level; the posterior limb of internal capsule (PLIC), and a lower level in the pons. RESULTS There was no significant change in DTI measures over 12 months of observation. Better correlation of manual and atlas-based ROI methods was found in the posterior limb of the internal capsule than the pons. CONCLUSION While previous DTI studies showed significant differences between ALS subjects and controls, within individual subjects there is little evidence of progression over 12 months. This suggests that DTI is not a suitable biomarker to assess disease progression in ALS.
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Affiliation(s)
- Ashwag R Alruwaili
- The University of Queensland, Centre for Clinical Research, Brisbane, Australia. .,King Saud University, Riyadh, Saudi Arabia. .,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Kerstin Pannek
- Australian E-Health Research Centre, CSIRO, Brisbane, Australia
| | - Robert D Henderson
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,The Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Marcus Gray
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia.,Gehrmann Laboratory, University of Queensland, Brisbane, QLD, Australia
| | - Nyoman D Kurniawan
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Pamela A McCombe
- The University of Queensland, Centre for Clinical Research, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, QLD, Australia.,The Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
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Fujimori J, Uryu K, Fujihara K, Wattjes MP, Suzuki C, Nakashima I. Measurements of the corpus callosum index and fractional anisotropy of the corpus callosum and their cutoff values are useful to assess global brain volume loss in multiple sclerosis. Mult Scler Relat Disord 2020; 45:102388. [PMID: 32659734 DOI: 10.1016/j.msard.2020.102388] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Recent studies suggest that parameters of the corpus callosum (CC), such as the CC index (CCI) and fractional anisotropy (FA) of the CC, may be related to the degree of brain volume loss (BVL) in MS patients; however, cutoff values that determine the degree of BVL have not been set. METHODS Seventy-five MS patients and 21 healthy controls (HCs) underwent volumetric MRI examinations. MS patients were also evaluated for T2 lesion load, the CCI, and FA of the CC. Among the 75 MS patients, 20 had undergone cognitive assessments with the Symbol Digit Modalities Test (SDMT). After 75 MS patients were categorized into mild, moderate, or severe BVL subgroups according to our previous report, we performed receiver operating characteristic analysis to determine the cutoff values of CCI and FA, categorizing the MS patients into the three subgroups. RESULTS The volume of the CC was significantly reduced in MS patients compared to that in HCs. The CCI and FA were significantly associated with EDSS, disease duration, clinical phenotype, T2-lesion load, and whole brain volume. The FA was significantly correlated with the SDMT score. We identified optimal cutoff values for the CCI and FA of 0.32 (85% sensitivity, 92% specificity) and 0.39 (100% sensitivity, 92% specificity), respectively, which discriminated the severe BVL group from others, and 0.385 (84% sensitivity, 74% specificity) and 0.45 (81% sensitivity, 89% specificity), respectively, which discriminated the mild BVL group from others. CONCLUSION The CCI and FA cutoff values may be useful for evaluating the degree of MS brain atrophy in clinical practice.
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Affiliation(s)
- Juichi Fujimori
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Kengo Uryu
- School of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, Fukushima Medical University School of Medicine and Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Chihiro Suzuki
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ichiro Nakashima
- Division of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Andersen KW, Lasič S, Lundell H, Nilsson M, Topgaard D, Sellebjerg F, Szczepankiewicz F, Siebner HR, Blinkenberg M, Dyrby TB. Disentangling white-matter damage from physiological fibre orientation dispersion in multiple sclerosis. Brain Commun 2020; 2:fcaa077. [PMID: 32954329 PMCID: PMC7472898 DOI: 10.1093/braincomms/fcaa077] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 01/23/2023] Open
Abstract
Multiple sclerosis leads to diffuse damage of the central nervous system, affecting also the normal-appearing white matter. Demyelination and axonal degeneration reduce regional fractional anisotropy in normal-appearing white matter, which can be routinely mapped with diffusion tensor imaging. However, the standard fractional anisotropy metric is also sensitive to physiological variations in orientation dispersion of white matter fibres. This complicates the detection of disease-related damage in large parts of cerebral white matter where microstructure physiologically displays a high degree of fibre dispersion. To resolve this ambiguity, we employed a novel tensor-valued encoding method for diffusion MRI, which yields a microscopic fractional anisotropy metric that is unaffected by regional variations in orientation dispersion. In 26 patients with relapsing-remitting multiple sclerosis, 14 patients with primary-progressive multiple sclerosis and 27 age-matched healthy controls, we compared standard fractional anisotropy mapping with the novel microscopic fractional anisotropy mapping method, focusing on normal-appearing white matter. Mean microscopic fractional anisotropy and standard fractional anisotropy of normal-appearing white matter were significantly reduced in both patient groups relative to healthy controls, but microscopic fractional anisotropy yielded a better reflection of disease-related white-matter alterations. The reduction in mean microscopic fractional anisotropy showed a significant positive linear relationship with physical disability, as reflected by the expanded disability status scale. Mean reduction of microscopic fractional anisotropy in normal-appearing white matter also scaled positively with individual cognitive dysfunction, as measured with the symbol digit modality test. Mean microscopic fractional anisotropy reduction in normal-appearing white matter also showed a positive relationship with total white-matter lesion load as well as lesion load in specific tract systems. None of these relationships between normal-appearing white-matter microstructure and clinical, cognitive or structural measures emerged when using mean fractional anisotropy. Together, the results provide converging evidence that microscopic fractional anisotropy mapping substantially advances the assessment of cerebral white matter in multiple sclerosis by disentangling microstructure damage from variations in physiological fibre orientation dispersion at the stage of data acquisition. Since tensor-valued encoding can be implemented in routine diffusion MRI, microscopic fractional anisotropy mapping bears considerable potential for the future assessment of disease progression in normal-appearing white matter in both relapsing-remitting and progressive forms of multiple sclerosis as well as other white-matter-related brain diseases.
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Affiliation(s)
- Kasper Winther Andersen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Samo Lasič
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Random Walk Imaging, AB, 222 24 Lund, Sweden
| | - Henrik Lundell
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Markus Nilsson
- Department of Radiology, Clinical Sciences, Lund, Lund University, 221 00 Lund, Sweden
| | - Daniel Topgaard
- Division of Physical Chemistry, Department of Chemistry, Lund University, 221 00 Lund, Sweden
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Filip Szczepankiewicz
- Department of Medical Radiation Physics, Clinical Sciences, Lund, Lund University, 221 00 Lund, Sweden
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg, 2400 Copenhagen NV, Denmark
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Center, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Tim B Dyrby
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2700 Kongens Lyngby, Denmark
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Chang K, Premeaux TA, Cobigo Y, Milanini B, Hellmuth J, Rubin LH, Javandel S, Allen I, Ndhlovu LC, Paul R, Valcour V. Plasma inflammatory biomarkers link to diffusion tensor imaging metrics in virally suppressed HIV-infected individuals. AIDS 2020; 34:203-213. [PMID: 31634200 PMCID: PMC6933087 DOI: 10.1097/qad.0000000000002404] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Inflammation may contribute to brain white matter health in people living with HIV who report cognitive symptoms despite adherence to combination antiretroviral therapy and viral suppression. We explored relationships between diffusion tensor imaging (DTI) metrics of white matter, plasma biomarkers of immune activation, and cognitive function in the HIV-infected population. DESIGN Retrospective study of older adults living with HIV who are combination antiretroviral therapy adherent, virally suppressed, and self-report cognitive symptoms. METHODS MRI, blood draws, and standardized neuropsychological test scores were collected from HIV-infected individuals. DTI metrics (fractional anisotropy, mean diffusivity, radial diffusivity, axial diffusivity) and plasma biomarkers (soluble CD163, soluble CD14, neopterin, IFN γ-induced protein 10, monocyte chemoattractant protein 1) were quantified. Statistical analysis explored associations between biomarker levels or neuropsychological test scores and DTI metrics using region of interest analyses and a voxelwise approach. RESULTS A total of 43 participants with median (interquartile range) age of 64 (62-66 years), CD4 cell count of 600 (400-760 cell/μl) who were all virally suppressed (<100 copies/ml) were selected. Higher levels of monocyte chemoattractant protein 1 associated with lower fractional anisotropy and higher mean diffusivity (P < 0.05) across white matter tracts including corpus callosum, corona radiata, and superior longitudinal fasciculus. Higher neopterin associated with higher mean diffusivity in the genu of corpus callosum, and higher soluble CD14 associated with lower fractional anisotropy in the bilateral superior corona radiata (P < 0.05). Worse global performance and speed domain scores associated with higher mean diffusivity and lower fractional anisotropy, and worse executive domain scores associated with lower fractional anisotropy (P < 0.05). CONCLUSION Elevated inflammatory plasma biomarkers link to white matter abnormalities among virally suppressed individuals. DTI abnormalities associate to cognitive performance. We conclude that inflammatory processes impact clinically relevant brain health indices despite viral suppression.
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Affiliation(s)
- Kevin Chang
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California
| | - Thomas A Premeaux
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Yann Cobigo
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California
| | - Benedetta Milanini
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California
| | - Joanna Hellmuth
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California
| | - Leah H Rubin
- Department of Neurology and Psychiatry, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - Shireen Javandel
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California
| | - Isabel Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Lishomwa C Ndhlovu
- Department of Tropical Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Robert Paul
- Missouri Institute of Mental Health, University of Missouri St Louis, St Louis, Missouri, USA
| | - Victor Valcour
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California
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Sun P, George A, Perantie DC, Trinkaus K, Ye Z, Naismith RT, Song SK, Cross AH. Diffusion basis spectrum imaging provides insights into MS pathology. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 7:7/2/e655. [PMID: 31871296 PMCID: PMC7011117 DOI: 10.1212/nxi.0000000000000655] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/04/2019] [Indexed: 11/15/2022]
Abstract
Objective To use diffusion basis spectrum imaging (DBSI) to assess how damage to normal-appearing white matter (NAWM) in the corpus callosum (CC) influences neurologic impairment in people with MS (pwMS). Methods Using standard MRI, the primary pathologies in MS of axonal injury/loss, demyelination, and inflammation are not differentiated well. DBSI has been shown in animal models, phantoms, and in biopsied and autopsied human CNS tissues to distinguish these pathologies. Fifty-five pwMS (22 relapsing-remitting, 17 primary progressive, and 16 secondary progressive) and 13 healthy subjects underwent DBSI analyses of NAWM of the CC, the main WM tract connecting the cerebral hemispheres. Tract-based spatial statistics were used to minimize misalignment. Results were correlated with scores from a battery of clinical tests focused on deficits typical of MS. Results Normal-appearing CC in pwMS showed reduced fiber fraction and increased nonrestricted isotropic fraction, with the most extensive abnormalities in secondary progressive MS (SPMS). Reduced DBSI-derived fiber fraction and increased DBSI-derived nonrestricted isotropic fraction of the CC correlated with worse cognitive scores in pwMS. Increased nonrestricted isotropic fraction in the body of the CC correlated with impaired hand function in the SPMS cohort. Conclusions DBSI fiber fraction and nonrestricted isotropic fraction were the most useful markers of injury in the NAWM CC. These 2 DBSI measures reflect axon loss in animal models. Because of its ability to reveal axonal loss, as well as demyelination, DBSI may be a useful outcome measure for trials of CNS reparative treatments.
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Affiliation(s)
- Peng Sun
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Ajit George
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Dana C Perantie
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Kathryn Trinkaus
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Zezhong Ye
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Robert T Naismith
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Sheng-Kwei Song
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Anne H Cross
- From the Radiology (P.S., A.G., Z.Y., S.-K.S.), Washington University in Saint Louis, MO; Neurology (D.C.P., R.T.N., A.H.C.), Washington University in Saint Louis, MO; and Biostatistics Shared Resource (K.T.), Washington University in Saint Louis, Siteman Cancer Center, Washington University School of Medicine, St Louis, MO.
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10
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Li CMF, Hung PSP, Chu PP, Tohyama S, Hodaie M. Trigeminal neuralgia associated with multiple sclerosis: A multimodal assessment of brainstem plaques and response to Gamma Knife radiosurgery. Mult Scler 2019; 26:1877-1888. [PMID: 31769728 DOI: 10.1177/1352458519886070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gamma Knife radiosurgery (GKRS) is a minimally invasive procedure for trigeminal neuralgia secondary to multiple sclerosis (MS-TN). Patients with MS-TN experience suboptimal response rates to treatment, and the relationship between trigeminal microstructure and treatment outcome is poorly understood. OBJECTIVE To characterize imaging features of MS-TN pain and GKRS response. METHODS 3 T diffusion-weighted imaging (DWI), T1-w, T2-w, and fluid-attenuated inversion recovery (FLAIR) sequences were acquired for 18 MS-TN patients undergoing GKRS. Brainstem plaques were standardized into a common space to determine plaque distribution. Ratio of T1-w/T2-w or "myelin maps (MM)" was generated. Multi-tensor tractography was used to delineate the radiosurgical target (RT), root entry zone (REZ), and proximal pontine segment (PPS) of the trigeminal nerves. RESULTS Laterality of MS-TN is associated with increased axial diffusivity at the PPS, whereas decreased MM at the PPS correlated with poor GKRS response. Preoperatively, GKRS responders have higher fractional anisotropy at the RT, higher axial diffusivity at the REZ, and higher MM intensities at the PPS. CONCLUSION This study demonstrates that diffusivities and MM intensities are important correlates of pain and treatment response, respectively. Overall, preoperative multimodal assessment of the central trigeminal pathway is a better indicator of GKRS response than postoperative assessment of the reduction in fractional anisotropy peripherally.
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Affiliation(s)
- Cathy Meng Fei Li
- Faculty of Medicine, University of Toronto, ON, Canada/Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter Shih-Ping Hung
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging, and Behavior-Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada/Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Powell Pw Chu
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sarasa Tohyama
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging, and Behavior-Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada/Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Mojgan Hodaie
- Faculty of Medicine, University of Toronto, ON, Canada/Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada/Division of Brain, Imaging, and Behavior-Systems Neuroscience, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
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11
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Kolasa M, Hakulinen U, Brander A, Hagman S, Dastidar P, Elovaara I, Sumelahti ML. Diffusion tensor imaging and disability progression in multiple sclerosis: A 4-year follow-up study. Brain Behav 2019; 9:e01194. [PMID: 30588771 PMCID: PMC6346728 DOI: 10.1002/brb3.1194] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Diffusion tensor imaging (DTI) is sensitive technique to detect widespread changes in water diffusivity in the normal-appearing white matter (NAWM) that appears unaffected in conventional magnetic resonance imaging. We aimed to investigate the prognostic value and stability of DTI indices in the NAWM of the brain in an assessment of disability progression in patients with a relapsing-onset multiple sclerosis (MS). METHODS Forty-six MS patients were studied for DTI indices (fractional anisotropy (FA), mean diffusivity (MD), radial (RD), and axial (AD) diffusivity) in the NAWM of the corpus callosum (CC) and the internal capsule at baseline and at 1 year after. DTI analysis for 10 healthy controls was also performed at baseline. Simultaneously, focal brain lesion volume and atrophy measurements were done at baseline for MS patients. Associations between DTI indices, volumetric measurements, and disability progression over 4 years were studied by multivariate logistic regression analysis. RESULTS At baseline, most DTI metrics differed significantly between MS patients and healthy controls. There was tendency for associations between baseline DTI indices in the CC and disability progression (p < 0.05). Changes in DTI indices over 1 year were observed only in the CC (p < 0.008), and those changes were not found to predict clinical worsening over 4 years. Clear-cut association with disability progression was not detected for baseline volumetric measurements. CONCLUSION Aberrant diffusivity measures in the NAWM of the CC may provide additional information for individual disability progression over 4 years in MS with the relapsing-onset disease. CC may be a good target for DTI measurements in monitoring disease activity in MS, and more studies are needed to assess the related prognostic potential.
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Affiliation(s)
- Marcin Kolasa
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland.,Department of Radiology, Medical Imaging Center of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Ullamari Hakulinen
- Department of Radiology, Medical Imaging Center of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland.,Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland.,Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Antti Brander
- Department of Radiology, Medical Imaging Center of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Sanna Hagman
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
| | - Prasun Dastidar
- Department of Radiology, Medical Imaging Center of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - Irina Elovaara
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
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12
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Harel A, Sperling D, Petracca M, Ntranos A, Katz-Sand I, Krieger S, Lublin F, Wang Z, Liu Y, Inglese M. Brain microstructural injury occurs in patients with RRMS despite 'no evidence of disease activity'. J Neurol Neurosurg Psychiatry 2018; 89:977-982. [PMID: 29549189 DOI: 10.1136/jnnp-2017-317606] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The accuracy of 'no evidence of disease activity' (NEDA) in predicting long-term clinical outcome in patients with relapsing remitting multiple sclerosis (RRMS) is unproven, and there is growing evidence that NEDA does not rule out disease worsening. We used diffusion tensor imaging (DTI) to investigate whether ongoing brain microstructural injury occurs in patients with RRMS meeting NEDA criteria. METHODS We performed a retrospective study to identify patients with RRMS visiting our centre over a 3-month period who had undergone prior longitudinal DTI evaluation at our facility spanning ≥2 years. Patients meeting NEDA criteria throughout the evaluation period were included in the NEDA group, and those not meeting NEDA criteria were included in an 'evidence of disease activity' (EDA) group. Fractional anisotropy (FA) and mean diffusivity (MD) maps were created, and annual rates of change were calculated. RESULTS We enrolled 85 patients, 39 meeting NEDA criteria. Both NEDA and EDA groups showed longitudinal DTI worsening. Yearly FA decrease was lower in the NEDA group (0.5%, p<0.0001) than in the EDA group (1.2%, p=0.003), while yearly MD increase was similar in both groups (0.8% for NEDA and EDA, both p<0.01). There was no statistical difference in deterioration within and outside of T2 lesions. DTI parameters correlated with disability scores and fatigue complaints. CONCLUSIONS White matter microstructural deterioration occurs in patients with RRMS over short-term follow-up in patients with NEDA, providing further evidence of the limitations of conventional measures and arguing for DTI in monitoring of the disease process.
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Affiliation(s)
- Asaff Harel
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurology, Lenox Hill Hospital, New York, USA
| | - Dylan Sperling
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria Petracca
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Achillefs Ntranos
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ilana Katz-Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen Krieger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Fred Lublin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zichen Wang
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Yangbo Liu
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Matilde Inglese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Departmentof Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Perinatal Sciences, University of Genoa andIRCCS Azienda Ospedale Università San Martino-IST, Genoa, Italy
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13
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Huang J, Liu Y, Zhao T, Shu N, Duan Y, Ren Z, Sun Z, Liu Z, Chen H, Dong H, Li K. White matter microstructural alterations in clinically isolated syndrome and multiple sclerosis. J Clin Neurosci 2018; 53:27-33. [PMID: 29754967 DOI: 10.1016/j.jocn.2018.01.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 10/26/2017] [Accepted: 01/07/2018] [Indexed: 10/16/2022]
Abstract
This study aims to determine whether and how diffusion alteration occurs in the earliest stage of multiple sclerosis (MS) and the differences in diffusion metrics between CIS and MS by using the tract-based spatial statistics (TBSS) method based on diffusion tensor imaging (DTI). Thirty-six CIS patients (mean age ± SD: 34.0 years ± 12.6), 36 relapsing-remitting multiple sclerosis (RRMS) patients (mean age ± SD: 35.0 years ± 9.4) and 36 age- and gender-matched normal controls (NCs) were included in this study. Voxel-wise analyses were performed with TBSS using multiple diffusion metrics, including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ1) and radial diffusivity (λ23). In the CIS patients, TBSS analyses revealed diffusion alterations in a few white matter (WM) regions including the anterior thalamic radiation, corticospinal tract, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, body and splenium of the corpus callosum, internal capsule, external capsule, and cerebral peduncle. MS patients showed more widespread diffusion changes (decreased FA, increased λ1, λ23 and MD) than CIS. Exploratory analyses also revealed the possible associations between WM diffusion metrics and clinical variables (Expanded Disability Status Scale and disease duration) in the patients. This study provided imaging evidence for DTI abnormalities in CIS and MS and suggested that DTI can improve our knowledge of the path physiology of CIS and MS and clinical progression.
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Affiliation(s)
- Jing Huang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Tengda Zhao
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research Beijing Normal University, Beijing 100857, PR China
| | - Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research Beijing Normal University, Beijing 100857, PR China
| | - Yunyun Duan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zhuoqiong Ren
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zheng Sun
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China
| | - Zheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Hai Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China; Brain Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, PR China.
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14
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Peterson DS, Fling BW. How changes in brain activity and connectivity are associated with motor performance in people with MS. Neuroimage Clin 2017; 17:153-162. [PMID: 29071209 PMCID: PMC5651557 DOI: 10.1016/j.nicl.2017.09.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 01/18/2023]
Abstract
People with multiple sclerosis (MS) exhibit pronounced changes in brain structure, activity, and connectivity. While considerable work has begun to elucidate how these neural changes contribute to behavior, the heterogeneity of symptoms and diagnoses makes interpretation of findings and application to clinical practice challenging. In particular, whether MS related changes in brain activity or brain connectivity protect against or contribute to worsening motor symptoms is unclear. With the recent emergence of neuromodulatory techniques that can alter neural activity in specific brain regions, it is critical to establish whether localized brain activation patterns are contributing to (i.e. maladaptive) or protecting against (i.e. adaptive) progression of motor symptoms. In this manuscript, we consolidate recent findings regarding changes in supraspinal structure and activity in people with MS and how these changes may contribute to motor performance. Furthermore, we discuss a hypothesis suggesting that increased neural activity during movement may be either adaptive or maladaptive depending on where in the brain this increase is observed. Specifically, we outline preliminary evidence suggesting sensorimotor cortex activity in the ipsilateral cortices may be maladaptive in people with MS. We also discuss future work that could supply data to support or refute this hypothesis, thus improving our understanding of this important topic.
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Affiliation(s)
- Daniel S Peterson
- Arizona State University, Tempe, AZ, USA; Veterans Affairs Phoenix Medical Center Phoenix, AZ, USA.
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15
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Wood ET, Ercan E, Sati P, Cortese ICM, Ronen I, Reich DS. Longitudinal MR spectroscopy of neurodegeneration in multiple sclerosis with diffusion of the intra-axonal constituent N-acetylaspartate. Neuroimage Clin 2017; 15:780-788. [PMID: 28702353 PMCID: PMC5496488 DOI: 10.1016/j.nicl.2017.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/08/2017] [Accepted: 06/20/2017] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis (MS) is a pathologically complex CNS disease: inflammation, demyelination, and neuroaxonal degeneration occur concurrently and may depend on one another. Current therapies are aimed at the immune-mediated, inflammatory destruction of myelin, whereas axonal degeneration is ongoing and not specifically targeted. Diffusion-weighted magnetic resonance spectroscopy can measure the diffusivity of metabolites in vivo, such as the axonal/neuronal constituent N-acetylaspartate, allowing compartment-specific assessment of disease-related changes. Previously, we found significantly lower N-acetylaspartate diffusivity in people with MS compared to healthy controls (Wood et al., 2012) suggesting that this technique can measure axonal degeneration and could be useful in developing neuroprotective agents. In this longitudinal study, we found that N-acetylaspartate diffusivity decreased by 8.3% (p < 0.05) over 6 months in participants who were experiencing clinical or MRI evidence of inflammatory activity (n = 13), whereas there was no significant change in N-acetylaspartate diffusivity in the context of clinical and radiological stability (n = 6). As N-acetylaspartate diffusivity measurements are thought to more specifically reflect the intra-axonal space, these data suggest that N-acetylaspartate diffusivity can report on axonal health on the background of multiple pathological processes in MS, both cross-sectionally and longitudinally.
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Key Words
- Axonopathy
- DW-MRS, diffusion-weighted magnetic resonance spectroscopy
- Diffusion-weighted magnetic resonance spectroscopy
- EDSS, Expanded Disability Scale Score
- HV, healthy volunteer
- ICV, intracranial volume
- MS, multiple sclerosis
- Multiple sclerosis
- NAA, N-acetylaspartate
- PASAT, Paced Auditory Symbol Addition Test
- T, Tesla
- VOI, volume of interest
- WM, white matter
- White matter
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Affiliation(s)
- Emily Turner Wood
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ece Ercan
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Pascal Sati
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Irene C M Cortese
- Neuroimmunology Clinic, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Itamar Ronen
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
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16
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Sander C, Eling P, Hanken K, Klein J, Kastrup A, Hildebrandt H. The Impact of MS-Related Cognitive Fatigue on Future Brain Parenchymal Loss and Relapse: A 17-Month Follow-up Study. Front Neurol 2016; 7:155. [PMID: 27708613 PMCID: PMC5030297 DOI: 10.3389/fneur.2016.00155] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/06/2016] [Indexed: 11/13/2022] Open
Abstract
Background Fatigue is a disabling syndrome in multiple sclerosis (MS), which may be associated with inflammation and faster disease progression. Objective To analyze the significance of cognitive fatigue for subsequent disease progression. Method We followed 46 MS patients and 14 healthy controls in a study over 17 months. At the beginning (t1) and at the end (t2) of the study participants scored their fatigue, performed the Multiple Sclerosis Functional Composite and received MRI scanning, encompassing MPR T1, FLAIR, and DTI sequences. At t1, MS patients were divided into those with and those without cognitive fatigue (cut-off score for moderate cognitive fatigue of the Fatigue Scale for Motor and Cognition). We calculated ANCOVAs for repeated measurement to analyze the relevance of cognitive fatigue status for the number of relapses and for MRI parameters. Results At t1, but not at t2, patients with cognitive fatigue showed increased axial and radial diffusivity of corpus callosum fibers. At t2, these patients showed significantly more loss of brain parenchyma and greater enlargement of lateral ventricles. Moreover, they developed more relapses, but there was no difference in lesion load or in performance deterioration. Additional analyses showed that only cognitive fatigue but not a more general score for fatigue (Fatigue Severity Scale) had an impact on the worsening of the disease status. Conclusion Patients with cognitive fatigue may develop more brain atrophy and relapses during the next 17 months than patients without cognitive fatigue. Hence, experiencing cognitive fatigue might indicate more aggressive inflammatory processes and subsequent neurodegeneration.
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Affiliation(s)
- Carina Sander
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Rehazentrum Wilhelmshaven, Wilhelmshaven, Germany
| | - Paul Eling
- Donders Institute for Brain, Cognition and Behaviour, Radboud University , Nijmegen , Netherlands
| | - Katrin Hanken
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
| | - Jan Klein
- Fraunhofer MEVIS Institute for Medical Image Computing , Bremen , Germany
| | - Andreas Kastrup
- Department of Neurology, Klinikum Bremen-Ost , Bremen , Germany
| | - Helmut Hildebrandt
- Department of Psychology, University of Oldenburg, Oldenburg, Germany; Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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17
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Applications of MR fiber tractography imaging in multiple scleros. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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18
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Kipp M, Wagenknecht N, Beyer C, Samer S, Wuerfel J, Nikoubashman O. Thalamus pathology in multiple sclerosis: from biology to clinical application. Cell Mol Life Sci 2015; 72:1127-47. [PMID: 25417212 PMCID: PMC11113280 DOI: 10.1007/s00018-014-1787-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/29/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
There is a broad consensus that MS represents more than an inflammatory disease: it harbors several characteristic aspects of a classical neurodegenerative disorder, i.e. damage to axons, synapses and nerve cell bodies. While the clinician is equipped with appropriate tools to dampen peripheral cell recruitment and, thus, is able to prevent immune-cell driven relapses, effective therapeutic options to prevent the simultaneously progressing neurodegeneration are still missing. Furthermore, while several sophisticated paraclinical methods exist to monitor the inflammatory-driven aspects of the disease, techniques to monitor progression of early neurodegeneration are still in their infancy and have not been convincingly validated. In this review article, we aim to elaborate why the thalamus with its multiple reciprocal connections is sensitive to pathological processes occurring in different brain regions, thus acting as a "barometer" for diffuse brain parenchymal damage in MS. The thalamus might be, thus, an ideal region of interest to test the effectiveness of new neuroprotective MS drugs. Especially, we will address underlying pathological mechanisms operant during thalamus degeneration in MS, such as trans-neuronal or Wallerian degeneration. Furthermore, we aim at giving an overview about different paraclinical methods used to estimate the extent of thalamic pathology in MS patients, and we discuss their limitations. Finally, thalamus involvement in different MS animal models will be described, and their relevance for the design of preclinical trials elaborated.
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Affiliation(s)
- Markus Kipp
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany,
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19
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Hanken K, Eling P, Kastrup A, Klein J, Hildebrandt H. Integrity of hypothalamic fibers and cognitive fatigue in multiple sclerosis. Mult Scler Relat Disord 2014; 4:39-46. [PMID: 25787051 DOI: 10.1016/j.msard.2014.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/31/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
Abstract
Cognitive fatigue is a common and disabling symptom of multiple sclerosis (MS), but little is known about its pathophysiology. The present study investigated whether the posterior hypothalamus, which is considered as the waking center, is associated with MS-related cognitive fatigue. We analyzed the integrity of posterior hypothalamic fibers in 49 patients with relapsing-remitting MS and 14 healthy controls. Diffusion tensor imaging (DTI) parameters were calculated for fibers between the posterior hypothalamus and, respectively, the mesencephalon, pons and prefrontal cortex. In addition, DTI parameters were computed for fibers between the anterior hypothalamus and these regions and for the corpus callosum. Cognitive fatigue was assessed using the Fatigue Scale for Motor and Cognitive Functions. Analyses of variance with repeated measures were performed to investigate the impact of cognitive fatigue on diffusion parameters. Cognitively fatigued patients (75.5%) showed a significantly lower mean axial and radial diffusivity for fibers between the posterior hypothalamus and the mesencephalon than cognitively non-fatigued patients (Group(⁎)Target area(⁎)Diffusion orientation: F=4.047; p=0.023). For fibers of the corpus callosum, MS patients presented significantly higher axial and radial diffusivity than healthy controls (Group(⁎)Diffusion orientation: F=9.904; p<0.001). Depressive mood, used as covariate, revealed significant interaction effects for anterior hypothalamic fibers (Target area(⁎)Diffusion orientation(⁎)Depression: F=5.882; p=0.021; Hemisphere(⁎)Diffusion orientation(⁎) Depression: F=8.744; p=0.008). Changes in integrity of fibers between the posterior hypothalamus and the mesencephalon appear to be associated with MS-related cognitive fatigue. These changes might cause an altered modulation of hypothalamic centers responsible for wakefulness. Furthermore, integrity of anterior hypothalamic fibers might be related to depression in MS.
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Affiliation(s)
- Katrin Hanken
- Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany
| | - Paul Eling
- Radboud University Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Andreas Kastrup
- Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany
| | - Jan Klein
- Fraunhofer-MeVis Institute, University of Bremen, Germany
| | - Helmut Hildebrandt
- Klinikum Bremen-Ost, Department of Neurology, Züricher Str. 40, 28325 Bremen, Germany; University of Oldenburg, Institute of Psychology, 26111 Oldenburg, Germany.
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20
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Lee JY, Taghian K, Petratos S. Axonal degeneration in multiple sclerosis: can we predict and prevent permanent disability? Acta Neuropathol Commun 2014; 2:97. [PMID: 25159125 PMCID: PMC4243718 DOI: 10.1186/s40478-014-0097-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/06/2014] [Indexed: 12/24/2022] Open
Abstract
Axonal degeneration is a major determinant of permanent neurological impairment during multiple sclerosis (MS). Due to the variable course of clinical disease and the heterogeneity of MS lesions, the mechanisms governing axonal degeneration may differ between disease stages. While the etiology of MS remains elusive, there now exist potential prognostic biomarkers that can predict the conversion to clinically definite MS. Specialized imaging techniques identifying axonal injury and drop-out are becoming established in clinical practice as a predictive measure of MS progression, such as optical coherence tomography (OCT) or diffusion tensor imaging (DTI). However, these imaging techniques are still being debated as predictive biomarkers since controversy surrounds their lesion-specific association with expanded disability status scale (EDSS). A more promising diagnostic measure of axonal degeneration has been argued for the detection of reduced N-acetyl aspartate (NAA) and Creatine ratios via magnetic resonance spectroscopic (MRS) imaging, but again fail with its specificity for predicting actual axonal degeneration. Greater accuracy of predictive biomarkers is therefore warranted and may include CSF neurofilament light chain (NF-L) and neurofilament heavy chain (NF-H) levels, for progressive MS. Furthermore, defining the molecular mechanisms that occur during the neurodegenerative changes in the various subgroups of MS may in fact prove vital for the future development of efficacious neuroprotective therapies. The clinical translation of a combined Na+ and Ca2+ channel blocker may lead to the establishment of a bona fide neuroprotective agent for the treatment of progressive MS. However, more specific therapeutic targets to limit axonal damage in MS need investigation and may include such integral axonal proteins such as the collapsin response mediator protein-2 (CRMP-2), a molecule which upon post-translational modification may propagate axonal degeneration in MS. In this review, we discuss the current clinical determinants of axonal damage in MS and consider the cellular and molecular mechanisms that may initiate these neurodegenerative changes. In particular we highlight the therapeutic candidates that may formulate novel therapeutic strategies to limit axonal degeneration and EDSS during progressive MS.
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21
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Laukka JJ, Makki MI, Lafleur T, Stanley J, Kamholz J, Garbern JY. Diffusion tensor imaging of patients with proteolipid protein 1 gene mutations. J Neurosci Res 2014; 92:1723-32. [PMID: 25156430 DOI: 10.1002/jnr.23458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/10/2014] [Accepted: 07/05/2014] [Indexed: 11/08/2022]
Abstract
Pelizaeus-Merzbacher disease (PMD) is an X-linked disorder of the central nervous system (CNS) caused by a wide variety of mutations affecting proteolipid protein 1 (PLP1). We assessed the effects of PLP1 mutations on water diffusion in CNS white matter by using diffusion tensor imaging. Twelve patients with different PLP1 point mutations encompassing a range of clinical phenotypes were analyzed, and the results were compared with a group of 12 age-matched controls. The parallel (λ// ), perpendicular (λ⊥ ), and apparent diffusion coefficients (ADC) and fractional anisotropy were measured in both limbs of the internal capsule, the genu and splenium of corpus callosum, the base of the pons, and the cerebral peduncles. The mean ADC and λ⊥ in the PMD patient group were both significantly increased in all selected structures, except for the base of the pons, compared with controls. PMD patients with the most severe disease, however, had a significant increase of both λ// and λ⊥ . In contrast, more mildly affected patients had much smaller changes in λ// and λ⊥ . These data suggest that myelin, the structure responsible in part for the λ⊥ barrier, is the major site of disease pathogenesis in this heterogeneous group of patients. Axons, in contrast, the structures mainly responsible for λ// , are much less affected, except within the subgroup of patients with the most severe disease. Clinical disability in patients with PLP1 point mutation is thus likely determined by the extent of pathological involvement of both myelin and axons, with alterations of both structures causing the most severe disease. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Jeremy J Laukka
- Department of Neuroscience, University of Toledo, Toledo, Ohio; Center of Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
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22
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DTI Measurements in Multiple Sclerosis: Evaluation of Brain Damage and Clinical Implications. Mult Scler Int 2013; 2013:671730. [PMID: 23606965 PMCID: PMC3628664 DOI: 10.1155/2013/671730] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 02/20/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Diffusion tensor imaging (DTI) is an effective means of quantifying parameters of demyelination and axonal loss. The application of DTI in Multiple Sclerosis (MS) has yielded noteworthy results. DTI abnormalities, which are already detectable in patients with clinically isolated syndrome (CIS), become more pronounced as disease duration and neurological impairment increase. The assessment of the microstructural alterations of white and grey matter in MS may shed light on mechanisms responsible for irreversible disability accumulation. In this paper, we examine the DTI analysis methods, the results obtained in the various tissues of the central nervous system, and correlations with clinical features and other MRI parameters. The adoption of DTI metrics to assess the outcome of prognostic measures may represent an extremely important step forward in the MS research field.
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23
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Neural correlates of stimulus response and stimulus outcome shifting in healthy participants and MS patients. Brain Cogn 2013; 81:57-66. [DOI: 10.1016/j.bandc.2012.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/29/2012] [Accepted: 10/02/2012] [Indexed: 11/17/2022]
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24
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Tract-specific quantitative MRI better correlates with disability than conventional MRI in multiple sclerosis. J Neurol 2012; 260:397-406. [PMID: 22886062 DOI: 10.1007/s00415-012-6638-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 07/19/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
Although diffusion tensor imaging (DTI) and the magnetization transfer ratio (MTR) have been extensively studied in multiple sclerosis (MS), it is still unclear if they are more effective biomarkers of disability than conventional MRI. MRI scans were performed on 117 participants with MS in addition to 26 healthy volunteers. Mean values were obtained for DTI indices and MTR for supratentorial brain and three white matter tracts of interest. DTI and MTR values were tested for correlations with measures of atrophy and lesion volume and were compared with these more conventional indices for prediction of disability. All DTI and MTR values correlated to an equivalent degree with lesion volume and cerebral volume fraction (CVF). Thalamic volumes correlated with all indices in the optic radiations and with mean and perpendicular diffusivity in the corpus callosum. Nested model regression analysis demonstrated that, compared with CVF, DTI indices in the optic radiations were more strongly correlated with Expanded Disability Status Scale and were also more strongly correlated than both CVF and lesion volume with low-contrast visual acuity. Abnormalities in DTI and MTR are equivalently linked with brain atrophy and inflammatory lesion burden, suggesting that for practical purposes they are markers of multiple aspects of MS pathology. Our findings that some DTI and MTR indices are more strongly linked with disability than conventional MRI measures justifies their potential use as targeted, functional system-specific clinical trial outcomes in MS.
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Tamm L, Barnea-Goraly N, Reiss A. Diffusion tensor imaging reveals white matter abnormalities in Attention-Deficit/Hyperactivity Disorder. Psychiatry Res 2012; 202:150-4. [PMID: 22703620 PMCID: PMC3398227 DOI: 10.1016/j.pscychresns.2012.04.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 11/26/2022]
Abstract
The specific brain structures or neural mechanisms underlying dysfunction in individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) are not well established, particularly in regard to white matter (WM). Diffusion tensor imaging (DTI) was used to investigate WM in 12 adolescent males diagnosed with ADHD only and 12 typically developing controls (group matched; mean age=15.64 years, SD=1.15). In addition to fractional anisotropy (FA), we also examined axial and radial diffusivity (AD and RD) in an effort to help elucidate conflicting findings suggesting that both lower and higher FA values are characteristic of ADHD. Tract-based spatial statistics and voxel-wide analyses were conducted on the data utilizing a pre-frontal mask to enable focus on fronto-striatal and prefrontal pathways. Adolescents with ADHD had significantly higher FA and AD values in fronto-striatal pathways compared with controls. No differences were observed for RD. These results contribute to the growing literature implicating prefrontal WM variations in neuropsychiatric disorders, and are consistent with findings suggesting a role for fronto-striatal pathways in ADHD pathophysiology.
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Affiliation(s)
- Leanne Tamm
- Center for ADHD, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Naama Barnea-Goraly
- Center for Interdisciplinary Brain Sciences Research, Stanford University, California, United States
| | - Allan Reiss
- Center for Interdisciplinary Brain Sciences Research, Stanford University, California, United States
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Hasan KM, Walimuni IS, Abid H, Datta S, Wolinsky JS, Narayana PA. Human brain atlas-based multimodal MRI analysis of volumetry, diffusimetry, relaxometry and lesion distribution in multiple sclerosis patients and healthy adult controls: implications for understanding the pathogenesis of multiple sclerosis and consolidation of quantitative MRI results in MS. J Neurol Sci 2011; 313:99-109. [PMID: 21978603 DOI: 10.1016/j.jns.2011.09.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/31/2011] [Accepted: 09/13/2011] [Indexed: 01/18/2023]
Abstract
Multiple sclerosis (MS) is the most common immune-mediated disabling neurological disease of the central nervous system. The pathogenesis of MS is not fully understood. Histopathology implicates both demyelination and axonal degeneration as the major contributors to the accumulation of disability. The application of several in vivo quantitative magnetic resonance imaging (MRI) methods to both lesioned and normal-appearing brain tissue has not yet provided a solid conclusive support of the hypothesis that MS might be a diffuse disease. In this work, we adopted FreeSurfer to provide standardized macrostructure or volumetry of lesion free normal-appearing brain tissue in combination with multiple quantitative MRI metrics (T(2) relaxation time, diffusion tensor anisotropy and diffusivities) that characterize tissue microstructural integrity. By incorporating a large number of healthy controls, we have attempted to separate the natural age-related change from the disease-induced effects. Our work shows elevation in diffusivity and relaxation times and reduction in volume in a number of normal-appearing white matter and gray matter structures in relapsing-remitting multiple sclerosis patients. These changes were related in part with the spatial distribution of lesions. The whole brain lesion load and age-adjusted expanded disability status score showed strongest correlations in regions such as corpus callosum with qMRI metrics that are believed to be specific markers of axonal dysfunction, consistent with histologic data of others indicating axonal loss that is independent of focal lesions. Our results support that MS at least in part has a neurodegenerative component.
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Affiliation(s)
- Khader M Hasan
- The University of Texas Health Science Center at Houston, Department of Diagnostic & Interventional Imaging, 6431 Fannin Street, MSB 2.100, Houston, Texas 77030, USA.
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Bonzano L, Tacchino A, Roccatagliata L, Sormani M, Mancardi G, Bove M. Impairment in explicit visuomotor sequence learning is related to loss of microstructural integrity of the corpus callosum in multiple sclerosis patients with minimal disability. Neuroimage 2011; 57:495-501. [DOI: 10.1016/j.neuroimage.2011.04.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 04/18/2011] [Accepted: 04/19/2011] [Indexed: 11/26/2022] Open
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Jurkiewicz E, Kotulska K. [Neuroimaging of multiple sclerosis in children]. Neurol Neurochir Pol 2011; 45:152-60. [PMID: 21574120 DOI: 10.1016/s0028-3843(14)60027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There is an increasing appreciation that multiple sclerosis (MS) can affect children. Up to 10% of MS patients experience their first symptoms before the age of 16. The natural history and magnetic resonance imaging of MS in child-hood differ from those observed in adult patients. The differential diagnosis of MS in children should also encompass some paediatric diseases. Recently, the diagnostic criteria for MS in children were published. Due to the high frequency of relapses and the risk of disability at a young age, early diagnosis and treatment of MS in children is very important. This work presents recent data regarding epidemiology, pathogenesis and diagnosis of MS in children, including the role of neuroimaging in the diagnosis of childhood multiple sclerosis.
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Affiliation(s)
- Elżbieta Jurkiewicz
- Instytut "Pomnik - Centrum Zdrowia Dziecka", Al. Dzieci Polskich 20, 04-730 Warszawa.
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Shu N, Liu Y, Li K, Duan Y, Wang J, Yu C, Dong H, Ye J, He Y. Diffusion tensor tractography reveals disrupted topological efficiency in white matter structural networks in multiple sclerosis. ACTA ACUST UNITED AC 2011; 21:2565-77. [PMID: 21467209 DOI: 10.1093/cercor/bhr039] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is currently known about the alterations in the topological organization of the white matter (WM) structural networks in patients with multiple sclerosis (MS). In the present study, we used diffusion tensor imaging and deterministic tractography to map the WM structural networks in 39 MS patients and 39 age- and gender-matched healthy controls. Graph theoretical methods were applied to investigate alterations in the network efficiency in these patients. The MS patients and the controls exhibited efficient small-world properties in their WM structural networks. However, the global and local network efficiencies were significantly decreased in the MS patients compared with the controls, with the most pronounced changes observed in the sensorimotor, visual, default-mode, and language areas. Furthermore, the decreased network efficiencies were significantly correlated with the expanded disability status scale scores, the disease durations, and the total WM lesion loads. Together, the results suggest a disrupted integrity in the large-scale brain systems in MS, thus providing new insights into the understanding of MS connectome. Our data also suggest that a topology-based brain network analysis can provide potential biomarkers for disease diagnosis and for monitoring the progression and treatment effects for patients with MS.
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Affiliation(s)
- Ni Shu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing 100875, China
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30
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Grabner G, Dal-Bianco A, Schernthaner M, Vass K, Lassmann H, Trattnig S. Analysis of multiple sclerosis lesions using a fusion of 3.0 T FLAIR and 7.0 T SWI phase: FLAIR SWI. J Magn Reson Imaging 2011; 33:543-9. [DOI: 10.1002/jmri.22452] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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31
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Harrison DM, Caffo BS, Shiee N, Farrell JAD, Bazin PL, Farrell SK, Ratchford JN, Calabresi PA, Reich DS. Longitudinal changes in diffusion tensor-based quantitative MRI in multiple sclerosis. Neurology 2011; 76:179-86. [PMID: 21220722 DOI: 10.1212/wnl.0b013e318206ca61] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To estimate longitudinal changes in a quantitative whole-brain and tract-specific MRI study of multiple sclerosis (MS), with the intent of assessing the feasibility of this approach in clinical trials. METHODS A total of 78 individuals with MS underwent a median of 3 scans over 2 years. Diffusion tensor imaging indices, magnetization transfer ratio, and T2 relaxation time were analyzed in supratentorial brain, corpus callosum, optic radiations, and corticospinal tracts by atlas-based tractography. Linear mixed-effect models estimated annualized rates of change for each index, and sample size estimates for potential clinical trials were determined. RESULTS There were significant changes over time in fractional anisotropy and perpendicular diffusivity in the supratentorial brain and corpus callosum, mean diffusivity in the supratentorial brain, and magnetization transfer ratio in all areas studied. Changes were most rapid in the corpus callosum, where fractional anisotropy decreased 1.7% per year, perpendicular diffusivity increased 1.2% per year, and magnetization transfer ratio decreased 0.9% per year. The T2 relaxation time changed more rapidly than diffusion tensor imaging indices and magnetization transfer ratio but had higher within-participant variability. Magnetization transfer ratio in the corpus callosum and supratentorial brain declined at an accelerated rate in progressive MS relative to relapsing-remitting MS. Power analysis yielded reasonable sample sizes (on the order of 40 participants per arm or fewer) for 1- or 2-year trials. CONCLUSIONS Longitudinal changes in whole-brain and tract-specific diffusion tensor imaging indices and magnetization transfer ratio can be reliably quantified, suggesting that small clinical trials using these outcome measures are feasible.
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Affiliation(s)
- D M Harrison
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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