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Elkhooly M, Bao F, Raghib M, Millis S, Bernitsas E. Role of white matter in cognitive impairment among relapsing remitting multiple sclerosis patients. Mult Scler Relat Disord 2023; 79:105030. [PMID: 37837669 DOI: 10.1016/j.msard.2023.105030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/14/2023] [Accepted: 09/23/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Multiple Sclerosis (MS) associated cognitive impairment is believed to be mostly connected with damage to gray matter. The contribution of white matter is still poorly understood. We aim to examine the relationship between cognition and white matter tracts among relapsing remitting MS (RRMS) patients. METHODS Thirty RRMS patients were selected undergo the (3-seconds-interstimulus-interval paced auditory serial addition test) PASAT-3, the (symbol digit modalities test (SDMT) and full-brain MRI scans on a SIEMENS 3 Tesla Verio scanner. Diffusion Tensor Imaging (DTI) parameters, such as fractional anisotropy (FA) and mean diffusivity (MD) were examined in 37 white matter (WM) tracts. WM tracts were selected from the association pathways, projection pathways, commissural pathways by applying Human Connectome project (HCP)842 tractography atlas after DTI data reconstruction and registration to HCP1065 diffusion template in DSI Studio (version March 2021) In SPSS v26, Spearman's rank correlation analysis was used to examine the connection between DTI WM tracts and cognitive scores. The power of the study was increased by using false discovery rate (FDR) software. RESULTS The mean scores on the PASAT-3 and SDMT were 31.5 ± 12.8 and 46.9 ± 16.7 respectively. Better cognitive performance was correlated to higher FA values, while lower cognitive function was correlated to higher MD values. There was a positive correlation between FA values in the right medial lemniscus and superior cerebellar peduncle and SDMT scores (p 0.05). Additionally, there was a trend for significance between the FA values in the left corticothalamic tract and SDMT scores. MD values in the superior cerebellar peduncle, left arcuate Fasciculus and left extreme capsule were negatively correlated with SDMT scores (p<0.05). PASAT-3 scores were negatively correlated with MD values in the right cerebellum, however, there was no significant correlation between PASAT-3 and FA values. CONCLUSIONS White matter tracts, particularly the superior cerebellar peduncle, contribute to the cognitive impairment in RRMS. Larger sample sizes for longitudinal research are necessary.
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Affiliation(s)
- Mahmoud Elkhooly
- Neurology Department, Wayne State University, Detroit, MI 48201, USA; Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Fen Bao
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
| | - Muhammad Raghib
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
| | - Scott Millis
- Neurology Department, Wayne State University, Detroit, MI 48201, USA
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York EN, Thrippleton MJ, Meijboom R, Hunt DPJ, Waldman AD. Quantitative magnetization transfer imaging in relapsing-remitting multiple sclerosis: a systematic review and meta-analysis. Brain Commun 2022; 4:fcac088. [PMID: 35652121 PMCID: PMC9149789 DOI: 10.1093/braincomms/fcac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Myelin-sensitive MRI such as magnetization transfer imaging has been widely used in multiple sclerosis. The influence of methodology and differences in disease subtype on imaging findings is, however, not well established. Here, we systematically review magnetization transfer brain imaging findings in relapsing-remitting multiple sclerosis. We examine how methodological differences, disease effects and their interaction influence magnetization transfer imaging measures. Articles published before 06/01/2021 were retrieved from online databases (PubMed, EMBASE and Web of Science) with search terms including 'magnetization transfer' and 'brain' for systematic review, according to a pre-defined protocol. Only studies that used human in vivo quantitative magnetization transfer imaging in adults with relapsing-remitting multiple sclerosis (with or without healthy controls) were included. Additional data from relapsing-remitting multiple sclerosis subjects acquired in other studies comprising mixed disease subtypes were included in meta-analyses. Data including sample size, MRI acquisition protocol parameters, treatments and clinical findings were extracted and qualitatively synthesized. Where possible, effect sizes were calculated for meta-analyses to determine magnetization transfer (i) differences between patients and healthy controls; (ii) longitudinal change and (iii) relationships with clinical disability in relapsing-remitting multiple sclerosis. Eighty-six studies met inclusion criteria. MRI acquisition parameters varied widely, and were also underreported. The majority of studies examined the magnetization transfer ratio in white matter, but magnetization transfer metrics, brain regions examined and results were heterogeneous. The analysis demonstrated a risk of bias due to selective reporting and small sample sizes. The pooled random-effects meta-analysis across all brain compartments revealed magnetization transfer ratio was 1.17 per cent units (95% CI -1.42 to -0.91) lower in relapsing-remitting multiple sclerosis than healthy controls (z-value: -8.99, P < 0.001, 46 studies). Linear mixed-model analysis did not show a significant longitudinal change in magnetization transfer ratio across all brain regions [β = 0.12 (-0.56 to 0.80), t-value = 0.35, P = 0.724, 14 studies] or normal-appearing white matter alone [β = 0.037 (-0.14 to 0.22), t-value = 0.41, P = 0.68, eight studies]. There was a significant negative association between the magnetization transfer ratio and clinical disability, as assessed by the Expanded Disability Status Scale [r = -0.32 (95% CI -0.46 to -0.17); z-value = -4.33, P < 0.001, 13 studies]. Evidence suggests that magnetization transfer imaging metrics are sensitive to pathological brain changes in relapsing-remitting multiple sclerosis, although effect sizes were small in comparison to inter-study variability. Recommendations include: better harmonized magnetization transfer acquisition protocols with detailed methodological reporting standards; larger, well-phenotyped cohorts, including healthy controls; and, further exploration of techniques such as magnetization transfer saturation or inhomogeneous magnetization transfer ratio.
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Affiliation(s)
- Elizabeth N. York
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | | | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | - David P. J. Hunt
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic,
University of Edinburgh, Edinburgh, UK
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
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Edwards EM, Wu W, Fritz NE. Using Myelin Water Imaging to Link Underlying Pathology to Clinical Function in Multiple Sclerosis: A Scoping Review. Mult Scler Relat Disord 2022; 59:103646. [DOI: 10.1016/j.msard.2022.103646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/14/2021] [Accepted: 01/29/2022] [Indexed: 12/28/2022]
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Quantitative evaluation of callosal abnormalities in relapsing-remitting multiple sclerosis using diffusion tensor imaging: A systemic review and meta-analysis. Clin Neurol Neurosurg 2021; 201:106442. [DOI: 10.1016/j.clineuro.2020.106442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 01/13/2023]
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Norimoto M, Eguchi Y, Kanamoto H, Oikawa Y, Matsumoto K, Masuda Y, Furuya T, Orita S, Inage K, Maki S, Shiga Y, Kinoshita H, Abe K, Inoue M, Umimura T, Sato T, Sato M, Suzuki M, Enomoto K, Ohtori S. Diffusion Tensor Imaging of the Spinal Canal in Quantitative Assessment of Patients with Lumbar Spinal Canal Stenosis. Asian Spine J 2020; 15:207-215. [PMID: 32872759 PMCID: PMC8055456 DOI: 10.31616/asj.2020.0026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/10/2020] [Indexed: 12/05/2022] Open
Abstract
Study Design Retrospective observational study. Purpose Lumbar spinal stenosis (LSS) has traditionally been evaluated morphologically, there is a paucity of literature on quantitative assessment of LSS. The purpose of this study was to investigate whether intraspinal diffusion tensor imaging (DTI) parameters such as apparent diffusion coefficient (ADC) and fractional anisotropy (FA) are useful for assessing LSS. Overview of Literature Quantitative assessment of LSS is challenging. Methods Study participants comprised five healthy volunteers (mean age, 27.2 years) and 27 patients with LSS (mean age, 58.4 years) who were individually assessed using 3.0 Tesla magnetic resonance imaging. Intraspinal ADC and FA values of 10 intervertebral discs from healthy volunteers and 52 intervertebral discs from LSS patients were measured. Also, intraspinal canal area, Schizas classification (A: normal, B: mild stenosis, C: severe stenosis) and correlations with symptoms were investigated. Clinical symptoms were checked for the presence of low back pain (LBP), intermittent claudication (IMC), and bladder and bowel dysfunction (BBD). Results Compared to healthy individuals, LSS patients had significantly lower ADC (p<0.05) and significantly higher FA values (p<0.01). In Schizas classification, stenosis worsened from A to C. ADC values decreased significantly while FA values increased significantly in that order (p<0.05). A positive correlation was found between intraspinal canal area and ADC values (r=0.63, p<0.01) and a negative correlation between intraspinal canal area and FA values (p=−0.61, p<0.01). No correlations were noted between LBP and ADC or FA values. On the other hand, ADC values were significantly lower (p<0.05) and FA values were significantly higher (p<0.05) in patients with IMC or BBD. Conclusions Intraspinal DTI parameters such as ADC and FA values were associated with the Schizas classification, intraspinal canal area, and clinical symptoms, suggesting that ADC and FA may be useful for quantitative assessment of LSS.
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Affiliation(s)
- Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | | | - Yasuhiro Oikawa
- Department of Orthopaedic Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Sato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keigo Enomoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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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: 11] [Impact Index Per Article: 2.8] [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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Kanamoto H, Norimoto M, Eguchi Y, Oikawa Y, Orita S, Inage K, Abe K, Inoue M, Kinoshita H, Umimura T, Matsumoto K, Masuda Y, Furuya T, Koda M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. Evaluating Spinal Canal Lesions Using Apparent Diffusion Coefficient Maps with Diffusion-Weighted Imaging. Asian Spine J 2020; 14:312-319. [PMID: 32050309 PMCID: PMC7280930 DOI: 10.31616/asj.2019.0266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Observational study. PURPOSE To evaluate healthy volunteers and patients with spinal canal lesions using apparent diffusion coefficient (ADC) maps with diffusion-weighted imaging. OVERVIEW OF LITERATURE Decompression surgery for lumbar spinal stenosis (LSS) is selected on the basis of subjective assessment and cross-sectional magnetic resonance imaging (MRI). However, there is no objective standard for this procedure. METHODS We performed 3T MRI in 10 healthy volunteers and 13 patients with LSS. The ADC values in the spinal canal were evaluated at 46 vertebrae (L4/5 and L5/S1 for each participant), and the reduced and conventional fields of view were compared. RESULTS The ADC values were 2.72±0.12 at L4/5 in healthy volunteers, 2.76±0.19 at L5/S1 in healthy volunteers, 1.77±0.58 at L4/5 in patients with LSS, and 2.35±0.29 at L5/S1 in patients with LSS. The ADC value at L4/5 in patients with LSS was significantly lower than that at L5/S1 in patients with LSS and that at L4/5 and L5/S1 in healthy volunteers (p <0.05). With an ADC cutoff value of 2.46 to identify LSS, this approach provided an area under the curve of 0.81, sensitivity of 0.92, and specificity of 0.76 (p <0.05). CONCLUSIONS Preoperative examination using ADC maps permits visualization and quantification of spinal canal lesions, thus proving the utility of ADC maps in the selection of decompression surgery for LSS.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaki Norimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Yasuhiro Oikawa
- Division of Orthopaedic Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideyuki Kinoshita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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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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Zhou M, Niu C, Jia L, He H. The value of MGMT promote methylation and IDH-1 mutation on diagnosis of pseudoprogression in patients with high-grade glioma: A meta-analysis. Medicine (Baltimore) 2019; 98:e18194. [PMID: 31852075 PMCID: PMC6922590 DOI: 10.1097/md.0000000000018194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To date, there are several published studies on the value of IDH-1 (isocitrate dehydrogenase-1) mutation and MGMT (O6-Methylguanine-DNA methyltransferas) promoter methylated status on the diagnosis of pseudoprogression (PSP) and true tumor progression after or within chemo-radiotherapy of high grade glioma (HGG). We performed a meta-analysis about the significant value of these 2 molecular markers on the diagnosis of PsP in high- grade glioma. METHODS We searched the eligible studies from PubMed, Medline, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI) and Wan Fang Database. The relevant studies published before October 2018 were identified. ORs (odds ratios) with 95%CIs (confidence intervals) were used to evaluate the value using fixed- or random-effect model. RESULTS Thirteen studies about MGMT promoter methylated status and 4 studies about IDH-1 mutations were found eligible for this present meta-analysis. Significant value of MGMT promoter methylation status (OR = 4.02, 95%CI = 2.76-5.87, P < .001) and IDH-1 mutations (OR = 12.78, 95%CI = 3.86-42.35, P < .001) were observed. CONCLUSIONS This meta-analysis provided evidences that MGMT promoter methylation status and IDH-1 mutations could distinguish PSP from true tumor progression.
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Affiliation(s)
- Min Zhou
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
- Anhui Provincial Stereotactic Neurosurgical Institute
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, PR China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
- Anhui Provincial Stereotactic Neurosurgical Institute
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, PR China
| | - Li Jia
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
- Anhui Provincial Stereotactic Neurosurgical Institute
| | - Hu He
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China
- Anhui Provincial Stereotactic Neurosurgical Institute
- Anhui Province Key Laboratory of Brain Function and Brain Disease, Hefei, Anhui, PR China
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Abel S, Vavasour I, Lee LE, Johnson P, Ackermans N, Chan J, Dvorak A, Schabas A, Wiggermann V, Tam R, Kuan AJ, Morrow SA, Wilken J, Laule C, Rauscher A, Bhan V, Sayao AL, Devonshire V, Li DK, Carruthers R, Traboulsee A, Kolind SH. Myelin Damage in Normal Appearing White Matter Contributes to Impaired Cognitive Processing Speed in Multiple Sclerosis. J Neuroimaging 2019; 30:205-211. [PMID: 31762132 DOI: 10.1111/jon.12679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is a core symptom in multiple sclerosis (MS). Damage to normal appearing white matter (NAWM) is likely involved. We sought to determine if greater myelin heterogeneity in NAWM is associated with decreased cognitive performance in MS. METHODS A total of 27 participants with MS and 13 controls matched for age, sex, and education underwent myelin water imaging (MWI) from which the myelin water fraction (MWF) was calculated. Corpus callosum, superior longitudinal fasciculus, and cingulum were chosen as regions of interest (ROIs) a priori based on their involvement in MS-related cognitive impairment. Cognitive performance was assessed using the Symbol Digit Modalities Test (SDMT). Pearson ́s product moment correlations were performed to assess relationships between cognitive performance and myelin heterogeneity (variance of MWF within an ROI). RESULTS In MS, myelin heterogeneity in all three ROIs was significantly associated with performance on the SDMT. These correlations ranged from moderate (r = -.561) to moderately strong (r = -.654) and were highly significant (P values ranged from .001 to .0002). Conversely, myelin heterogeneity was not associated with SDMT performance in controls in any ROI (P > .108). CONCLUSION Increased myelin heterogeneity in NAWM is associated with decreased cognitive processing speed performance in MS.
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Affiliation(s)
- Shawna Abel
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Irene Vavasour
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Eunyoung Lee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Poljanka Johnson
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathalie Ackermans
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jillian Chan
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Dvorak
- Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alice Schabas
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Wiggermann
- Department of Physics and Astronomy and Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roger Tam
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie J Kuan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Jeffrey Wilken
- Department of Neurology and Washington Neuropsychology Research Group, Georgetown University Hospital, LLC, Fairfax, VA
| | - Cornelia Laule
- Department of Radiology Pathology & Laboratory Medicine, Physics & Astronomy and International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Virender Bhan
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana-Luiza Sayao
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Virginia Devonshire
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - David Kb Li
- Department of Radiology and Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Carruthers
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Traboulsee
- Department of Medicine (Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon H Kolind
- Department of Medicine (Neurology), Radiology, Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Manca R, Sharrack B, Paling D, Wilkinson ID, Venneri A. Brain connectivity and cognitive processing speed in multiple sclerosis: A systematic review. J Neurol Sci 2018; 388:115-127. [PMID: 29627004 DOI: 10.1016/j.jns.2018.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/06/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Processing speed (PS) decline is the most commonly observed cognitive deficit in people with multiple sclerosis (MS) resulting in a significant impact on quality of life. Despite its importance, knowledge of the underlying neural substrates is lacking. OBJECTIVE As MS is increasingly recognised as a disconnection syndrome, our aim was to carry out a systematic literature review to clarify the relationship between PS performance and MRI measures of structural and functional brain connectivity in people with MS. SEARCH METHODS A literature search was carried out on PubMed and Web of Science that included publications predating September 2017. Additional articles were added after inspection of the reference lists of all selected papers. DATA EXTRACTION All selected papers were categorised in three sections according to the MRI measures investigated, independently or both. Quality assessment was carried out using a customised set of criteria. RESULTS Thirty-two articles met the inclusion criteria and were included in the review. Microstructural integrity of the anterior corpus callosum and functional connectivity of frontal areas were more consistently found to correlate with PS performance, though high variability of findings was observed across studies. Several methodological flaws emerged from the reviewed literature. CONCLUSIONS Despite the observed trends, no definite conclusions can be drawn on the relationship between brain connectivity and PS decline in MS given the limitations of the current literature. Future investigations may benefit from theoretical and methodological advances to clarify how MS-related brain damage affects patients' cognition.
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Affiliation(s)
- Riccardo Manca
- Department of Neurosciences, University of Sheffield, Sheffield, UK
| | - Basil Sharrack
- Department of Neurosciences, University of Sheffield, Sheffield, UK; Department of Neurology, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - David Paling
- Department of Neurosciences, University of Sheffield, Sheffield, UK; Department of Neurology, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - Iain D Wilkinson
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Annalena Venneri
- Department of Neurosciences, University of Sheffield, Sheffield, UK.
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12
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Eguchi Y, Kanamoto H, Oikawa Y, Suzuki M, Yamanaka H, Tamai H, Kobayashi T, Orita S, Yamauchi K, Suzuki M, Inage K, Aoki Y, Watanabe A, Furuya T, Koda M, Takahashi K, Ohtori S. Recent advances in magnetic resonance neuroimaging of lumbar nerve to clinical applications: A review of clinical studies utilizing Diffusion Tensor Imaging and Diffusion-weighted magnetic resonance neurography. Spine Surg Relat Res 2017; 1:61-71. [PMID: 31440614 PMCID: PMC6698557 DOI: 10.22603/ssrr.1.2016-0015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/30/2016] [Indexed: 11/05/2022] Open
Abstract
Much progress has been made in neuroimaging with Magnetic Resonance neurography and Diffusion Tensor Imaging (DTI) owing to higher magnetic fields and improvements in pulse sequence technology. Reports on lumbar nerve DTI have also increased considerably. Many studies have shown that the use of DTI in lumbar nerve lesions, such as lumbar foraminal stenosis and lumbar disc herniation, makes it possible to capture images of interruptions of tractography at stenotic sties, enabling the diagnosis of stenosis. DTI can also reveal significant decreases in fractional anisotropy (FA) with significant increases in apparent diffusion coefficient (ADC) values in compression lesions. FA values have higher accuracy than ADC values. Furthermore, strong correlations exist between FA values and indications of neurological severity, including the Japanese Orthopedic Association (JOA) score, the Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ) in patients with lumbar disc herniation-induced radiculopathy. Most lumbar DTI has become 3T; 3T MRI has made it possible to take high-resolution DTI measurements in a short period of time. However, increased motion artifacts in the magnetic susceptibility effect lead to signal irregularities and image distortion. In the future, high-resolution DTI with reduced field-of-view may become useful in clinical applications, since visualization of nerve lesions and quantification of DTI parameters could allow more accurate diagnoses of lumbar nerve dysfunctions. Future translational studies will be necessary to successfully bring MR neuroimaging of lumbar nerve into clinical use.
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Affiliation(s)
- Yawara Eguchi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Hirohito Kanamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Yasuhiro Oikawa
- Division of Orthopaedic Surgery, Chiba Children's Hospital, Japan
| | - Munetaka Suzuki
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Hajime Yamanaka
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Hiroshi Tamai
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Tatsuya Kobayashi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Kazuyo Yamauchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Miyako Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Masao Koda
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Japan
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13
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Uher T, Krasensky J, Sobisek L, Blahova Dusankova J, Seidl Z, Kubala Havrdova E, Sormani MP, Horakova D, Kalincik T, Vaneckova M. Cognitive clinico-radiological paradox in early stages of multiple sclerosis. Ann Clin Transl Neurol 2017; 5:81-91. [PMID: 29376094 PMCID: PMC5771324 DOI: 10.1002/acn3.512] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate whether the strength of the association between magnetic resonance imaging (MRI) metrics and cognitive outcomes differs between various multiple sclerosis subpopulations. Methods A total of 1052 patients were included in this large cross‐sectional study. Brain MRI (T1 and T2 lesion volume and brain parenchymal fraction) and neuropsychological assessment (Brief International Cognitive Assessment for Multiple Sclerosis and Paced Auditory Serial Addition Test) were performed. Results Weak correlations between cognitive domains and MRI measures were observed in younger patients (age≤30 years; absolute Spearman's rho = 0.05–0.21), with short disease duration (<2 years; rho = 0.01–0.21), low Expanded Disability Status Scale [EDSS] (≤1.5; rho = 0.08–0.18), low T2 lesion volume (lowest quartile; <0.59 mL; rho = 0.01–0.20), and high brain parenchymal fraction (highest quartile; >86.66; rho = 0.01–0.16). Stronger correlations between cognitive domains and MRI measures were observed in older patients (age>50 years; rho = 0.24–0.50), with longer disease duration (>15 years; rho = 0.26–0.53), higher EDSS (≥5.0; rho = 0.23–0.39), greater T2 lesion volume (highest quartile; >5.33 mL; rho = 0.16–0.32), and lower brain parenchymal fraction (lowest quartile; <83.71; rho = 0.13–0.46). The majority of these observed results were confirmed by significant interactions (P ≤ 0.01) using continuous variables. Interpretation The association between structural brain damage and functional cognitive impairment is substantially weaker in multiple sclerosis patients with a low disease burden. Therefore, disease stage should be taken into consideration when interpreting associations between structural and cognitive measures in clinical trials, research studies, and clinical practice.
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Affiliation(s)
- Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Jan Krasensky
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Lukas Sobisek
- Department of Statistics and Probability University of Economics in Prague Prague Czech Republic
| | - Jana Blahova Dusankova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Zdenek Seidl
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Tomas Kalincik
- CORe Department of Medicine University of Melbourne Melbourne Australia.,Department of Neurology Royal Melbourne Hospital Melbourne Australia
| | - Manuela Vaneckova
- Department of Radiodiagnostic First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
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14
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Kanamoto H, Eguchi Y, Oikawa Y, Orita S, Inage K, Fujimoto K, Shiga Y, Abe K, Inoue M, Kinoshita H, Matsumoto K, Masuda Y, Furuya T, Koda M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. Visualization of lumbar nerves using reduced field of view diffusion tensor imaging in healthy volunteers and patients with degenerative lumbar disorders. Br J Radiol 2017; 90:20160929. [PMID: 28937274 PMCID: PMC6047648 DOI: 10.1259/bjr.20160929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 08/08/2017] [Accepted: 08/31/2017] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated high resolution diffusion tensor imaging (DTI) of lumbar nerves with reduced field of view (rFOV) using 3 T MRI. METHODS DTI measured with rFOV was compared with conventional FOV (cFOV) 3.0 T MRI in 5 healthy volunteers and 10 patients with degenerative lumbar disorders. The intracanal, foramina and extraforamina of the L5 nerve were established as the regions of interest and fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values were measured. Image quality for tractography and FA maps and ADC maps, interindividual and intraindividual reliability of FA and ADC, and signal-to-noise (SNR) were studied. RESULTS Both of image qualities with tractography, FA map and ADC map showed that lumbar nerves were more clearly imaged with the rFOV. Intraindividual reliability was higher with rFOV compared with the conventional method for ADC values, while interindividual reliability was higher for both FA values and ADC values with the rFOV method over the conventional method (p < 0.05). Significantly higher SNR was obtained with rFOV compared with cFOV in the spinal canal (p < 0.05). CONCLUSION rFOV enabled clearer imaging of the lumbar nerve, allowing for more accurate measurement of FA and ADC values. Significantly higher SNR was obtained with rFOV compared with cFOV in the spinal canal. To our knowledge, this research showed for the first time the usefulness of rFOV in patients with degenerative lumbar disorders. High resolution DTI using rFOV may become useful in clinical applications because visualization of nerve entrapments and quantification of DTI parameters may allow more accurate diagnoses of lumbar nerve dysfunction. Advances in knowledge: Compared with traditional methods, rFOV allows for clear imaging of the lumbar nerve and enables accurate measurements of the FA and ADC values. High-resolution DTI with rFOV may be used to visualize nerve entrapments and allow for more accurate diagnosis of DTI parameter quantification with opportunities for clinical applications.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopaedic Surgery, Shimoshizu National HospitalShikawatashi, Yotsukaido,Shimoshizu National HospitalShikawatashi, Yotsukaido, Shimoshizu National HospitalShikawatashi, Yotsukaido, Chiba, Japan
| | - Yasuhiro Oikawa
- Division of Orthopaedic Surgery, Chiba Children’s Hospital, Heta-Chou, Midori-ku,Chiba Children’s Hospital, Heta-Chou, Midori-ku, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Kazuki Fujimoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Koki Abe
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Hideyuki Kinoshita
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Koji Matsumoto
- Department of Radiology, Chiba University Hospital, Inohana, Chuo-ku,Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Yoshitada Masuda
- Department of Radiology, Chiba University Hospital, Inohana, Chuo-ku,Chiba University Hospital, Inohana, Chuo-ku, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Masao Koda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical CenterOkayamadai, Togane,Eastern Chiba Medical CenterOkayamadai, Togane, Eastern Chiba Medical CenterOkayamadai, Togane, Chiba, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical CenterOkayamadai, Togane,Eastern Chiba Medical CenterOkayamadai, Togane, Eastern Chiba Medical CenterOkayamadai, Togane, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Inohana, Chuo-ku,Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba, Japan
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15
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Wybrecht D, Reuter F, Pariollaud F, Zaaraoui W, Le Troter A, Rico A, Confort-Gouny S, Soulier E, Guye M, Maarouf A, Ranjeva JP, Pelletier J, Audoin B. New brain lesions with no impact on physical disability can impact cognition in early multiple sclerosis: A ten-year longitudinal study. PLoS One 2017; 12:e0184650. [PMID: 29149177 PMCID: PMC5693435 DOI: 10.1371/journal.pone.0184650] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/28/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE In early multiple sclerosis, although brain T2 lesions accrual are hallmark of the disease, only weak correlations were found between T2 lesions accrual and EDSS progression, the disability scale commonly used in multiple sclerosis studies. This may be related to the very poor sensitivity of EDSS to cognitive dysfunctions that may occur and progress from the first stage of the disease. In the present study, we aimed to demonstrate that cognitive deficits progress during the first ten years of MS and are significantly impacted by new T2 lesions. METHODS EDSS and extensive neuropsychological battery (22 measures) exploring memory, attention/speed of information processing and executive functions were assessed at baseline, Year 1 and Year 10 in 26 patients enrolled after their first clinical attack. To limit the bias of test-retest effect, only measures obtained at Year 1 and Year 10 were reported in the analysis. Raw scores of patients were transformed into z-scores using published normative data when available or scores of matched controls. Lesion probability mapping was used to assess the potential relationships between T2 lesions accumulation, cognitive decline and EDSS progression (P<0.05, FWE-corrected). RESULTS At Year 1, 27% of patients showed attention/speed of information processing deficits, 11.5% executive dysfunction and 11.5% memory impairment. During the follow-up, frequency and severity of executive dysfunction increased (from 11.5% of patients at Year 1 to 42% at Year 10, p<0.01) while no significant changes were evidenced for the other cognitive domains. Median EDSS increased from 0.5 [range: 0-3] at Year 1 to 2.5 [range: 0-6.5] at Year 10 (p<0.001). During the ten-year follow-up, lesions accumulation in the left cerebellum and semi-ovale centers was associated with EDSS progression. In contrast, most lesions accumulation in the frontal, parietal and temporal lobes were associated with cognitive decline but had no effect on EDSS progression. CONCLUSION The present study provides strong evidence that clinically silent T2 lesions impact cognition in early MS. In daily practice, early prevention of T2 lesions accrual may be useful to limit cognitive decline.
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Affiliation(s)
- D. Wybrecht
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- Hôpital d’Instruction des Armées Sainte Anne, Toulon, France
- * E-mail:
| | - F. Reuter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - F. Pariollaud
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - W. Zaaraoui
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - A. Le Troter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - A. Rico
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - S. Confort-Gouny
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - E. Soulier
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - M. Guye
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle d’Imagerie Médicale, CEMEREM, Marseille, France
| | - A. Maarouf
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - J-P. Ranjeva
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - J. Pelletier
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - B. Audoin
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
- APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
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16
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Papathanasiou A, Messinis L, Zampakis P, Papathanasopoulos P. Corpus callosum atrophy as a marker of clinically meaningful cognitive decline in secondary progressive multiple sclerosis. Impact on employment status. J Clin Neurosci 2017; 43:170-175. [PMID: 28601572 DOI: 10.1016/j.jocn.2017.05.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/22/2017] [Indexed: 11/16/2022]
Abstract
Cognitive impairment in Multiple Sclerosis (MS) is more frequent and pronounced in secondary progressive MS (SPMS). Cognitive decline is an important predictor of employment status in patients with MS. Magnetic Resonance Imaging (MRI) markers have been used to associate tissue damage with cognitive dysfunction. The aim of the study was to designate the MRI marker that predicts cognitive decline in SPMS and explore its effect on employment status. 30 SPMS patients and 30 healthy participants underwent neuropsychological assessment using the Trail Making Test (TMT) parts A and B, semantic and phonological verbal fluency task and a computerized cognitive screening battery (Central Nervous System Vital Signs). Employment status was obtained as a quality of life measure. Brain MRI was performed in all participants. We measured total lesion volume, third ventricle width, thalamic and corpus callosum atrophy. The frequency of cognitive decline for our SPMS patients was 80%. SPMS patients differed significantly from controls in all neuropsychological measures. Corpus callosum area was correlated with cognitive flexibility, processing speed, composite memory, executive functions, psychomotor speed, reaction time and phonological verbal fluency task. Processing speed and composite memory were the most sensitive markers for predicting employment status. Corpus callosum area was the most sensitive MRI marker for memory and processing speed. Corpus callosum atrophy predicts a clinically meaningful cognitive decline, affecting employment status in our SPMS patients.
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Affiliation(s)
- Athanasios Papathanasiou
- Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece.
| | - Lambros Messinis
- Neuropsychology Section, Department of Neurology, University of Patras Medical School, Patras 265 04, Greece
| | - Petros Zampakis
- Department of Radiology, University of Patras Medical School, Patras 265 04, Greece
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17
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Mollison D, Sellar R, Bastin M, Mollison D, Chandran S, Wardlaw J, Connick P. The clinico-radiological paradox of cognitive function and MRI burden of white matter lesions in people with multiple sclerosis: A systematic review and meta-analysis. PLoS One 2017; 12:e0177727. [PMID: 28505177 PMCID: PMC5432109 DOI: 10.1371/journal.pone.0177727] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/02/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Moderate correlation exists between the imaging quantification of brain white matter lesions and cognitive performance in people with multiple sclerosis (MS). This may reflect the greater importance of other features, including subvisible pathology, or methodological limitations of the primary literature. OBJECTIVES To summarise the cognitive clinico-radiological paradox and explore the potential methodological factors that could influence the assessment of this relationship. METHODS Systematic review and meta-analysis of primary research relating cognitive function to white matter lesion burden. RESULTS Fifty papers met eligibility criteria for review, and meta-analysis of overall results was possible in thirty-two (2050 participants). Aggregate correlation between cognition and T2 lesion burden was r = -0.30 (95% confidence interval: -0.34, -0.26). Wide methodological variability was seen, particularly related to key factors in the cognitive data capture and image analysis techniques. CONCLUSIONS Resolving the persistent clinico-radiological paradox will likely require simultaneous evaluation of multiple components of the complex pathology using optimum measurement techniques for both cognitive and MRI feature quantification. We recommend a consensus initiative to support common standards for image analysis in MS, enabling benchmarking while also supporting ongoing innovation.
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Affiliation(s)
- Daisy Mollison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Sellar
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mark Bastin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Denis Mollison
- Department of Actuarial Mathematics and Statistics, Heriot-Watt University, Edinburgh, United Kingdom
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Connick
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Morrow SA, Menon S, Rosehart H, Sharma M. Developing easy to perform routine MRI measurements as potential surrogates for cognitive impairment in MS. Clin Neurol Neurosurg 2017; 153:73-78. [PMID: 28061362 DOI: 10.1016/j.clineuro.2016.12.015] [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: 02/05/2016] [Revised: 12/22/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES One of the most frequently disabling symptoms in Multiple Sclerosis (MS) is cognitive impairment which is often insidious in onset and therefore difficult to recognize in the early stages, for both persons with MS and clinicians. A biomarker that would help identify those at risk of cognitive impairment, or with only mild impairment, would be a useful tool for clinicians. Using MRI, already an integral tool in the diagnosis and monitoring of disease activity in MS, would be ideal. Thus, this study aimed to determine if simple measures on routine MRI could serve as potential biomarkers for cognitive impairment in MS. PATIENTS AND METHODS We retrospectively identified 51 persons with MS who had a cognitive assessment and MRI within six months of the MRI. Simple linear measurements of the hippocampi, bifrontral and third ventricular width, bicaudate width and the anterior, mid and posterior corpus callosum were made. Pearson's correlations examined the relationship between these MRI measures and cognitive tests, and MRI measures were compared in persons with MS who were either normal or cognitively impaired on objective cognitive tests using Analysis of Covariance (ANCOVA). RESULTS Bicaudate span and third ventricular width were both negatively correlated, while corpus callosal measures were positive correlated with cognitive test performance. After controlling for potential confounders, bicaudate span was significant different on measures of immediate recall. Both anterior and posterior corpus collosal measure were significantly different on measures of verbal fluency, immediate recall and higher executive function; while the anterior corpus callosum was also significantly different on processing speed. The middle corpus collosal measure was significantly different on immediate recall and higher executive function. CONCLUSION This study presents data demonstrating that simple to apply MRI measures of atrophy may serve as biomarkers for cognitive impairment in persons with MS. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Sarah A Morrow
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Clinical Neurological Sciences, LHSC-UH, 339 Windermere Road, London, ON N5A 5A5, Canada; St. Joseph's Health Care, Parkwood Institute, Department of Cognitive Neurology, 550 Wellington Road, London, ON N6C 0A7, Canada.
| | - Suresh Menon
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Clinical Neurological Sciences, LHSC-UH, 339 Windermere Road, London, ON N5A 5A5, Canada; Present Address: McMaster University, Hamilton General Hospital, 237 Barton Street East, Department of Medicine, Division of Neurology, Hamilton, ON L8L 2X2, Canada
| | - Heather Rosehart
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Clinical Neurological Sciences, LHSC-UH, 339 Windermere Road, London, ON N5A 5A5, Canada
| | - Manas Sharma
- University of Western Ontario (Western), London Health Sciences Center, University Hospital, Department of Radiology/Medical Imaging, LHSC-UH, 339 Windermere Road B10-006, London, ON N5A 5A5, Canada
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Dulamea AO. Role of Oligodendrocyte Dysfunction in Demyelination, Remyelination and Neurodegeneration in Multiple Sclerosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 958:91-127. [PMID: 28093710 DOI: 10.1007/978-3-319-47861-6_7] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oligodendrocytes (OLs) are the myelinating cells of the central nervous system (CNS) during development and throughout adulthood. They result from a complex and well controlled process of activation, proliferation, migration and differentiation of oligodendrocyte progenitor cells (OPCs) from the germinative niches of the CNS. In multiple sclerosis (MS), the complex pathological process produces dysfunction and apoptosis of OLs leading to demyelination and neurodegeneration. This review attempts to describe the patterns of demyelination in MS, the steps involved in oligodendrogenesis and myelination in healthy CNS, the different pathways leading to OLs and myelin loss in MS, as well as principles involved in restoration of myelin sheaths. Environmental factors and their impact on OLs and pathological mechanisms of MS are also discussed. Finally, we will present evidence about the potential therapeutic targets in re-myelination processes that can be accessed in order to develop regenerative therapies for MS.
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Affiliation(s)
- Adriana Octaviana Dulamea
- Neurology Clinic, University of Medicine and Pharmacy "Carol Davila", Fundeni Clinical Institute, Building A, Neurology Clinic, Room 201, 022328, Bucharest, Romania.
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Odenthal C, Simpson S, Oughton J, van der Mei I, Rose S, Fripp J, Lucas R, Taylor B, Dear K, Ponsonby AL, Coulthard A. Midsagittal corpus callosum area and conversion to multiple sclerosis after clinically isolated syndrome: A multicentre Australian cohort study. J Med Imaging Radiat Oncol 2016; 61:453-460. [DOI: 10.1111/1754-9485.12570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Cara Odenthal
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Steve Simpson
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | - Justin Oughton
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Ingrid van der Mei
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | - Stephen Rose
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- ICT - Australian e-Health Research Centre; Brisbane Queensland Australia
| | - Jurgen Fripp
- ICT - Australian e-Health Research Centre; Brisbane Queensland Australia
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health; Australian National University; Canberra Australian Capital Territory Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research; University of Tasmania; Hobart Tasmania Australia
| | | | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute; Royal Children's Hospital; University of Melbourne; Melbourne Victoria Australia
| | - Alan Coulthard
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
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Discrimination between Lumbar Intraspinal Stenosis and Foraminal Stenosis using Diffusion Tensor Imaging Parameters: Preliminary Results. Asian Spine J 2016; 10:327-34. [PMID: 27114775 PMCID: PMC4843071 DOI: 10.4184/asj.2016.10.2.327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/24/2015] [Accepted: 09/24/2015] [Indexed: 11/21/2022] Open
Abstract
Study Design Retrospective observational study. Purpose To examine fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values of damaged nerves to discriminate between lumbar intraspinal stenosis (IS) and foraminal stenosis (FS) using diffusion tensor imaging (DTI) Overview of Literature It is important in the selection of surgical procedure to discriminate between lumbar IS and FS, but such discrimination is difficult. Methods There were 9 cases of IS, 7 cases of FS, and 5 healthy controls. The regions of interest were established in the lumbar intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez). The FA and ADC values were measured on the affected and unaffected sides of the nerves. The FA ratio and the ADC ratio were calculated as the affected side/unaffected side ×100 (%). Results In the Ez, the FA value was significantly lower in FS than in IS (p<0.01). FA ratio was significantly lower in FS than in IS for the Ez (p<0.01). In the Iz, the ADC value was significantly higher in IS than FS (p<0.01). ADC ratio was significantly higher in FS than in IS for the N and Ez (p<0.05). For the Ez, receiver operating characteristic analysis of parameters revealed that the FA values showed a higher accuracy for the diagnosis of FS than the ADC values, and the FA value cut-off value was 0.42 (sensitivity: 85.7%, false positive: 11.1%) and the FA ratio cut-off value was 83.9% (sensitivity: 85.7%, false positive: 22.2%). Conclusions The low FA value in the extraforaminal zone suggests the presence of foraminal stenosis. When the FA value and FA ratio cut-off value were established as 0.42 and 83.9%, respectively, the accuracy was high for the diagnosis of foraminal stenosis. It may be possible to use DTI parameters to help in the discrimination between IS and FS.
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Kanamoto H, Eguchi Y, Suzuki M, Oikawa Y, Yamanaka H, Tamai H, Kobayashi T, Orita S, Yamauchi K, Suzuki M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. The diagnosis of double-crush lesion in the L5 lumbar nerve using diffusion tensor imaging. Spine J 2016; 16:315-21. [PMID: 26592484 DOI: 10.1016/j.spinee.2015.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/07/2015] [Accepted: 11/04/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A double-crush lesion is a condition in which the lumbar nerve is compressed both medially and laterally in the spinal canal, where diagnosis can be very difficult, and is a factor leading to poor surgical success rates. PURPOSE Diffusion tensor imaging (DTI) was used to determine DTI parameter fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) in both intraspinal column lesions alone and in double-crush lesions. STUDY DESIGN This study used a prospective study. PATIENT SAMPLE Of the 56 cases (mean age: 72.2 years) that underwent laminectomy for lumbar spinal stenosis at our clinic between April 2013 to March, 2015, 10 cases with L5 radiculopathy caused by L4-L5 stenosis (Intraspinal stenosis group (Group I); mean age: 74.7 years), and 5 cases with persistent symptoms caused by L5 foraminal stenosis despite L4-L5 decompression surgery (Double-crush group (Group D); mean age: 77.6 years) were targeted. One patient in Group D was diagnosed through microendoscopic intrapedicular partial pediculotomy and the remaining four cases by nerve root infiltration. Five healthy cases (mean age: 54 years) were studied as controls. OUTCOME MEASURES Intraspinal zone (Iz), nerve root (N), and extraforaminal zone (Ez) were established as the regions of interest, and the L5 nerve FA and ADC values were determined on the affected side. METHODS Diffusion tensor imaging was performed prospectively by 1.5T magnetic resonance imaging before surgery, and DTI parameters of L5 nerve were evaluated in all patients and healthy volunteers. Student t test was used for group comparisons, and a p<.05 was considered statistically significant. RESULTS Fractional anisotropy values (Iz, N, Ez) were 0.415, 0.448, and 0.517, respectively, increasing as sites became more distal. Group I values were 0.335, 0.393, and 0.484, and Group D values were 0.296, 0.367, and 0.360. Compared with the healthy volunteers, Group D had significantly lower Iz (p<.05) and Ez (p<.001) values, while Group I had significantly lower Iz (p<.05) values. In Group D, Ez FA values were significantly lower (p<.001) than in Group I. Apparent diffusion coefficient values (Iz, N, Ez) in the healthy control group were 1.270 mm2/s, 1.151 mm2/s, and 0.937 mm2/s with values decreasing as sites grew distal. In Group I, the ADC values were 1.406 mm2/s, 1.184 mm2/s, and 1.001 mm2/s, while in Group D they were 1.551 mm2/s, 1.412 mm2/s, and 1.329 mm2/s. Compared with the healthy volunteers, Iz (p<.05) and Ez (p<.05) values were significantly higher in Group D. The N (p<.01) and Ez (p<.001) ADC values were significantly higher in Group D than in Group I. CONCLUSIONS Depending on where the nerve was compressed, changes in DTI parameters revealed nerve damage (low FA values and increased ADC) in the intraspinal canal in the Intraspinal Group, and over a widespread area in the Double-crush Group spanning the medial to lateral spinal canal. Our research suggests that in cases where double crush is suspected before surgery, failed back surgery syndrome may be prevented by evaluating DTI images.
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Affiliation(s)
- Hirohito Kanamoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan.
| | - Munetaka Suzuki
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Yasuhiro Oikawa
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Ichihara, Chiba 299-0111, Japan
| | - Hajime Yamanaka
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Hiroshi Tamai
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Tatsuya Kobayashi
- Department of Orthopedic Surgery, National Hospital Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Kazuyo Yamauchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Miyako Suzuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba 283-686, Japan
| | - Atsuya Watanabe
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, Togane, Chiba 283-686, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Chiba, Japan
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Rimkus CDM, Steenwijk MD, Barkhof F. Causes, effects and connectivity changes in MS-related cognitive decline. Dement Neuropsychol 2016; 10:2-11. [PMID: 29213424 PMCID: PMC5674907 DOI: 10.1590/s1980-57642016dn10100002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cognitive decline is a frequent but undervalued aspect of multiple sclerosis (MS). Currently, it remains unclear what the strongest determinants of cognitive dysfunction are, with grey matter damage most directly related to cognitive impairment. Multi-parametric studies seem to indicate that individual factors of MS-pathology are highly interdependent causes of grey matter atrophy and permanent brain damage. They are associated with intermediate functional effects (e.g. in functional MRI) representing a balance between disconnection and (mal) adaptive connectivity changes. Therefore, a more comprehensive MRI approach is warranted, aiming to link structural changes with functional brain organization. To better understand the disconnection syndromes and cognitive decline in MS, this paper reviews the associations between MRI metrics and cognitive performance, by discussing the interactions between multiple facets of MS pathology as determinants of brain damage and how they affect network efficiency.
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Affiliation(s)
- Carolina de Medeiros Rimkus
- Department of Radiology, Laboratory of Medical Investigation (LIM-44), Faculty of Medicine of the University of São Paulo, São Paulo SP, Brazil and Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Radiology, Laboratory of Medical Investigation (LIM-44), Faculty of Medicine of the University of São Paulo, São Paulo SP, Brazil and Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn D Steenwijk
- Department of Radiology, Laboratory of Medical Investigation (LIM-44), Faculty of Medicine of the University of São Paulo, São Paulo SP, Brazil and Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands and Department of Physics and Medical technology, Neuroscience campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology, Laboratory of Medical Investigation (LIM-44), Faculty of Medicine of the University of São Paulo, São Paulo SP, Brazil and Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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25
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Eguchi Y, Oikawa Y, Suzuki M, Orita S, Yamauchi K, Suzuki M, Aoki Y, Watanabe A, Takahashi K, Ohtori S. Diffusion tensor imaging of radiculopathy in patients with lumbar disc herniation. Bone Joint J 2016; 98-B:387-94. [DOI: 10.1302/0301-620x.98b3.36036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Aims The aim of this study was to evaluate the time course of changes in parameters of diffusion tensor imaging (DTI) such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in patients with symptomatic lumbar disc herniation. We also investigated the correlation between the severity of neurological symptoms and these parameters. Patients and Methods A total of 13 patients with unilateral radiculopathy due to herniation of a lumbar disc were investigated with DTI on a 1.5T MR scanner and underwent micro discectomy. There were nine men and four women, with a median age of 55.5 years (19 to 79). The changes in the mean FA and ADC values and the correlation between these changes and the severity of the neurological symptoms were investigated before and at six months after surgery. Results The mean FA values were significantly lower (p = 0.0005) and mean ADC values were significantly higher (p = 0.0115) in compressed nerves than in intact nerves. Although the FA values increased significantly at six months after surgical treatment (p = 0.020), the ADC values decreased but not significantly (p = 0.498). There were strong correlations between the DTI parameters such as the FA value and the severity of the neurological symptoms as assessed using the Japanese Orthopaedic Association (JOA) score and the Roland-Morris Disability Questionnaire (RDQ). Conclusion This preliminary study suggests that it may be possible to use DTI to diagnose, quantitatively evaluate and follow-up patients with lumbar nerve entrapment. Take home message: DTI is a potential tool for functional diagnosis of lumbar nerve damage. Cite this article: Bone Joint J 2016;98-B:387–94.
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Affiliation(s)
- Y. Eguchi
- Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan
| | - Y. Oikawa
- Chiba Children’s Hospital, 579-1
Heta-Chou, Midori-ku, Chiba, 266-0007, Japan
| | - M. Suzuki
- Shimoshizu National Hospital, 934-5, Shikawatashi, Yotsukaido, Chiba, 284-0003, Japan
| | - S. Orita
- Chiba University, 1-8-1
Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - K. Yamauchi
- Chiba University, 1-8-1
Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - M. Suzuki
- Chiba University, 1-8-1
Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Y. Aoki
- Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan
| | - A. Watanabe
- Eastern Chiba Medical Center, 3-6-2, Okayamadai, Togane, Chiba, 283-8686, Japan
| | - K. Takahashi
- Chiba University, 1-8-1
Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - S. Ohtori
- Chiba University, 1-8-1
Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Diagnosis of Lumbar Foraminal Stenosis using Diffusion Tensor Imaging. Asian Spine J 2016; 10:164-9. [PMID: 26949473 PMCID: PMC4764530 DOI: 10.4184/asj.2016.10.1.164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/08/2022] Open
Abstract
Diagnosis of lumbar foraminal stenosis remains difficult. Here, we report on a case in which bilateral lumbar foraminal stenosis was difficult to diagnose, and in which diffusion tensor imaging (DTI) was useful. The patient was a 52-year-old woman with low back pain and pain in both legs that was dominant on the right. Right lumbosacral nerve compression due to a massive uterine myoma was apparent, but the leg pain continued after a myomectomy was performed. No abnormalities were observed during nerve conduction studies. Computed tomography and magnetic resonance imaging indicated bilateral L5 lumbar foraminal stenosis. DTI imaging was done. The extraforaminal values were decreased and tractography was interrupted in the foraminal region. Bilateral L5 vertebral foraminal stenosis was treated by transforaminal lumbar interbody fusion and the pain in both legs disappeared. The case indicates the value of DTI for diagnosing vertebral foraminal stenosis.
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27
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Roman CAF, Arnett PA. Structural brain indices and executive functioning in multiple sclerosis: A review. J Clin Exp Neuropsychol 2016; 38:261-74. [DOI: 10.1080/13803395.2015.1105199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Watanabe T, Frahm J, Michaelis T. In Vivo Brain MR Imaging at Subnanoliter Resolution: Contrast and Histology. Magn Reson Med Sci 2015; 15:11-25. [PMID: 26346405 DOI: 10.2463/mrms.2015-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This article provides an overview of in vivo magnetic resonance (MR) imaging contrasts obtained for mammalian brain in relation to histological knowledge. Emphasis is paid to the (1) significance of high spatial resolution for the optimization of T1, T2, and magnetization transfer contrast, (2) use of exogenous extra- and intracellular contrast agents for validating endogenous contrast sources, and (3) histological structures and biochemical compounds underlying these contrasts and (4) their relevance to neuroradiology. Comparisons between MR imaging at subnanoliter resolution and histological data indicate that (a) myelin sheaths, (b) nerve cells, and (c) the neuropil are most responsible for observed MR imaging contrasts, while (a) diamagnetic macromolecules, (b) intracellular paramagnetic ions, and (c) extracellular free water, respectively, emerge as the dominant factors. Enhanced relaxation rates due to paramagnetic ions, such as iron and manganese, have been observed for oligodendrocytes, astrocytes, microglia, and blood cells in the brain as well as for nerve cells. Taken together, a plethora of observations suggests that the delineation of specific structures in high-resolution MR imaging of mammalian brain and the absence of corresponding contrasts in MR imaging of the human brain do not necessarily indicate differences between species but may be explained by partial volume effects. Second, paramagnetic ions are required in active cells in vivo which may reduce the magnetization transfer ratio in the brain through accelerated T1 recovery. Third, reductions of the magnetization transfer ratio may be more sensitive to a particular pathological condition, such as astrocytosis, microglial activation, inflammation, and demyelination, than changes in relaxation. This is because the simultaneous occurrence of increased paramagnetic ions (i.e., shorter relaxation times) and increased free water (i.e., longer relaxation times) may cancel T1 or T2 effects, whereas both processes reduce the magnetization transfer ratio.
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Affiliation(s)
- Takashi Watanabe
- Biomedizinische NMR Forschungs GmbH am Max-Planck-Institut für biophysikalische Chemie
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29
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Gonyea JV, Watts R, Applebee A, Andrews T, Hipko S, Nickerson JP, Thornton L, Filippi CG. In vivo quantitative whole‐brain T
1
rho MRI of multiple sclerosis. J Magn Reson Imaging 2015; 42:1623-30. [DOI: 10.1002/jmri.24954] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 05/04/2015] [Accepted: 05/05/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jay V. Gonyea
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Richard Watts
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Angela Applebee
- Department of Neurological SciencesUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Trevor Andrews
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
- Philips HealthTechCleveland Ohio USA
| | - Scott Hipko
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Joshua P. Nickerson
- Department of RadiologyUniversity of Vermont College of MedicineBurlington Vermont USA
| | - Lindsay Thornton
- Department of RadiologyUniversity of FloridaGainesville Florida USA
| | - Christopher G. Filippi
- Department of Neurological SciencesUniversity of Vermont College of MedicineBurlington Vermont USA
- Department of RadiologyNorth Shore University Hospital‐Long Island JewishNew York New York USA
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30
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Granberg T, Bergendal G, Shams S, Aspelin P, Kristoffersen-Wiberg M, Fredrikson S, Martola J. MRI-Defined Corpus Callosal Atrophy in Multiple Sclerosis: A Comparison of Volumetric Measurements, Corpus Callosum Area and Index. J Neuroimaging 2015; 25:996-1001. [DOI: 10.1111/jon.12237] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Tobias Granberg
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Gösta Bergendal
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - Sara Shams
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Peter Aspelin
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- Department of Neurology; Karolinska University Hospital; Stockholm Sweden
| | - Juha Martola
- Department of Clinical Science, Intervention, and Technology; Karolinska Institutet; Stockholm Sweden
- Department of Radiology; Karolinska University Hospital; Stockholm Sweden
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Rocca MA, Amato MP, De Stefano N, Enzinger C, Geurts JJ, Penner IK, Rovira A, Sumowski JF, Valsasina P, Filippi M. Clinical and imaging assessment of cognitive dysfunction in multiple sclerosis. Lancet Neurol 2015; 14:302-17. [PMID: 25662900 DOI: 10.1016/s1474-4422(14)70250-9] [Citation(s) in RCA: 368] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In patients with multiple sclerosis (MS), grey matter damage is widespread and might underlie many of the clinical symptoms, especially cognitive impairment. This relation between grey matter damage and cognitive impairment has been lent support by findings from clinical and MRI studies. However, many aspects of cognitive impairment in patients with MS still need to be characterised. Standardised neuropsychological tests that are easy to administer and sensitive to disease-related abnormalities are needed to gain a better understanding of the factors affecting cognitive performance in patients with MS than exists at present. Imaging measures of the grey matter are necessary, but not sufficient to fully characterise cognitive decline in MS. Imaging measures of both lesioned and normal-appearing white matter lend support to the hypothesis of the existence of an underlying disconnection syndrome that causes clinical symptoms to trigger. Findings on cortical reorganisation support the contribution of brain plasticity and cognitive reserve in limiting cognitive deficits. The development of clinical and imaging biomarkers that can monitor disease development and treatment response is crucial to allow early identification of patients with MS who are at risk of cognitive impairment.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria P Amato
- Department of Neurofarba, Section of Neurosciences, University of Florence, Florence, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Jeroen J Geurts
- Department of Anatomy and Neuroscience, Section of Clinical Neuroscience, VU University Medical Centre, VUmc Multiple Sclerosis Centre Amsterdam, Amsterdam, Netherlands
| | - Iris-K Penner
- University and University Children's Hospital Basel, Cognitive Psychology and Methodology and Division of Paediatric Neurology and Developmental Medicine, Basel, Switzerland
| | - Alex Rovira
- Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - James F Sumowski
- Neuropsychology and Neuroscience, Kessler Foundation Research Center, West Orange, NJ, USA
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
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Chen Z, Chen JT, Johnson M, Gossman ZC, Hendrickson M, Sakaie K, Martinez-Rubio C, Gale JT, Trapp BD. Cuprizone does not induce CNS demyelination in nonhuman primates. Ann Clin Transl Neurol 2014; 2:208-13. [PMID: 25750925 PMCID: PMC4338961 DOI: 10.1002/acn3.159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/10/2014] [Accepted: 11/19/2014] [Indexed: 01/26/2023] Open
Abstract
Cognitive decline is a common symptom in multiple sclerosis patients, with profound effects on the quality of life. A nonhuman primate model of multiple sclerosis would be best suited to test the effects of demyelination on complex cognitive functions such as learning and reasoning. Cuprizone has been shown to reliably induce brain demyelination in mice. To establish a nonhuman primate model of multiple sclerosis, young adult cynomolgus monkeys were administered cuprizone per os as a dietary supplement. The subjects received increasing cuprizone doses (0.3–3% of diet) for up to 18 weeks. Magnetic resonance imaging and immunohistological analyses did not reveal demyelination in these monkeys.
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Affiliation(s)
- Zhihong Chen
- Department of Neurosciences, Cleveland Clinic Cleveland, Ohio
| | | | - Matthew Johnson
- Department of Neurosciences, Cleveland Clinic Cleveland, Ohio
| | | | | | - Ken Sakaie
- Neurological Institute, Cleveland Clinic Cleveland, Ohio
| | | | - John T Gale
- Department of Neurosciences, Cleveland Clinic Cleveland, Ohio ; Center for Neurological Restoration, Neurological Institute, Cleveland Clinic Cleveland, Ohio
| | - Bruce D Trapp
- Department of Neurosciences, Cleveland Clinic Cleveland, Ohio
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Granberg T, Martola J, Bergendal G, Shams S, Damangir S, Aspelin P, Fredrikson S, Kristoffersen-Wiberg M. Corpus callosum atrophy is strongly associated with cognitive impairment in multiple sclerosis: Results of a 17-year longitudinal study. Mult Scler 2014; 21:1151-8. [DOI: 10.1177/1352458514560928] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/30/2014] [Indexed: 11/15/2022]
Abstract
Background: Cognitive impairment is common in multiple sclerosis (MS) and may be subtle. The corpus callosum is essential for connectivity-demanding cognitive tasks and is significantly affected in MS, therefore it may serve as a marker for cognitive function. Objective: The objective of this paper is to longitudinally study the normalized corpus callosum area (nCCA) as a marker of cognitive function and disability in MS. Methods: Thirty-seven MS patients were followed from 1996 with follow-ups in 2004 and 2013. A healthy matched control group was recruited. The Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT) were assessed. The nCCA was measured on T2-weighted images. Volumetry was performed with FreeSurfer. Results: Disease duration spanned five decades (1.6–46 years). Annual corpus callosal atrophy rate decreased with disease duration. nCCA was strongly correlated with SDMT ( r = 0.793, p < 0.001) and moderately correlated with EDSS ( r = −0.545, p < 0.001) after adjusting for disease duration, age and sex. The correlations of brain parenchymal fraction, white matter fraction, gray matter fraction and normalized lesion volume were less strong. Conclusions: The nCCA correlates well with physical and cognitive disability in time perspectives close to two decades, outperforming volumetric measurements. The nCCA is fast and could be feasible for clinical implementation where it may help identify patients in need of neuropsychological evaluation.
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Affiliation(s)
- Tobias Granberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Juha Martola
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Gösta Bergendal
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Shams
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Soheil Damangir
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden/Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Kristoffersen-Wiberg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden/Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
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Correlations between MRI and Information Processing Speed in MS: A Meta-Analysis. Mult Scler Int 2014; 2014:975803. [PMID: 24795824 PMCID: PMC3984845 DOI: 10.1155/2014/975803] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/25/2014] [Accepted: 02/09/2014] [Indexed: 12/03/2022] Open
Abstract
Objectives. To examine relationships between conventional MRI measures and the paced auditory serial addition test (PASAT) and symbol digit modalities test (SDMT). Methods. A systematic literature review was conducted. Included studies had ≥30 multiple sclerosis (MS) patients, administered the SDMT or PASAT, and measured T2LV or brain atrophy. Meta-analysis of MRI/information processing speed (IPS) correlations, analysis of MRI/IPS significance tests to account for reporting bias, and binomial testing to detect trends when comparing correlation strengths of SDMT versus PASAT and T2LV versus atrophy were conducted. Results. The 39 studies identified frequently reported only significant correlations, suggesting reporting bias. Direct meta-analysis was only feasible for correlations between SDMT and T2LV (r = −0.45, P < 0.001) and atrophy in patients with mixed-MS subtypes (r = −0.54, P < 0.001). Familywise Holm-Bonferroni testing found that selective reporting was not the source of at least half of significant results reported. Binomial tests (P = 0.006) favored SDMT over PASAT in strength of MRI correlations. Conclusions. A moderate-to-strong correlation exists between impaired IPS and MRI in mixed MS populations. Correlations with MRI were stronger for SDMT than for PASAT. Neither heterogeneity among populations nor reporting bias appeared to be responsible for these findings.
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White matter abnormalities and working memory impairment in systemic lupus erythematosus. Cogn Behav Neurol 2014; 26:63-72. [PMID: 23812169 DOI: 10.1097/wnn.0b013e31829d5c74] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE/BACKGROUND Many patients with systemic lupus erythematosus (SLE) have working memory deficits. Few studies have evaluated working memory performance and neurometabolite profile using magnetic resonance spectroscopy in SLE. METHODS We gave the Paced Auditory Serial Addition Test (PASAT), a measure of working memory, to 73 patients with SLE. We calculated total score, dyads, chunking, and cognitive fatigue. Using magnetic resonance spectroscopy, we determined the ratio of choline to creatine (Ch/Cr) in normal-looking right and left frontal lobe white matter. RESULTS Twenty-nine percent of patients showed impaired working memory on the PASAT. Total PASAT score inversely correlated with right and left frontal white matter Ch/Cr. Left frontal white matter Ch/Cr correlated with percent chunking and inversely correlated with total and percent dyads. Right frontal white matter Ch/Cr correlated with percent chunking and inversely correlated with total and percent dyads. There was no relationship between cognitive fatigue and either left or right frontal white matter Ch/Cr. Longer disease duration was associated with higher left frontal white matter Ch/Cr. Correlations remained significant when we considered disease duration and left frontal white matter Ch/Cr against total PASAT score and total dyads. CONCLUSIONS Patients with SLE were impaired on the PASAT. Lower total PASAT score and fewer dyads correlated with higher left frontal microstructural white matter damage, while cognitive fatigue did not. This pattern suggests that early white matter damage interferes with working memory in SLE and provides further insight into the neurobiological basis of mild cognitive dysfunction related to microstructural white matter injury.
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Yaldizli Ö, Penner IK, Frontzek K, Naegelin Y, Amann M, Papadopoulou A, Sprenger T, Kuhle J, Calabrese P, Radü EW, Kappos L, Gass A. The relationship between total and regional corpus callosum atrophy, cognitive impairment and fatigue in multiple sclerosis patients. Mult Scler 2013; 20:356-64. [DOI: 10.1177/1352458513496880] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: The objective of this paper is to investigate the relationship between total and regional corpus callosum (CC) atrophy, neuropsychological test performance and fatigue in multiple sclerosis (MS) patients. Methods: We conducted a cross-sectional study in 113 MS patients: mean age 48±11 years, 75/113 women, 84/113 relapsing–remitting MS, mean disease duration 21±9 years, mean Expanded Disability Status Scale (EDSS) score 3.2±1.7. All patients underwent brain magnetic resonance imaging, standardised neurological assessment and comprehensive cognitive testing including assessments for fatigue and depression. Total and regional CC atrophy was assessed using the corpus callosum index (CCI). Results: CCI correlated more strongly with T2- and T1-lesion volume and whole brain volume than with disease duration or EDSS score. CCI correlated strongly with the verbal fluency test (VFT), Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT). Multivariate regression analysis revealed that atrophy of the posterior CC segment was significantly associated with poor outcome in the PASAT, VFT and SDMT. In contrast, atrophy of the anterior CC segment was significantly associated with fatigue severity and poor outcome in the long-term memory test. Conclusions: Atrophy of the CC is associated with cognitive impairment and fatigue. Regional CCI results indicate that these associations are partially spatially segregated.
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Affiliation(s)
- Özgür Yaldizli
- Department of Neurology, University Hospital Basel, Switzerland
| | - Iris-Katharina Penner
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Cognitive Psychology and Methodology, University of Basel, Switzerland
| | - Karl Frontzek
- Institute of Neuropathology, University Hospital Zurich, Switzerland
| | - Yvonne Naegelin
- Department of Neurology, University Hospital Basel, Switzerland
| | - Michael Amann
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neuroradiology, University Hospital Basel, Switzerland
| | - Athina Papadopoulou
- Department of Neurology, University Hospital Basel, Switzerland
- Medical Image Analysis Center, Switzerland
| | - Till Sprenger
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neuroradiology, University Hospital Basel, Switzerland
| | - Jens Kuhle
- Department of Neurology, University Hospital Basel, Switzerland
- Bone and Joint Research Unit/Neuroimmunology Unit, William Harvey Research Institute/Blizard Institute at Barts and the London School of Medicine and Dentistry, UK
| | - Pasquale Calabrese
- Division of Molecular and Cognitive Neuroscience, University of Basel, Switzerland
| | | | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Switzerland
| | - Achim Gass
- Department of Neurology, University Hospital Basel, Switzerland
- Department of Neurology, University Hospital Mannheim, Germany
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Bayesian scalar-on-image regression with application to association between intracranial DTI and cognitive outcomes. Neuroimage 2013; 83:210-23. [PMID: 23792220 DOI: 10.1016/j.neuroimage.2013.06.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 06/02/2013] [Accepted: 06/03/2013] [Indexed: 11/21/2022] Open
Abstract
Diffusion tensor imaging (DTI) measures water diffusion within white matter, allowing for in vivo quantification of brain pathways. These pathways often subserve specific functions, and impairment of those functions is often associated with imaging abnormalities. As a method for predicting clinical disability from DTI images, we propose a hierarchical Bayesian "scalar-on-image" regression procedure. Our procedure introduces a latent binary map that estimates the locations of predictive voxels and penalizes the magnitude of effect sizes in these voxels, thereby resolving the ill-posed nature of the problem. By inducing a spatial prior structure, the procedure yields a sparse association map that also maintains spatial continuity of predictive regions. The method is demonstrated on a simulation study and on a study of association between fractional anisotropy and cognitive disability in a cross-sectional sample of 135 multiple sclerosis patients.
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Bodini B, Cercignani M, Toosy A, De Stefano N, Miller DH, Thompson AJ, Ciccarelli O. A novel approach with "skeletonised MTR" measures tract-specific microstructural changes in early primary-progressive MS. Hum Brain Mapp 2013; 35:723-33. [PMID: 23616276 DOI: 10.1002/hbm.22196] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/26/2012] [Accepted: 08/20/2012] [Indexed: 11/05/2022] Open
Abstract
We combined tract-based spatial statistics (TBSS) and magnetization transfer (MT) imaging to assess white matter (WM) tract-specific short-term changes in early primary-progressive multiple sclerosis (PPMS) and their relationships with clinical progression. Twenty-one PPMS patients within 5 years from onset underwent MT and diffusion tensor imaging (DTI) at baseline and after 12 months. Patients' disability was assessed. DTI data were processed to compute fractional anisotropy (FA) and to generate a common WM "skeleton," which represents the tracts that are "common" to all subjects using TBSS. The MT ratio (MTR) was computed from MT data and co-registered with the DTI. The skeletonization procedure derived for FA was applied to each subject's MTR image to obtain a "skeletonised" MTR map for every subject. Permutation tests were used to assess (i) changes in FA, principal diffusivities, and MTR over the follow-up, and (ii) associations between changes in imaging parameters and changes in disability. Patients showed significant decreases in MTR over one year in the corpus callosum (CC), bilateral corticospinal tract (CST), thalamic radiations, and superior and inferior longitudinal fasciculi. These changes were located both within lesions and the normal-appearing WM. No significant longitudinal change in skeletonised FA was found, but radial diffusivity (RD) significantly increased in several regions, including the CST bilaterally and the right inferior longitudinal fasciculus. MTR decreases, RD increases, and axial diffusivity decreases in the CC and CST correlated with a deterioration in the upper limb function. We detected tract-specific multimodal imaging changes that reflect the accrual of microstructural damage and possibly contribute to clinical impairment in PPMS. We propose a novel methodology that can be extended to other diseases to map cross-subject and tract-specific changes in MTR.
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Affiliation(s)
- Benedetta Bodini
- Department of Brain Repair and Rehabilitation, University College London Institute of Neurology, Queen Square, London, United Kingdom
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39
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Investigating the role of the corpus callosum in regulating motor overflow in multiple sclerosis. J Neurol 2013; 260:1997-2004. [DOI: 10.1007/s00415-013-6914-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/31/2013] [Accepted: 04/02/2013] [Indexed: 12/13/2022]
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Bergendal G, Martola J, Stawiarz L, Kristoffersen-Wiberg M, Fredrikson S, Almkvist O. Callosal atrophy in multiple sclerosis is related to cognitive speed. Acta Neurol Scand 2013; 127:281-9. [PMID: 22988936 DOI: 10.1111/ane.12006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term changes regarding corpus callosum area (CCA) and information processing speed in cognitive and sensory-motor tasks have rarely been studied in multiple sclerosis (MS). OBJECTIVE AND METHODS Information processing speed in cognitive (Symbol Digit Modalities Test, SDMT), sensory (visual and auditory reaction time) and motor (finger-tapping speed, FT; right and left hand) tasks as well as auditory inter-hemispheric transfer (verbal dichotic listening, VDL) was related to CCA, measured by MRI at baseline and at follow-up after nine years in 22 patients with MS. Possible confounding by demographic (age, gender and education), clinical (symptom onset, duration, severity of disease) and relative brain volume (RBV) as well as T2 lesion load was taken into account. RESULTS The smaller the CCA at baseline, the slower was SDMT performance at baseline. In a similar way, CCA at follow-up was associated with poor SDMT result at follow-up. Furthermore, the higher the annual rate of change in CCA, the poorer was performance in VDL on the left ear and the more pronounced was the right ear advantage. A positive relationship between performance in VDL right ear and annual rate of change in RBV was also seen. Sensory-motor tests were not significantly associated with CCA. T2 lesion load at baseline was associated with FT performance at baseline. Demographic, clinical and radiological (RBV and T2 lesion load) characteristics did not confound the significant relation between CCA and SDMT. CONCLUSIONS CCA unlike RBV and T2 lesion load was associated with SDMT, which indicated a marked cognitive rather than perceptual-motor component.
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Affiliation(s)
- G. Bergendal
- Division of Alzheimer Neurobiology center, Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm; Sweden
| | - J. Martola
- Division of Medical Imaging and Technology, Department of Clinical Science; Intervention and Technology at Karolinska Institutet; Stockholm; Sweden
| | | | - M. Kristoffersen-Wiberg
- Division of Medical Imaging and Technology, Department of Clinical Science; Intervention and Technology at Karolinska Institutet; Stockholm; Sweden
| | - S. Fredrikson
- Division of Neurology, Department of Clinical Neuroscience; Karolinska Institutet; Stockholm; Sweden
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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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Utriainen D, Feng W, Elias S, Latif Z, Hubbard D, Haacke EM. Using Magnetic Resonance Imaging as a Means to Study Chronic Cerebral Spinal Venous Insufficiency in Multiple Sclerosis Patients. Tech Vasc Interv Radiol 2012; 15:101-12. [DOI: 10.1053/j.tvir.2012.02.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Llufriu S, Blanco Y, Martinez-Heras E, Casanova-Molla J, Gabilondo I, Sepulveda M, Falcon C, Berenguer J, Bargallo N, Villoslada P, Graus F, Valls-Sole J, Saiz A. Influence of corpus callosum damage on cognition and physical disability in multiple sclerosis: a multimodal study. PLoS One 2012; 7:e37167. [PMID: 22606347 PMCID: PMC3351399 DOI: 10.1371/journal.pone.0037167] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 04/16/2012] [Indexed: 12/21/2022] Open
Abstract
Background Corpus callosum (CC) is a common target for multiple sclerosis (MS) pathology. We investigated the influence of CC damage on physical disability and cognitive dysfunction using a multimodal approach. Methods Twenty-one relapsing-remitting MS patients and 13 healthy controls underwent structural MRI and diffusion tensor of the CC (fractional anisotropy; mean diffusivity, MD; radial diffusivity, RD; axial diffusivity). Interhemisferic transfer of motor inhibition was assessed by recording the ipsilateral silent period (iSP) to transcranial magnetic stimulation. We evaluated cognitive function using the Brief Repeatable Battery and physical disability using the Expanded Disability Status Scale (EDSS) and the MS Functional Composite (MSFC) z-score. Results The iSP latency correlated with physical disability scores (r ranged from 0.596 to 0.657, P values from 0.004 to 0.001), and with results of visual memory (r = −0.645, P = 0.002), processing speed (r = −0.51, P = 0.018) and executive cognitive domain tests (r = −0.452, P = 0.039). The area of the rostrum correlated with the EDSS (r = −0.442, P = 0.045). MD and RD correlated with cognitive performance, mainly with results of visual and verbal memory tests (r ranged from −0.446 to −0.546, P values from 0.048 to 0.011). The iSP latency correlated with CC area (r = −0.345, P = 0.049), volume (r = −0.401, P = 0.002), MD (r = 0.404, P = 0.002) and RD (r = 0.415, P = 0.016). Conclusions We found evidence for structural and microstructural CC abnormalities associated with impairment of motor callosal inhibitory conduction in MS. CC damage may contribute to cognitive dysfunction and in less extent to physical disability likely through a disconnection mechanism.
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Affiliation(s)
- Sara Llufriu
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Yolanda Blanco
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Eloy Martinez-Heras
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Iñigo Gabilondo
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Sepulveda
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carles Falcon
- Medical Imaging Platform, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centros de Investigación Biomédica en Red (CIBER-BBN), Barcelona, Spain
| | - Joan Berenguer
- Service of Radiology and Imaging Diagnostic Center, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Bargallo
- Medical Imaging Platform, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Service of Radiology and Imaging Diagnostic Center, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pablo Villoslada
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Graus
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Albert Saiz
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- * E-mail:
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Comparison of neuropsychological impairment and vocational outcomes in systemic lupus erythematosus and multiple sclerosis patients. J Int Neuropsychol Soc 2012; 18:530-40. [PMID: 22410107 DOI: 10.1017/s1355617712000057] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are chronic immunologic diseases that can cause cognitive dysfunction. MS is a central nervous system (CNS) disease characterized by demyelination and progressive brain atrophy. SLE is an autoimmune disease capable of damaging multiple organ systems, including the CNS. Cognitive disturbances are seen in both SLE and MS. The present study is concerned with understanding the similarities and differences between the cognitive profiles of SLE and MS as well as the relationship between cognitive impairment and vocational disability in these patients. We examined 47 SLE patients, 47 MS patients, and 44 healthy controls. The groups were well matched on demographics and the patient groups were also matched on disease duration and severity. Group comparisons revealed that generative verbal fluency and visual-spatial memory are more profoundly affected in MS than SLE; whereas depression, fatigue, and working memory deficits are similarly involved in both diseases. Logistic regression analysis revealed that executive function, in particular, was predictive of vocational outcomes in SLE and MS patients.
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Yu HJ, Christodoulou C, Bhise V, Greenblatt D, Patel Y, Serafin D, Maletic-Savatic M, Krupp LB, Wagshul ME. Multiple white matter tract abnormalities underlie cognitive impairment in RRMS. Neuroimage 2011; 59:3713-22. [PMID: 22062194 DOI: 10.1016/j.neuroimage.2011.10.053] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 09/28/2011] [Accepted: 10/17/2011] [Indexed: 12/13/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a sensitive tool for detecting microstructural tissue damage in vivo. In this study, we investigated DTI abnormalities in individuals with relapsing remitting multiple sclerosis (RRMS) and examined the relations between imaging-based measures of white matter injury and cognitive impairment. DTI-derived metrics using tract-based spatial statistics (TBSS) were compared between 37 individuals with RRMS and 20 healthy controls. Cognitive impairment was assessed with three standard tests: the Symbol Digit Modalities Test (SDMT), which measures cognitive processing speed and visual working memory, the Rey Auditory Verbal Learning Test (RAVLT), which examines verbal memory, and the Paced Auditory Serial Addition Test (PASAT), which assesses sustained attention and working memory. Correlations between DTI-metrics and cognition were explored in regions demonstrating significant differences between the RRMS patients and the control group. Lower fractional anisotropy (FA) was found in RRMS participants compared to controls across the tract skeleton (0.40 ± 0.03 vs. 0.43 ± 0.01, p<0.01). In areas of reduced FA, mean diffusivity was increased and was dominated by increased radial diffusivity with no significant change in axial diffusivity, an indication of the role of damage to CNS myelin in MS pathology. In the RRMS group, voxelwise correlations were found between FA reduction and cognitive impairment in cognitively-relevant tracts, predominantly in the posterior thalamic radiation, the sagittal stratum, and the corpus callosum; the strongest correlations were with SDMT measures, with contributions to these associations from both lesion and normal-appearing white matter. Moreover, results using threshold-free cluster enhancement (TFCE) showed more widespread white matter involvement compared to cluster-based thresholding. These findings indicate the important role for DTI in delineating mechanisms underlying MS-associated cognitive impairment and suggest that DTI could play a critical role in monitoring the clinical and cognitive effects of the disease.
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Affiliation(s)
- Hui Jing Yu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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He D, Chen X, Zhao D, Zhou H. Cognitive function, depression, fatigue, and activities of daily living in patients with neuromyelitis optica after acute relapse. Int J Neurosci 2011; 121:677-83. [PMID: 21797812 DOI: 10.3109/00207454.2011.608456] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The status of fatigue, depression, and activities of daily living and their relationships with cognitive function in patients with neuromyelitis optica (NMO) after acute relapse has never been observed. This study investigated cognitive function, fatigue, depression, activities of daily living, and the relationships among them in NMO patients. Twenty-two NMO patients without visible lesions on conventional brain MRI after acute relapse, 22 depression patients, and 22 healthy comparison subjects received several scales to assess cognitive function, fatigue, and depression. Every NMO patient completed a survey of activities of daily living. Between-group comparisons and correlational analyses were applied to examine the differences and the relationships among them. We found that NMO patients had significantly impaired memory, decreased information processing speed, and damaged attention. Some impaired cognitive domains were significantly correlated with fatigue and depression, and activities of daily living were correlated with these impaired cognitive domains, fatigue, depression, and disability. These results confirm cognitive deficits in memory, information processing speed, and attention exist in NMO patients without visible brain lesions after acute relapse. Fatigue and depression may affect cognitive function and increase the negative impact of cognitive deficits on the activities of daily living in patients with NMO.
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Affiliation(s)
- Dian He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Anik Y, Demirci A, Efendi H, Bulut SSD, Celebi I, Komsuoglu S. Evaluation of normal appearing white matter in multiple sclerosis: comparison of diffusion magnetic resonance, magnetization transfer imaging and multivoxel magnetic resonance spectroscopy findings with expanded disability status scale. Clin Neuroradiol 2011; 21:207-15. [PMID: 21847666 DOI: 10.1007/s00062-011-0091-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 07/18/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to determine diffusion magnetic resonance imaging (MRI), magnetization transfer (MT) imaging and multivoxel MR spectroscopy findings in plaques, periplaque white matter and normal appearing white matter (NAWM) regions in multiple sclerosis (MS) and to correlate the findings with the expanded disability status scale (EDSS). METHODS A total of 30 patients with MS and 30 healthy control subjects were studied and apparent diffusion coefficient (ADC) values, MT ratio (MTR), N-acetyl-aspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr) ratios were measured in plaques, periplaques and NAWM regions and compared with the control subjects. RESULTS The MTR and NAA/Cr ratio were decreased more in plaques than periplaques and NAWM, in contrast ADC values and Cho/Cr ratios were highest in plaques and higher in periplaques than in NAWM. Decreased MTR and NAA/Cr in NAWM demonstrated moderate inverse correlations (r = - 0.604, p < 0.001 and r = - 0.494, p < 0.001, respectively) while Cho/Cr ratios and ADC of NAWM demonstrated weak linear correlations (r = 0.370, p = 0.004, r = 0.297, p = 0.021 respectively) with EDSS. CONCLUSIONS The MS, MTR and MR spectroscopy findings were found to be useful for detecting subtle abnormalities in NAWM. Although ADC values were significantly altered in plaque and periplaque regions a significance difference was not found in NAWM.
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Affiliation(s)
- Y Anik
- Department of Radiology, School of Medicine, Kocaeli University, 41380, Umuttepe Kocaeli, Turkey.
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Stankiewicz JM, Glanz BI, Healy BC, Arora A, Neema M, Benedict RHB, Guss ZD, Tauhid S, Buckle GJ, Houtchens MK, Khoury SJ, Weiner HL, Guttmann CRG, Bakshi R. Brain MRI lesion load at 1.5T and 3T versus clinical status in multiple sclerosis. J Neuroimaging 2011; 21:e50-6. [PMID: 19888926 DOI: 10.1111/j.1552-6569.2009.00449.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND/PURPOSE To assess correlation between brain lesions and clinical status with 1.5T and 3T magnetic resonance imaging (MRI). METHODS Brain MRI fluid-attenuated inversion-recovery (FLAIR) sequences were performed in 32 multiple sclerosis (MS) patients. Expanded Disability Status Scale (EDSS) score (mean±standard deviation) was 2±2.0 (range 0-8), disease duration 9.3±8.0 (range .8-29) years. RESULTS FLAIR lesion volume (FLLV) at 3T was higher than at 1.5T (P=.01). Correlation between 1.5T FLLV and EDSS score was poor, while 3T FLLV correlated moderately and significantly (rs=.39, P=.03). When controlling for age and depression, correlations between FLLV and cognitive measures were significant at 1.5T for the Judgment of Line Orientation test (JLO) (rs=-.44, P=.05), the Symbol Digit Modalities Test (SDMT) (rs=-.49, P=.02), and the California Verbal Learning Test Delayed Free Recall (CVLT DR) (rs=-.44, P=.04). Correlations at 3T were also significant for these tests, but of greater magnitude: JLO (rs=-.70, P=.0005), SDMT (rs=-.73, P=.0001), CVLT DR (rs=-.061, P=.003). Additional significant correlations obtained only at 3T included the 2 second-paced auditory serial addition test (rs=-.55, P=.01), the Brief Visuospatial Memory Test-Delayed Free Recall (rs=-.56, P=.007), and the California Verbal Learning Test Total Recall (rs=-.42, P=.05). CONCLUSION MRI at 3T may boost sensitivity and improve validity in MS brain lesion assessment.
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Affiliation(s)
- James M Stankiewicz
- Department of Neurology, Brigham and Women's Hospital, Partners MS Center, Harvard Medical School, Brookline, Massachusetts 02445, USA.
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Goldsmith J, Crainiceanu CM, Caffo BS, Reich DS. Penalized functional regression analysis of white-matter tract profiles in multiple sclerosis. Neuroimage 2011; 57:431-9. [PMID: 21554962 PMCID: PMC3114268 DOI: 10.1016/j.neuroimage.2011.04.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/23/2011] [Accepted: 04/20/2011] [Indexed: 10/18/2022] Open
Abstract
Diffusion tensor imaging (DTI) enables noninvasive parcellation of cerebral white matter into its component fiber bundles or tracts. These tracts often subserve specific functions, and damage to the tracts can therefore result in characteristic forms of disability. Attempts to quantify the extent of tract-specific damage have been limited in part by substantial spatial variation of imaging properties from one end of a tract to the other, variation that can be compounded by the effects of disease. Here, we develop a "penalized functional regression" procedure to analyze spatially normalized tract profiles, which powerfully characterize such spatial variation. The central idea is to identify and emphasize portions of a tract that are more relevant to a clinical outcome score, such as case status or degree of disability. The procedure also yields a "tract abnormality score" for each tract and MRI index studied. Importantly, the weighting function used in this procedure is constrained to be smooth, and the statistical associations are estimated using generalized linear models. We test the method on data from a cross-sectional MRI and functional study of 115 multiple-sclerosis cases and 42 healthy volunteers, considering a range of quantitative MRI indices, white-matter tracts, and clinical outcome scores, and using training and testing sets to validate the results. We show that attention to spatial variation yields up to 15% (mean across all tracts and MRI indices: 6.4%) improvement in the ability to discriminate multiple sclerosis cases from healthy volunteers. Our results confirm that comprehensive analysis of white-matter tract-specific imaging data improves with knowledge and characterization of the normal spatial variation.
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Affiliation(s)
- Jeff Goldsmith
- Department of Biostatistics, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD 21205
| | - Ciprian M. Crainiceanu
- Department of Biostatistics, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD 21205
| | - Brian S. Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, 615 N Wolfe St, Baltimore, MD 21205
| | - Daniel S. Reich
- Departments of Radiology and Neurology, Johns Hopkins School of Medicine, 600 N Wolfe St, Baltimore, MD 20892
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He D, Wu Q, Chen X, Zhao D, Gong Q, Zhou H. Cognitive impairment and whole brain diffusion in patients with neuromyelitis optica after acute relapse. Brain Cogn 2011; 77:80-8. [PMID: 21723024 DOI: 10.1016/j.bandc.2011.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 05/23/2011] [Accepted: 05/27/2011] [Indexed: 02/05/2023]
Abstract
The objective of this study investigated cognitive impairments and their correlations with fractional anisotropy (FA) and mean diffusivity (MD) in patients with neuromyelitis optica (NMO) without visible lesions on conventional brain MRI during acute relapse. Twenty one patients with NMO and 21 normal control subjects received several cognitive tests to assess cognitive function. Head diffusion tensor imaging (DTI) of all patients with NMO were collected with a 3-T MR system. Correlations of cognitive test scores and whole brain FA and MD were examined by voxel-based analysis. Region-of-interest analysis was applied to the significantly correlated regions which the most frequently appeared. We found that NMO patients without visible brain lesions had significantly impaired learning and memory, decreased information processing speed, and damaged attention compared with normal control subjects. These impaired cognitive domains were significantly correlated with FA and MD in local regions of corpus callosum, anterior cingulate and medial frontal cortex. In corpus callosum of NMO patients, mean FA was significantly lower and mean MD higher than normal control subjects. Our findings suggest that cognitive impairments in learning and memory, information processing speed and attention occur in NMO patients without visible brain lesions during acute relapse. The impairments in immediate and short-term memory in NMO patients may be due to information encoding deficits in the process of information acquisition. The corpus callosum of such patients may have local microscopic damages that play a role in cognitive impairments during acute relapse.
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Affiliation(s)
- Dian He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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