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Rocca MA, Preziosa P, Filippi M. What role should spinal cord MRI take in the future of multiple sclerosis surveillance? Expert Rev Neurother 2020; 20:783-797. [PMID: 32133874 DOI: 10.1080/14737175.2020.1739524] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In multiple sclerosis (MS), inflammatory, demyelinating, and neurodegenerative phenomena affect the spinal cord, with detrimental effects on patients' clinical disability. Although spinal cord imaging may be challenging, improvements in MRI technologies have contributed to better evaluate spinal cord involvement in MS. AREAS COVERED This review summarizes the current state-of-art of the application of conventional and advanced MRI techniques to evaluate spinal cord damage in MS. Typical features of spinal cord lesions, their role in the diagnostic work-up of suspected MS, their predictive role for subsequent disease course and clinical worsening, and their utility to define treatment response are discussed. The role of spinal cord atrophy and of other advanced MRI techniques to better evaluate the associations between spinal cord abnormalities and the accumulation of clinical disability are also evaluated. Finally, how spinal cord assessment could evolve in the future to improve monitoring of disease progression and treatment effects is examined. EXPERT OPINION Spinal cord MRI provides relevant additional information to brain MRI in understanding MS pathophysiology, in allowing an earlier and more accurate diagnosis of MS, and in identifying MS patients at higher risk to develop more severe disability. A future role in monitoring the effects of treatments is also foreseen.
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Affiliation(s)
- Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Neurophysiology Unit, IRCCS San Raffaele Scientific Institute , Milan, Italy.,Vita-Salute San Raffaele University , Milan, Italy
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2
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Andelova M, Uher T, Krasensky J, Sobisek L, Kusova E, Srpova B, Vodehnalova K, Friedova L, Motyl J, Preiningerova JL, Kubala Havrdova E, Horakova D, Vaneckova M. Additive Effect of Spinal Cord Volume, Diffuse and Focal Cord Pathology on Disability in Multiple Sclerosis. Front Neurol 2019; 10:820. [PMID: 31447759 PMCID: PMC6691803 DOI: 10.3389/fneur.2019.00820] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Spinal cord (SC) pathology is strongly associated with disability in multiple sclerosis (MS). We aimed to evaluate the association between focal and diffuse SC abnormalities and spinal cord volume and to assess their contribution to physical disability in MS patients. Methods: This large sample-size cross-sectional study investigated 1,249 patients with heterogeneous MS phenotypes. Upper cervical-cord cross-sectional area (MUCCA) was calculated on an axial 3D-T2w-FatSat sequence acquired at 3T using a novel semiautomatic edge-finding tool. SC images were scored for the presence of sharply demarcated hyperintense areas (focal lesions) and homogenously increased signal intensity (diffuse changes). Patients were dichotomized according EDSS in groups with mild (EDSS up to 3.0) and moderate (EDSS ≥ 3.5) physical disability. Analysis of covariance was used to identify factors associated with dichotomized MUCCA. In binary logistic regression, the SC imaging parameters were entered in blocks to assess their individual contribution to risk of moderate disability. In order to assess the risk of combined SC damage in terms of atrophy and lesional pathology on disability, secondary analysis was carried out where patients were divided into four categories (SC phenotypes) according to median dichotomized MUCCA and presence/absence of focal and/or diffuse changes. Results: MUCCA was strongly associated with total intracranial volume, followed by presence of diffuse SC pathology, and disease duration. Compared to the reference group (normally appearing SC, MUCCA>median), patients with the most severe SC changes (SC affected with focal and/or diffuse lesions, MUCCA
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Affiliation(s)
- Michaela Andelova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Tomas Uher
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jan Krasensky
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
| | | | - Eliska Kusova
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
| | - Barbora Srpova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Karolina Vodehnalova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Lucie Friedova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jiri Motyl
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Jana Lizrova Preiningerova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Eva Kubala Havrdova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Dana Horakova
- Department of Neurology, First Faculty of Medicine, Center of Clinical Neuroscience, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Manuela Vaneckova
- Department of Radiology, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czechia
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3
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Combès B, Monteau L, Bannier E, Callot V, Labauge P, Ayrignac X, Carra Dallière C, Pelletier J, Maarouf A, de Seze J, Collongues N, Barillot C, Edan G, Ferré JC, Kerbrat A. Measurement of magnetization transfer ratio (MTR) from cervical spinal cord: Multicenter reproducibility and variability. J Magn Reson Imaging 2018; 49:1777-1785. [PMID: 30350328 DOI: 10.1002/jmri.26537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessing the multicenter variability of magnetization transfer ratio (MTR) measurements in the spinal cord of healthy controls is the first step toward investigating its clinical use as a biomarker. PURPOSE To analyze the between-session, between-participant, and between-scanner variability of MTR measurements in automatically extracted regions of interest in the cervical cord of healthy controls. STUDY TYPE Control study. POPULATION Forty-four participants, distributed across five MRI scanners (all from the same manufacturer). Ten participants were scanned twice in the same scanner, and 10 others were scanned twice in two different scanners. FIELD STRENGTH/SEQUENCE 3D-gradient echo images, centered on C5, without and with magnetization transfer prepulse at 3T. ASSESSMENT We calculated the mean MTR for different vertebral levels in the whole cord (WC), as well as in the white matter and gray matter, and determined the between-session, between-participant, and between-scanner variabilities. STATISTICAL TESTS Coefficients of variation and intraclass correlations (ICCs) for the different variabilities and their associated confidence intervals. RESULTS The MTR measurements for Levels C4-C6 (near the slab center) exhibited a mean value in WC of 34.6 pu and a pooled standard deviation of 0.9 pu. The between-session coefficient of variation was estimated as 2.3% (ICC = 0.63), the between-participant coefficient as 1.6% (ICC = 0.32), and the between-scanner coefficient as 0.7% (ICC = 0.05). The resulting aggregate coefficient of variation was 2.9%, which was sufficiently low to detect an MTR reduction of 1 pu between groups of about 45 participants (Type-I error rate: 0.05; Type-II error rate: 0.10). DATA CONCLUSION The good between-scanner reproducibility and low overall variability in cervical spinal cord MTR measurements in a control population might pave the way for multicenter analyses in various neurological diseases with moderate cohort sizes. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1777-1785.
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Affiliation(s)
- Benoit Combès
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Visages, U1128, France
| | - Laureline Monteau
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Visages, U1128, France.,CHU Rennes, Radiology Department, F-35033, Rennes, France
| | - Elise Bannier
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Visages, U1128, France.,CHU Rennes, Radiology Department, F-35033, Rennes, France
| | - Virginie Callot
- AP-HM, Pôle d'imagerie médicale, Hôpital de la Timone, CEMEREM, Marseille, France.,Aix-Marseille Université, CNRS, UMR 7339, CRMBM, Marseille, France
| | | | | | | | - Jean Pelletier
- AP-HM, Pôle d'imagerie médicale, Hôpital de la Timone, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Adil Maarouf
- AP-HM, Pôle d'imagerie médicale, Hôpital de la Timone, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Jerome de Seze
- Strasbourg University Hospital, France; CIC Strasbourg INSERM 1434, Strasbourg, France
| | - Nicolas Collongues
- Strasbourg University Hospital, France; CIC Strasbourg INSERM 1434, Strasbourg, France
| | - Christian Barillot
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Visages, U1128, France
| | - Gilles Edan
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Visages, U1128, France.,Neurology Department, Rennes University Hospital, France
| | - Jean Christophe Ferré
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Visages, U1128, France.,CHU Rennes, Radiology Department, F-35033, Rennes, France
| | - Anne Kerbrat
- Univ Rennes, Inria, CNRS, Inserm, IRISA UMR 6074, Visages, U1128, France.,Neurology Department, Rennes University Hospital, France
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Combès B, Kerbrat A, Ferré JC, Callot V, Maranzano J, Badji A, Le Page E, Labauge P, Ayrignac X, Carra Dallière C, de Champfleur NM, Pelletier J, Maarouf A, de Seze J, Collongues N, Brassat D, Durand-Dubief F, Barillot C, Bannier E, Edan G. Focal and diffuse cervical spinal cord damage in patients with early relapsing-remitting MS: A multicentre magnetisation transfer ratio study. Mult Scler 2018; 25:1113-1123. [PMID: 29909771 DOI: 10.1177/1352458518781999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Studies including patients with well-established multiple sclerosis (MS) have shown a significant and disability-related reduction in the cervical spinal cord (SC) magnetisation transfer ratio (MTR). OBJECTIVES The objectives are to (1) assess whether MTR reduction is already measurable in the SC of patients with early relapsing-remitting multiple sclerosis (RRMS) and (2) describe its spatial distribution. METHODS We included 60 patients with RRMS <12 months and 34 age-matched controls at five centres. Axial T2*w, sagittal T2w, sagittal phase-sensitive inversion recovery (PSIR), 3DT1w, and axial magnetisation transfer (MT) images were acquired from C1 to C7. Lesions were manually labelled and mean MTR values computed both for the whole SC and for normal-appearing SC in different regions of interest. RESULTS Mean whole SC MTR was significantly lower in patients than controls (33.7 vs 34.9 pu, p = 0.00005), even after excluding lesions (33.9 pu, p = 0.0003). We observed a greater mean reduction in MTR for vertebral levels displaying the highest lesion loads (C2-C4). In the axial plane, we observed a greater mean MTR reduction at the SC periphery and barycentre. CONCLUSION Cervical SC tissue damage measured using MTR is not restricted to macroscopic lesions in patients with early RRMS and is not homogeneously distributed.
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Affiliation(s)
- Benoît Combès
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France
| | - Anne Kerbrat
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Neurology Department, Rennes University Hospital, Rennes, France
| | - Jean Christophe Ferré
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Radiology Department, CHU Rennes, Rennes, France
| | - Virginie Callot
- AP-HM, Pôle d'Imagerie Médicale, Hôpital de La Timone, CEMEREM, Marseille, France.,Aix-Marseille Université, CNRS, UMR 7339, CRMBM, Marseille, France
| | | | - Atef Badji
- Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montreal, Montreal, QC, Canada
| | | | | | | | | | | | - Jean Pelletier
- AP-HM, Pôle d'Imagerie Médicale, Hôpital de La Timone, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Adil Maarouf
- AP-HM, Pôle d'Imagerie Médicale, Hôpital de La Timone, CEMEREM, Marseille, France.,AP-HM, CHU Timone, Pole de Neurosciences Cliniques, Department of Neurology, Marseille, France
| | - Jérôme de Seze
- CIC, INSERM 1434, University Hospital of Strasbourg, Strasbourg, France
| | | | | | | | - Christian Barillot
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France
| | - Elise Bannier
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Radiology Department, CHU Rennes, Rennes, France
| | - Gilles Edan
- IRISA, UMR CNRS 6074, VisAGeS U1228, INSERM, INRIA, Université Rennes I, Rennes, France.,Neurology Department, Rennes University Hospital, Rennes, France
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5
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Lévy S, Guertin MC, Khatibi A, Mezer A, Martinu K, Chen JI, Stikov N, Rainville P, Cohen-Adad J. Test-retest reliability of myelin imaging in the human spinal cord: Measurement errors versus region- and aging-induced variations. PLoS One 2018; 13:e0189944. [PMID: 29293550 PMCID: PMC5749716 DOI: 10.1371/journal.pone.0189944] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 12/05/2017] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To implement a statistical framework for assessing the precision of several quantitative MRI metrics sensitive to myelin in the human spinal cord: T1, Magnetization Transfer Ratio (MTR), saturation imposed by an off-resonance pulse (MTsat) and Macromolecular Tissue Volume (MTV). METHODS Thirty-three healthy subjects within two age groups (young, elderly) were scanned at 3T. Among them, 16 underwent the protocol twice to assess repeatability. Statistical reliability indexes such as the Minimal Detectable Change (MDC) were compared across metrics quantified within different cervical levels and white matter (WM) sub-regions. The differences between pathways and age groups were quantified and interpreted in context of the test-retest repeatability of the measurements. RESULTS The MDC was respectively 105.7ms, 2.77%, 0.37% and 4.08% for T1, MTR, MTsat and MTV when quantified over all WM, while the standard-deviation across subjects was 70.5ms, 1.34%, 0.20% and 2.44%. Even though particular WM regions did exhibit significant differences, these differences were on the same order as test-retest errors. No significant difference was found between age groups for all metrics. CONCLUSION While T1-based metrics (T1 and MTV) exhibited better reliability than MT-based measurements (MTR and MTsat), the observed differences between subjects or WM regions were comparable to (and often smaller than) the MDC. This makes it difficult to determine if observed changes are due to variations in myelin content, or simply due to measurement error. Measurement error remains a challenge in spinal cord myelin imaging, but this study provides statistical guidelines to standardize the field and make it possible to conduct large-scale multi-center studies.
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Affiliation(s)
- Simon Lévy
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center (MHICC), Montreal Heart Institute, Montreal, QC, Canada
| | - Ali Khatibi
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Psychology Department, Bilkent University, Ankara, Turkey
- Interdisciplinary program in Neuroscience, Bilkent University, Ankara, Turkey
- National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Aviv Mezer
- The Edmond and Lily Safra Center for Brain Sciences (ELSC), The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kristina Martinu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - Jen-I Chen
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Nikola Stikov
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Montreal Heart Institute, Montreal, QC, Canada
| | - Pierre Rainville
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
- Department of Stomatology, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
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6
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Martin AR, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG. Translating state-of-the-art spinal cord MRI techniques to clinical use: A systematic review of clinical studies utilizing DTI, MT, MWF, MRS, and fMRI. Neuroimage Clin 2015; 10:192-238. [PMID: 26862478 PMCID: PMC4708075 DOI: 10.1016/j.nicl.2015.11.019] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 10/23/2015] [Accepted: 11/27/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND A recent meeting of international imaging experts sponsored by the International Spinal Research Trust (ISRT) and the Wings for Life Foundation identified 5 state-of-the-art MRI techniques with potential to transform the field of spinal cord imaging by elucidating elements of the microstructure and function: diffusion tensor imaging (DTI), magnetization transfer (MT), myelin water fraction (MWF), MR spectroscopy (MRS), and functional MRI (fMRI). However, the progress toward clinical translation of these techniques has not been established. METHODS A systematic review of the English literature was conducted using MEDLINE, MEDLINE-in-Progress, Embase, and Cochrane databases to identify all human studies that investigated utility, in terms of diagnosis, correlation with disability, and prediction of outcomes, of these promising techniques in pathologies affecting the spinal cord. Data regarding study design, subject characteristics, MRI methods, clinical measures of impairment, and analysis techniques were extracted and tabulated to identify trends and commonalities. The studies were assessed for risk of bias, and the overall quality of evidence was assessed for each specific finding using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS A total of 6597 unique citations were identified in the database search, and after full-text review of 274 articles, a total of 104 relevant studies were identified for final inclusion (97% from the initial database search). Among these, 69 studies utilized DTI and 25 used MT, with both techniques showing an increased number of publications in recent years. The review also identified 1 MWF study, 11 MRS studies, and 8 fMRI studies. Most of the studies were exploratory in nature, lacking a priori hypotheses and showing a high (72%) or moderately high (20%) risk of bias, due to issues with study design, acquisition techniques, and analysis methods. The acquisitions for each technique varied widely across studies, rendering direct comparisons of metrics invalid. The DTI metric fractional anisotropy (FA) had the strongest evidence of utility, with moderate quality evidence for its use as a biomarker showing correlation with disability in several clinical pathologies, and a low level of evidence that it identifies tissue injury (in terms of group differences) compared with healthy controls. However, insufficient evidence exists to determine its utility as a sensitive and specific diagnostic test or as a tool to predict clinical outcomes. Very low quality evidence suggests that other metrics also show group differences compared with controls, including DTI metrics mean diffusivity (MD) and radial diffusivity (RD), the diffusional kurtosis imaging (DKI) metric mean kurtosis (MK), MT metrics MT ratio (MTR) and MT cerebrospinal fluid ratio (MTCSF), and the MRS metric of N-acetylaspartate (NAA) concentration, although these results were somewhat inconsistent. CONCLUSIONS State-of-the-art spinal cord MRI techniques are emerging with great potential to improve the diagnosis and management of various spinal pathologies, but the current body of evidence has only showed limited clinical utility to date. Among these imaging tools DTI is the most mature, but further work is necessary to standardize and validate its use before it will be adopted in the clinical realm. Large, well-designed studies with a priori hypotheses, standardized acquisition methods, detailed clinical data collection, and robust automated analysis techniques are needed to fully demonstrate the potential of these rapidly evolving techniques.
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Affiliation(s)
- Allan R Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Izabela Aleksanderek
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Lindsay Tetreault
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - David W Cadotte
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adrian Crawley
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Howard Ginsberg
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Gass A, Rocca MA, Agosta F, Ciccarelli O, Chard D, Valsasina P, Brooks JCW, Bischof A, Eisele P, Kappos L, Barkhof F, Filippi M. MRI monitoring of pathological changes in the spinal cord in patients with multiple sclerosis. Lancet Neurol 2015; 14:443-54. [PMID: 25748099 DOI: 10.1016/s1474-4422(14)70294-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The spinal cord is a clinically important site that is affected by pathological changes in most patients with multiple sclerosis; however, imaging of the spinal cord with conventional MRI can be difficult. Improvements in MRI provide a major advantage for spinal cord imaging, with better signal-to-noise ratio and improved spatial resolution. Through the use of multiplanar MRI, identification of diffuse and focal changes in the whole spinal cord is now routinely possible. Corroborated by related histopathological analyses, several new techniques, such as magnetisation transfer, diffusion tension imaging, functional MRI, and proton magnetic resonance spectroscopy, can detect non-focal, spinal cord pathological changes in patients with multiple sclerosis. Additionally, functional MRI can reveal changes in the response pattern to sensory stimulation in patients with multiple sclerosis. Through use of these techniques, findings of cord atrophy, intrinsic cord damage, and adaptation are shown to occur largely independently of focal spinal cord lesion load, which emphasises their relevance in depiction of the true burden of disease. Combinations of magnetisation transfer ratio or diffusion tension imaging indices with cord atrophy markers seem to be the most robust and meaningful biomarkers to monitor disease evolution in early multiple sclerosis.
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Affiliation(s)
- Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany.
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Olga Ciccarelli
- Department of Brain Repair and Rehabilitation, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Declan Chard
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London, Institute of Neurology National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - Paola Valsasina
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Antje Bischof
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Philipp Eisele
- Department of Neurology, Universitätsmedizin Mannheim UMM, University of Heidelberg, Germany
| | - Ludwig Kappos
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, Netherlands
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience and Department of Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Stoolman JS, Duncker PC, Huber AK, Segal BM. Site-specific chemokine expression regulates central nervous system inflammation and determines clinical phenotype in autoimmune encephalomyelitis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2014; 193:564-70. [PMID: 24928987 PMCID: PMC4091641 DOI: 10.4049/jimmunol.1400825] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The adoptive transfer of myelin-reactive T cells into wild-type hosts results in spinal cord inflammation and ascending paralysis, referred to as conventional experimental autoimmune encephalomyelitis (EAE), as opposed to brainstem inflammation and ataxia, which characterize disease in IFN-γRKO hosts (atypical EAE). In this article, we show that atypical EAE correlates with preferential upregulation of CXCL2 in the brainstem, and is driven by CXCR2-dependent recruitment of neutrophils. In contrast, conventional EAE is associated with upregulation of CCL2 in the spinal cord, and is driven by recruitment of monocytes via a partially CCR2-dependent pathway. This study illustrates how regional differences in chemokine expression within a target organ shape the spatial pattern and composition of autoimmune infiltrates, leading to disparate clinical outcomes.
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MESH Headings
- Animals
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Antigens, Differentiation, T-Lymphocyte/immunology
- Antigens, Differentiation, T-Lymphocyte/metabolism
- Brain Stem/immunology
- Brain Stem/metabolism
- Brain Stem/pathology
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/metabolism
- Central Nervous System/immunology
- Central Nervous System/metabolism
- Central Nervous System/pathology
- Chemokines/biosynthesis
- Chemokines/immunology
- Demyelinating Diseases/genetics
- Demyelinating Diseases/immunology
- Demyelinating Diseases/metabolism
- Encephalomyelitis, Autoimmune, Experimental/genetics
- Encephalomyelitis, Autoimmune, Experimental/immunology
- Encephalomyelitis, Autoimmune, Experimental/metabolism
- Flow Cytometry
- Immunophenotyping
- Inflammation/genetics
- Inflammation/immunology
- Inflammation/metabolism
- Interleukin-12/immunology
- Interleukin-12/metabolism
- Interleukin-17/immunology
- Interleukin-17/metabolism
- Interleukin-2 Receptor alpha Subunit/immunology
- Interleukin-2 Receptor alpha Subunit/metabolism
- Lectins, C-Type/immunology
- Lectins, C-Type/metabolism
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Microscopy, Confocal
- Monocytes/immunology
- Monocytes/metabolism
- Myelin-Oligodendrocyte Glycoprotein
- Neutrophils/immunology
- Neutrophils/metabolism
- Peptide Fragments
- Receptors, CCR2/deficiency
- Receptors, CCR2/genetics
- Receptors, CCR2/immunology
- Receptors, Interferon/deficiency
- Receptors, Interferon/genetics
- Receptors, Interferon/immunology
- Receptors, Interleukin-8B/immunology
- Receptors, Interleukin-8B/metabolism
- Interferon gamma Receptor
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Affiliation(s)
- Joshua S Stoolman
- Department of Neurology, Holtom-Garrett Program in Neuroimmunology and Multiple Sclerosis Center, University of Michigan School of Medicine, Ann Arbor, MI 48109; Graduate Program in Immunology, University of Michigan School of Medicine, Ann Arbor, MI 48109; and
| | - Patrick C Duncker
- Department of Neurology, Holtom-Garrett Program in Neuroimmunology and Multiple Sclerosis Center, University of Michigan School of Medicine, Ann Arbor, MI 48109; Graduate Program in Immunology, University of Michigan School of Medicine, Ann Arbor, MI 48109; and
| | - Amanda K Huber
- Department of Neurology, Holtom-Garrett Program in Neuroimmunology and Multiple Sclerosis Center, University of Michigan School of Medicine, Ann Arbor, MI 48109
| | - Benjamin M Segal
- Department of Neurology, Holtom-Garrett Program in Neuroimmunology and Multiple Sclerosis Center, University of Michigan School of Medicine, Ann Arbor, MI 48109; Graduate Program in Immunology, University of Michigan School of Medicine, Ann Arbor, MI 48109; and Neuroscience Program, University of Michigan School of Medicine, Ann Arbor, MI 48109
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9
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Smith AK, Dortch RD, Dethrage LM, Smith SA. Rapid, high-resolution quantitative magnetization transfer MRI of the human spinal cord. Neuroimage 2014; 95:106-16. [PMID: 24632465 DOI: 10.1016/j.neuroimage.2014.03.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/05/2014] [Accepted: 03/07/2014] [Indexed: 11/27/2022] Open
Abstract
Quantitative magnetization transfer (qMT) imaging can provide indices describing the interactions between free water protons and immobile macromolecular protons. These indices include the macromolecular proton fraction (MPF), which has been shown to correlate with myelin content in white matter. Because of the long scan times required for high-resolution spinal cord imaging, qMT studies of the human spinal cord have not found wide-spread application. Herein, we investigated whether these limitations could be overcome by utilizing only a single MT-weighted acquisition and a reference measurement, as was recently proposed in the brain. High-resolution, in vivo qMT data were obtained at 3.0T in the spinal cords of healthy volunteers and patients with relapsing remitting multiple sclerosis (MS). Low- and high-resolution acquisitions (low/high resolution=1×1×5mm(3)/0.65×0.65×5mm(3)) with clinically acceptable scan times (12min/7min) were evaluated. We also evaluated the reliability over time and the sensitivity of the model to the assumptions made in the single-point method, both in disease and healthy tissues. Our findings suggest that the single point qMT technique can provide maps of the MPF in the spinal cord in vivo with excellent grey/white matter contrast, can be reliably obtained within reasonable scan times, and are sensitive to MS pathology. Consistent with previous qMT studies in the brain, the observed MPF values were higher in healthy white matter (0.16±0.01) than in grey matter (0.13±0.01) and in MS lesions (0.09±0.01). The single point qMT technique applied at high resolution provides an improved method for obtaining qMT in the human spinal cord and may offer a reliable outcome measure for evaluating spinal cord disease.
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Affiliation(s)
- Alex K Smith
- Department of Biomedical Engineering, Vanderbilt University, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University, USA
| | - Richard D Dortch
- Department of Biomedical Engineering, Vanderbilt University, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University, USA; Department of Radiology and Radiological Sciences, Vanderbilt University, USA
| | - Lindsey M Dethrage
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, USA
| | - Seth A Smith
- Department of Biomedical Engineering, Vanderbilt University, USA; Vanderbilt University Institute of Imaging Science, Vanderbilt University, USA; Department of Radiology and Radiological Sciences, Vanderbilt University, USA; Department of Physics and Astronomy, Vanderbilt University, USA.
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10
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Riccitelli G, Rocca MA, Pagani E, Martinelli V, Radaelli M, Falini A, Comi G, Filippi M. Mapping regional grey and white matter atrophy in relapsing-remitting multiple sclerosis. Mult Scler 2012; 18:1027-37. [PMID: 22422807 DOI: 10.1177/1352458512439239] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aimed to investigate the regional distribution of grey matter (GM) and white matter (WM) atrophy in patients with relapsing-remitting (RR) MS and their relationship with gender, clinical findings, and T2 lesions. METHODS Clinical and magnetic resonance imaging assessments were obtained from 78 patients with RRMS and 88 controls. GM and WM atrophy were estimated using voxel-based morphometry (SPM8). RESULTS Patients with RRMS experienced atrophy of the deep GM nuclei, and several cortical regions mainly located in the fronto-parietal lobes. WM atrophy involved posterior regions of the brain, including the cerebellum and brainstem. Compared with men, affected women showed atrophy of several WM tracts, while gender did not impact GM atrophy. Disease duration > 5 years was associated with atrophy of the thalami and inferior frontal gyrus, while WM atrophy was already prominent in patients with disease duration ≤ 5 years. Expanded Disability Status Scale score > 3.0 was associated with diffuse WM atrophy and basal ganglia and precentral gyrus atrophy. T2 lesions were marginally associated to focal atrophy. DISCUSSION In RRMS, GM and WM atrophy have distinct patterns of regional distribution, with a sparing of GM infratentorial regions. Gender, disease duration and disability affect differently the topography of GM/WM atrophy, while T2 lesions play a modest role.
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Affiliation(s)
- Gianna Riccitelli
- Neuroimaging Research Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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11
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Cohen AB, Neema M, Arora A, Dell'oglio E, Benedict RHB, Tauhid S, Goldberg-Zimring D, Chavarro-Nieto C, Ceccarelli A, Klein JP, Stankiewicz JM, Houtchens MK, Buckle GJ, Alsop DC, Guttmann CRG, Bakshi R. The relationships among MRI-defined spinal cord involvement, brain involvement, and disability in multiple sclerosis. J Neuroimaging 2011; 22:122-8. [PMID: 21447024 DOI: 10.1111/j.1552-6569.2011.00589.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the interrelationships between MRI-defined lesion and atrophy measures of spinal cord involvement and brain involvement and their relationships to disability in a small cohort of patients with multiple sclerosis (MS). BACKGROUND Although it is known that cervical spinal cord atrophy correlates with disability in MS, it is unknown whether it is the most important determinant when compared to other regions of the central nervous system (CNS). Furthermore, it is not clear to what extent brain and cord lesions and atrophy are related. DESIGN AND METHODS 3T MRI of the whole brain and whole spinal cord was obtained in 21 patients with MS, including 18 with relapsing-remitting, one with secondary progressive, one with primary progressive, and one with a clinically isolated syndrome. Brain global gray and white matter volumes were segmented with Statistical Parametric Mapping 8. Spinal cord contour volume was segmented in whole by a semi-automated method with bins assigned to either the cervical or thoracic regions. All CNS volumes were normalized by the intracranial volume. Brain and cord T2 hyperintense lesions were segmented using a semi-automated edge finding tool. RESULTS Among all MRI measures, only upper cervical spinal cord volume significantly correlated with Expanded Disability Status Scale score (r =-.515, P = .020). The brain cord relationships between whole or regional spinal cord volume or lesions and gray matter, white matter, or whole brain volume or whole brain lesions were generally weak and all nonsignificant. CONCLUSIONS AND RELEVANCE In this preliminary study of mildly disabled, treated MS patients, cervical spinal cord atrophy most strongly correlates with physical disability in MS when accounting for a wide range of other CNS measures of lesions and atrophy, including thoracic or whole spinal cord volume, and cerebral gray, white or whole brain volume. The weak relationship between spinal cord and brain lesions and atrophy may suggest that they progress rather independently in patients with MS.
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Affiliation(s)
- Adam B Cohen
- Departments of Neurology and Radiology, Brigham and Women's Hospital, Laboratory for Neuroimaging Research, Partners MS Center, Harvard Medical School, Boston, MA, USA
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12
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Abstract
Recent years have witnessed impressive advances in the use of magnetic resonance imaging (MRI) for the assessment of patients with multiple sclerosis (MS). Complementary to the clinical evaluation, conventional MRI provides crucial pieces of information for the diagnosis of MS. However, the correlation between the burden of lesions observed on conventional MRI scans and the clinical manifestations of the disease remains weak. The discrepancy between clinical and conventional MRI findings in MS is explained, at least partially, by the limited ability of conventional MRI to characterize and quantify the heterogeneous features of MS pathology. Other quantitative MR-based techniques, however, have the potential to overcome such a limitation of conventional MRI. Indeed, magnetization transfer MRI, diffusion tensor MRI, proton MR spectroscopy, and functional MRI are contributing to elucidate the mechanisms that underlie injury, repair, and functional adaptation in patients with MS. Such techniques are likely to benefit from the use of high-field MR systems and thus allow in the near future providing additional insight into all these aspects of the disease. This review summarizes how MRI is dramatically changing our understanding of the factors associated with the accumulation of irreversible disability in MS and highlights the reasons why they should be used more extensively in studies of disease evolution and clinical trials.
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Affiliation(s)
- M Filippi
- Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Hospital San Raffaele, Milan, Italy.
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